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Won YD, Lee SL, Seo KJ. Unusual Duodenal Ulcer: Metastatic Urothelial Carcinoma of the Renal Pelvis. Diagnostics (Basel) 2023; 13:2455. [PMID: 37510203 PMCID: PMC10377969 DOI: 10.3390/diagnostics13142455] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2023] [Revised: 07/21/2023] [Accepted: 07/22/2023] [Indexed: 07/30/2023] Open
Abstract
Metastatic urothelial carcinoma of the renal pelvis (MUCP), a type of metastatic upper tract urothelial carcinoma (MUTUC), is a rare malignancy, and some patients with MUCP present with distant metastasis at the time of diagnosis. MUCP in the gastrointestinal tract is even rarer. Herein, we report a 78-year-old man with MUCP that presented as a duodenal ulcer. He complained of anorