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Yoo Y, Choi E, Lee DH, Park S, Sung SH. Diagnostic value of urine cytology in detecting histologic variants of urothelial carcinomas in the urinary bladder: Cytopathologic correlation of 72 cases. Diagn Cytopathol 2020; 49:367-373. [PMID: 33331144 DOI: 10.1002/dc.24660] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Revised: 08/12/2020] [Accepted: 10/23/2020] [Indexed: 11/09/2022]
Abstract
BACKGROUND Precise identification of histologic variants in urothelial carcinoma (UC) is important because some histologic types have a poor prognosis and clinical management varies. Urine cytology is used for bladder cancer screening, but the cytomorphologic features of histologic variants have not been well described. In the current study, we evaluate the effectiveness of urine cytology in detecting histologic variants of UC in the urinary bladder. METHODS Seventy-two urine cytology specimens from patients diagnosed with high-grade UCs by radical cystectomy were retrospectively reviewed and correlated with histopathologic findings of subsequent radical cystectomy specimens. RESULTS Of 72 total cases, 24 (33%) cases showed six histologic variants in corresponding surgical specimens, including squamous differentiation (13 cases), plasmacytoid variant (3 cases), micropapillary variant (3 cases), sarcomatoid variant (3 cases), giant cell variant (1 case), and glandular differentiation (1 case). Histopathology and cytomorphology were well correlated in 13 cases (54%), with squamous differentiation in 11 of 13 cases (85%), micropapillary features in 1 out of 3 cases (33%), and spindle cell/sarcomatoid features in 1 of 3 cases (33%). Furthermore, mucosal involvement by histologic variants, not amount of histologic variant, was related to high concordance rates between cytology and histology diagnosis. CONCLUSIONS The morphologic features of some histologic variants of high-grade UCs, such as squamous differentiation, micropapillary variant, and sarcomatoid variant, are partially reflected on urine cytology. In addition, mucosal involvement by histologic variants was associated with a higher detection rate of histologic variants in urine cytology.
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Affiliation(s)
- Youngeun Yoo
- Department of Pathology, Ewha Womans University College of Medicine, Seoul, South Korea
| | - Euno Choi
- Department of Pathology, Ewha Womans University College of Medicine, Seoul, South Korea
| | - Dong Hyeon Lee
- Department of Urology, Ewha Womans University College of Medicine, Seoul, South Korea
| | - Sanghui Park
- Department of Pathology, Ewha Womans University College of Medicine, Seoul, South Korea
| | - Sun Hee Sung
- Department of Pathology, Ewha Womans University College of Medicine, Seoul, South Korea
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2
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Cyto-histo correlations of plasmacytoid and micropapillary variants of high-grade urothelial carcinoma: do they fit well in The Paris System for reporting urinary cytology? J Am Soc Cytopathol 2020; 10:20-24. [PMID: 32620533 DOI: 10.1016/j.jasc.2020.05.013] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2020] [Revised: 04/23/2020] [Accepted: 05/28/2020] [Indexed: 11/24/2022]
Abstract
INTRODUCTION Plasmacytoid and micropapillary variants of high-grade urothelial carcinoma (HGUC) exhibit unique histologic morphology and very aggressive clinical behavior. However, the morphology of these 2 variants in urinary cytology is not well studied and evaluated using The Paris System for reporting urinary cytology. MATERIALS AND METHODS A database search was performed in all patients with the diagnosis of plasmacytoid or micropapillary HGUC. A total of 5 patients with positive urinary cytology cases were identified. The cytomorphology of every urinary cytology case was correlated with the histologic features in the surgical specimens from the same patient. RESULTS One urine and 4 bladder washings were evaluated. Cytologically, plasmacytoid HGUCs are characterized by single, large tumor cells with hyperchromasia, irregular nuclear membranes, and vacuolated cytoplasm. The nuclear-to-cytoplasmic (N:C) ratio was less than 0.5 in many of the malignant cells due to the abundant cytoplasm. The cytology features of micropapillary HGUC include the presence of micropapillae of tumor cells with no fibrovascular core. Individual high-grade urothelial cells were also identified in all 4 cases, but 1 (25%) of these had only rare cells meeting The Paris System criteria for HGUC due to abundant cytoplasm and lack of hyperchromasia in most malignant cells. CONCLUSIONS Plasmacytoid and micropapillary variants of HGUC have unique cytomorphologic features in urinary cytology specimens, which are reflective of the corresponding histological findings. These 2 clinically aggressive variants of HGUC may not be as readily interpreted as malignant using The Paris System for reporting urinary cytology, creating potential diagnostic pitfalls.
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Kannan N, SreeRekha J, Gochhait D, Ks S, Siddaraju N. Are papillary clusters devoid of a fibro-vascular core significant in urine cytology? Cytopathology 2019; 30:444-446. [PMID: 30869803 DOI: 10.1111/cyt.12689] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2018] [Revised: 02/28/2019] [Accepted: 03/04/2019] [Indexed: 11/29/2022]
Affiliation(s)
- Narasimhapriyan Kannan
- Department of Pathology, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
| | - Jinkala SreeRekha
- Department of Pathology, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
| | - Debasis Gochhait
- Department of Pathology, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
| | - Sreerag Ks
- Department of Urology, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
| | - Neelaiah Siddaraju
- Department of Pathology, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
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Sanguedolce F, Russo D, Mancini V, Selvaggio O, Calo B, Carrieri G, Cormio L. Prognostic and therapeutic role of HER2 expression in micropapillary carcinoma of the bladder. Mol Clin Oncol 2019; 10:205-213. [PMID: 30680196 PMCID: PMC6327213 DOI: 10.3892/mco.2018.1786] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2018] [Accepted: 11/22/2018] [Indexed: 12/18/2022] Open
Abstract
Micropapillary carcinoma of the bladder (MPBC) is a variant type of infiltrating urothelial carcinoma, which portends a poor biological behavior in terms of disease stage at first diagnosis and clinical outcome; its peculiar morphology raises issues concerning the ability of tumor detection by imaging techniques and proper biopsy procedure, and the appropriate treatment for non-muscle infiltrating and muscle-infiltrating MPBC remains a matter of debate. On the basis of its established prognostic and therapeutic role in breast and gastro-esophageal cancer in the first instance, the human epidermal growth factor receptor-2 (HER2) has been investigated in selected case series of MPBC over the last 10 years. The aim of the present review was to summarize the existing evidence on HER2 status in MPBC, and to discuss its present and future utility in risk assessment and treatment choice of this uncommon, yet aggressive, disease.
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Affiliation(s)
| | - Davide Russo
- Department of Pathology, University Hospital, I-71121 Foggia, Italy
| | - Vito Mancini
- Department of Urology and Renal Transplantation, University Hospital, I-71121 Foggia, Italy
| | - Oscar Selvaggio
- Department of Urology and Renal Transplantation, University Hospital, I-71121 Foggia, Italy
| | - Beppe Calo
- Department of Urology and Renal Transplantation, University Hospital, I-71121 Foggia, Italy
| | - Giuseppe Carrieri
- Department of Urology and Renal Transplantation, University Hospital, I-71121 Foggia, Italy
| | - Luigi Cormio
- Department of Urology and Renal Transplantation, University Hospital, I-71121 Foggia, Italy
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Ishikawa R, Kadota K, Hayashi T, Motoyama M, Matsunaga T, Miyai Y, Katsuki N, Kushida Y, Haba R. Cytopathological features of villous adenoma of the urinary bladder in urine: A rare case report. Diagn Cytopathol 2016; 44:632-5. [PMID: 27121034 DOI: 10.1002/dc.23488] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2015] [Revised: 02/26/2016] [Accepted: 03/30/2016] [Indexed: 01/23/2023]
Abstract
Villous adenoma of the urinary bladder is a rare tumor that histologically mimics its enteric counterpart. Patients with an isolated villous adenoma have an excellent prognosis, but associated adenocarcinomas can frequently be identified in them as well. There is no literature that discusses the cytopathologic features of villous adenoma. Here we report a case which was diagnosed as villous adenoma histologically, which has been followed up with urine cytology. In urine cytology, many mucin producing cells are recognized. Few cell clusters show glandular formation or arrangement along the basement membrane. When glandular cells with columnar mucin-filled goblet cells are seen in urine cytology, the presence of a primary glandular lesion of the urinary bladder, such as villous adenoma, should be considered possible. Diagn. Cytopathol. 2016;44:632-635. © 2016 Wiley Periodicals, Inc.
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Affiliation(s)
- Ryou Ishikawa
- Department of Diagnostic Pathology, Faculty of Medicine, Kagawa University, Kagawa, Japan
| | - Kyuichi Kadota
- Department of Diagnostic Pathology, Faculty of Medicine, Kagawa University, Kagawa, Japan
| | - Toshitetsu Hayashi
- Department of Diagnostic Pathology, Takamatsu Red Cross Hospital, Kagawa, Japan
| | - Mutsumi Motoyama
- Department of Diagnostic Pathology, Faculty of Medicine, Kagawa University, Kagawa, Japan
| | - Toru Matsunaga
- Department of Diagnostic Pathology, Faculty of Medicine, Kagawa University, Kagawa, Japan
| | - Yumi Miyai
- Department of Diagnostic Pathology, Faculty of Medicine, Kagawa University, Kagawa, Japan
| | - Naomi Katsuki
- Department of Diagnostic Pathology, Faculty of Medicine, Kagawa University, Kagawa, Japan
| | - Yoshio Kushida
- Department of Diagnostic Pathology, Faculty of Medicine, Kagawa University, Kagawa, Japan
| | - Reiji Haba
- Department of Diagnostic Pathology, Faculty of Medicine, Kagawa University, Kagawa, Japan
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Park S, Cho MS, Kim KH. A case report of urothelial carcinoma with combined micropapillary and plasmacytoid morphology in the urinary bladder. Diagn Cytopathol 2015; 44:124-7. [PMID: 26607996 DOI: 10.1002/dc.23373] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2015] [Revised: 09/02/2015] [Accepted: 09/24/2015] [Indexed: 11/11/2022]
Abstract
A case of combined micropapillary and plasmacytoid urothelial carcinoma (UC) of the urinary bladder is presented for a 74-year-old male who was admitted to the hospital with gross hematuria and multifocal papillary bladder tumors. Abdominal computed tomography showed a large enhancing mass on the left lateral and anterior wall of the urinary bladder, which was highly suspicious for extravesicular extension and focal extension of the anterior lesion to the pubic bone. In voided urine, cancer cells were scattered as micropapillae or nests as well as single cells on the low power view. On a higher power view, micropapillae or nests were composed of pleomorphic, high grade tumor cells with an inverted nuclear arrangement and with acinar structures occasionally identified. Single cells were discohesive and large with a thick cytoplasm and eccentrically located nuclei. Histologically, the tumor from the resected bladder showed diffusely infiltrating micropapillae or nests with a surrounding halo and dense singly-scattered plasmacytoid cells. Immunohistochemically, the cancer cells were positive for cytokeratin-7 and cytokeratin-20 but negative for S-100, leukocyte common antigen, and vimentin. At the time of radical cystectomy, severe adhesions and peritoneal metastases were found and the surgery was discontinued. The patient received systemic chemotherapy, but died of bladder cancer 14 months after surgery.
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Affiliation(s)
- Sanghui Park
- Department of Pathology, Ewha Womans University School of Medicine, Seoul, Korea
| | - Min-Sun Cho
- Department of Pathology, Ewha Womans University School of Medicine, Seoul, Korea
| | - Kwang Hyun Kim
- Department of Urology, Ewha Womans University School of Medicine, Seoul, Korea
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Seo KJ, Shin OR, Lee JY, Choi YJ. Micropapillary urothelial carcinoma in a renal transplant recipient: a case report on urine cytomorphology emphasizing differentiation from high-grade urothelial carcinoma. Cytopathology 2014; 26:264-6. [PMID: 25123813 DOI: 10.1111/cyt.12197] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Affiliation(s)
- K-J Seo
- Department of Hospital Pathology, College of Medicine, The Catholic University of Korea, Seoul, South Korea
| | - O R Shin
- Department of Hospital Pathology, College of Medicine, The Catholic University of Korea, Seoul, South Korea
| | - J Y Lee
- Department of Urology, College of Medicine, The Catholic University of Korea, Seoul, South Korea
| | - Y-J Choi
- Department of Hospital Pathology, College of Medicine, The Catholic University of Korea, Seoul, South Korea
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Huq GE, Canberk S, Oznur M, Yildiz P, Bahadir B, Behzatoğlu K. Cytological features of pure micropapillary carcinoma of various organs: A report of eight cases. Oncol Lett 2014; 8:705-710. [PMID: 25013488 PMCID: PMC4081296 DOI: 10.3892/ol.2014.2198] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2013] [Accepted: 05/13/2014] [Indexed: 11/27/2022] Open
Abstract
Micropapillary carcinoma (MPC) is a rare aggressive tumor, which generally accompanies the primary carcinoma of the organ of its origin, while the pure form is extremely uncommon. Angiolymphatic involvement is widespread and a considerable proportion of the cases present with metastases. The current study presents eight pure MPC cases arising from the breast (n=3), urinary bladder (n=3), parotid gland (n=1) and lung (n=1, presenting with pericardial effusion), with the cytological findings. The eight patients included three female and five male cases aged between 48 and 74 years. The most common cytological findings were three-dimensional aggregates, cell clusters with angulated or scalloped borders, single cells with a columnar configuration and eccentric nuclei, and high-grade nuclear features. Histopathological sections showed accompanying in situ ductal carcinoma in the cases of MPC arising in the parotid gland and breast (n=3), and one case in the bladder exhibited only in situ MPC. The average follow-up period was 20 months (range, 6–54 months) and, during this period, three patients succumbed to the disease. At present, four patients are alive with disease and one patient is alive and disease-free. In conclusion, cytology is an important tool for the diagnosis and management of MPC.
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Affiliation(s)
- Gülben Erdem Huq
- Department of Pathology, Istanbul Education and Research Hospital, Istanbul 34098, Turkey
| | - Sule Canberk
- Department of Pathology, Istanbul University, Cerrahpasa Medical Faculty Istanbul 34320, Turkey
| | - Meltem Oznur
- Department of Pathology, Namık Kemal University Medical Faculty, Tekirdağ 59100, Turkey
| | - Pelin Yildiz
- Department of Pathology, Bezmialem University, Medical Faculty, Istanbul 34093, Turkey
| | - Burak Bahadir
- Department of Pathology, Bülent Ecevit University, Zonguldak 67100, Turkey
| | - Kemal Behzatoğlu
- Department of Pathology, Istanbul Education and Research Hospital, Istanbul 34098, Turkey
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González-Peramato P, Jiménez-Heffernan JA, Vicandi B, López-Ferrer P, Bárcena C, Alvarez-Rodríguez F, Picazo ML, Viguer JM. Micropapillary carcinoma of the urinary tract: a cytologic study of urine and fine-needle aspirate samples. Acta Cytol 2014; 58:269-74. [PMID: 24556948 DOI: 10.1159/000358506] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2013] [Accepted: 01/04/2014] [Indexed: 11/19/2022]
Abstract
OBJECTIVE Micropapillary carcinoma (MPC) is an aggressive variant of urothelial carcinoma that needs early and specific recognition. In order to determine whether this tumor variant can be recognized with cytology, we evaluated a large cytohistological series. STUDY DESIGN It was a retrospective cytohistological correlation study including 20 patients with MPC. Only those cases in which the tumor exhibited >50% of micropapillary growth were selected. Twenty exfoliative urine specimens and four needle aspirates from lymph node metastases were reviewed. RESULTS On histology, 14 cases were infiltrative, while 6 were exclusively superficial. Cytology was characterized by numerous small, cohesive groups and single neoplastic cells. Pseudopapillae were present in 17 cases and in 9 they were a relevant finding. Morules were present in 15 cases. Isolated microacini were seen in 14 cases. Infiltrative tumors showed more neoplastic groups. Cellular atypia was prominent in 17 cases. In 15 cases, a cytologic diagnosis of urothelial carcinoma was made. One case was diagnosed as adenocarcinoma. The remaining 4 cases were considered suspicious of malignancy. CONCLUSIONS The peculiar morphology of MPC of the urinary tract is partially reflected on cytology, allowing in some cases a specific recognition. This is important since the aggressive behavior of this neoplasm needs rapid management and treatment.
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Yoshida K, Ishida M, Kagotani A, Iwamoto N, Iwai M, Okabe H. Small cell carcinoma of the urinary bladder and prostate: Cytological analyses of four cases with emphasis on the usefulness of cytological examination. Oncol Lett 2013; 7:369-372. [PMID: 24396449 PMCID: PMC3881928 DOI: 10.3892/ol.2013.1715] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2013] [Accepted: 11/18/2013] [Indexed: 12/29/2022] Open
Abstract
The occurrence of small cell carcinoma in the urinary bladder and prostate is rare. Only a few reports on the cytological features of small cell carcinoma of the urinary bladder in the urine specimen have been documented and, moreover, the urinary cytological features of prostate small cell carcinoma have been rarely reported. In this study, we analyzed the cytological features of four cases of small cell carcinoma of the urinary bladder and prostate, and discussed the usefulness of cytological examination of urine specimen for this type of tumor. This study included two urinary bladder and two prostate small cell carcinoma cases. Analyses of the cytological features of these cases revealed the following: i) the background was mostly inflammatory and necrotic material was also occasionally observed; ii) numerous tumor cells were present in two cases, whereas only a few neoplastic cells were observed in the remaining cases; iii) the neoplastic cells were small in size, had scant cytoplasm and a high nuclear/cytoplasmic ratio, and were arranged in small clusters or occasionally as single cells; iv) the tumor cell clusters showed prominent nuclear moldings; and v) the nuclei of the neoplastic cells were round to oval in shape with finely granular chromatin containing inconspicuous nucleoli. The cytological features of small cell carcinoma in the urine specimen are characteristic. Therefore, careful observation of the urine specimen may lead to a correct diagnosis of small cell carcinoma of the urinary bladder and, moreover, cytodiagnosis of prostate small cell carcinoma may also be possible.
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Affiliation(s)
- Keiko Yoshida
- Division of Diagnostic Pathology and Department of Clinical Laboratory Medicine, Shiga University of Medical Science, Otsu, Shiga 520-2192, Japan
| | - Mitsuaki Ishida
- Division of Diagnostic Pathology and Department of Clinical Laboratory Medicine, Shiga University of Medical Science, Otsu, Shiga 520-2192, Japan
| | - Akiko Kagotani
- Division of Diagnostic Pathology and Department of Clinical Laboratory Medicine, Shiga University of Medical Science, Otsu, Shiga 520-2192, Japan
| | - Nozomi Iwamoto
- Division of Diagnostic Pathology and Department of Clinical Laboratory Medicine, Shiga University of Medical Science, Otsu, Shiga 520-2192, Japan
| | - Muneo Iwai
- Division of Diagnostic Pathology and Department of Clinical Laboratory Medicine, Shiga University of Medical Science, Otsu, Shiga 520-2192, Japan
| | - Hidetoshi Okabe
- Division of Diagnostic Pathology and Department of Clinical Laboratory Medicine, Shiga University of Medical Science, Otsu, Shiga 520-2192, Japan
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12
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Kim KH, Choi CH, Han JY, Kim L, Choi SJ, Park IS, Kim JM, Chu YC. Cytological findings of the micropapillary variant of urothelial carcinoma: a comparison with typical high-grade urothelial carcinoma. KOREAN JOURNAL OF PATHOLOGY 2013; 47:365-71. [PMID: 24009632 PMCID: PMC3759636 DOI: 10.4132/koreanjpathol.2013.47.4.365] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/19/2013] [Revised: 06/28/2013] [Accepted: 07/03/2013] [Indexed: 11/17/2022]
Abstract
Background Micropapillary variant of urothelial carcinoma (MPUC) showed distinct pathologic features and aggressive behavior. The cytologic findings of MPUC are still indistinct. In this study, we evaluated the cytological findings of MPUC compared with those of high-grade urothelial carcinoma (HGUC). Methods The voided urine cytology of 8 cases of MPUC and 8 cases of HGUC was reviewed. Following cytological parameters were evaluated: cellularity, background, number of small, tight papillary clusters, small acinar structure, scattered single cells, cytoplasmic features, nuclear-to-cytoplasmic ratio, nuclear pleomorphism, nuclear membrane irregularity, hyperchromasia, chromatin pattern and nucleoli. Results Compared to that of HGUC, cytology of MPUC showed large numbers of small, tight papillary clusters, small acinar structure, few numbers of single cells, and hyperchromatic nuclei. Other parameters were similar between the two groups; both groups showed similar cellularity, dense or vacuolated cytoplasm, moderate to severe nuclear pleomorphism, irregular nuclear membrane, coarse granular chromatin, and small and prominent nucleoli. Conclusions The urine cytology of MPUCs showed smaller and tighter papillary cell clusters, more small acinar structures, fewer numbers of scattered single cells, and more hyperchromatic nuclei than that of HGUC. These features can help to distinguish MPUC and HGUC and offer an early cytological diagnosis of MPUC.
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Affiliation(s)
- Kyu-Ho Kim
- Department of Pathology, Inha University Hospital, Inha University College of Medicine, Incheon, Korea
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Pusztaszeri M, Douaihy N, Pelte MF, Pache JC. Cervical lymph node metastasis of a micropapillary carcinoma of the bladder: a case report with fine-needle aspiration cytology and differential diagnosis. Diagn Cytopathol 2013; 41:617-9. [PMID: 22351519 DOI: 10.1002/dc.22845] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2011] [Accepted: 01/14/2011] [Indexed: 11/08/2022]
Affiliation(s)
- Marc Pusztaszeri
- Division of Clinical Pathology, Geneva University Hospital, 1 rue Michel-Servet, Geneva, Switzerland.
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Heymann JJ, Saqi A, Turk AT, Crapanzano J. Micropapillary urothelial carcinoma: Cytologic features in a retrospective series of urine specimens. Cytojournal 2013; 10:4. [PMID: 23599723 PMCID: PMC3623430 DOI: 10.4103/1742-6413.107986] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2012] [Accepted: 02/10/2013] [Indexed: 11/25/2022] Open
Abstract
Background: The micropapillary variant of urothelial carcinoma (uPC) is a rare variant of urothelial carcinoma that carries a poor prognosis. Definitive surgery may represent optimal management of low stage tumors. Urine cytology is indispensable in the screening and follow-up of urinary tract cancer. However, cytopathological criteria for diagnosis of uPC and its differentiation from conventional urothelial carcinoma (CUC) are not well-defined. Materials and Methods: Twenty-five cases of histologically confirmed micropapillary uPC from 21 patients were compared to 25 cases of histologically confirmed high-grade CUC. Results: In uPC cases, cell clusters were identified in 13 of 25 specimens from 10 patients. Six of the 13 specimens containing cell clusters corresponded to surgical pathology specimens in which micropapillary carcinoma accounted for at least 50% of total carcinoma. In contrast, only 1 of the 12 urine specimens devoid of cell clusters corresponded to surgical specimens in which micropapillary carcinoma accounted for at least 50% of total carcinoma. Cytomorphologic features of urinary specimens from patients with histologically confirmed micropapillary carcinoma were generally similar to those from patients with high-grade CUC, making it difficult to distinguish these entities in exfoliative urine specimens. Conclusions and Summary: Further investigation of the core cytopathological characteristics of uPC is warranted to refine its diagnostic criteria by exfoliative urine cytology.
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Affiliation(s)
- Jonas John Heymann
- Department of Pathology and Cell Biology, New York-Presbyterian Hospital-Columbia University Medical Center, 630 West 168 Street, VC14-215, New York, NY 10032
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Arita N, Ishida M, Yoshida K, Kagotani A, Iwamoto N, Iwai M, Okabe H. Sarcomatoid variant of urothelial carcinoma: Cytological analysis of three cases. Oncol Lett 2012; 5:49-52. [PMID: 23255892 DOI: 10.3892/ol.2012.990] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2012] [Accepted: 10/12/2012] [Indexed: 11/06/2022] Open
Abstract
Sarcomatoid variant of urothelial carcinoma (SV-UC) is characterized by the presence of biphasic malignant neoplastic components exhibiting morphological and/or immunohistochemical evidence of epithelial and mesenchymal differentiation. SV-UC is a rare variant of UC and the cytological features of this tumor have not been well described. In the present study, we analyzed the cytological features of a series of SV-UC cases; 6 voided urine specimens from 3 patients with SV-UC were reviewed. Several characteristic cytological features were revealed: i) tumor cells were abundant in a necrotic background and while single tumor cells were predominant, small clusters of cells were occasionally present; ii) tumor cells were large-sized and round to polygonal in shape with ill-defined cell borders; iii) tumor cells had a high nuclear/cytoplasmic ratio and enlarged round to oval nuclei containing coarse chromatin and occasional nucleoli; and iv) spindle-shaped atypical cells were rarely identified (1/6 specimens). The cytological features of i), ii) and iii) are indistinguishable from those of conventional invasive high-grade UC. We hypothesize that these tumor cells originated from the conventional high-grade UC component of SV-UC as this component is usually present in this type of lesion, particularly on the surface of the tumor. Moreover, the sarcomatoid component of SV-UC is usually present in the deeper portion of the tumor and therefore detection of this component in the voided cytological specimen is low. Although cytodiagnosis of SV-UC is extremely difficult, cytodiagnosis of malignancy may prove possible due to the presence of a conventional UC component.
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Affiliation(s)
- Namie Arita
- Division of Diagnostic Pathology and Department of Clinical Laboratory Medicine, Shiga University of Medical Science, Shiga 520-2192, Japan
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Micropapillary variant of urothelial carcinoma. Adv Urol 2011; 2011:217153. [PMID: 22007200 PMCID: PMC3189456 DOI: 10.1155/2011/217153] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2011] [Accepted: 08/09/2011] [Indexed: 11/18/2022] Open
Abstract
Micropapillary carcinoma (MPC) of urinary tract is an uncommon variant of urothelial carcinoma with significant diagnostic and prognostic implications. Though MPC shows characteristic microscopic features, there exists interobserver variability and also it needs to be differentiated from the metastasis from other organs. The prognosis is generally poor, depending on the proportion of the micropapillary component in some reports. Early cystectomy in cases with only lamina propria invasion may be indicated according to recent studies. This review outlines the general features of this entity and briefly comments on the controversies and the recent development.
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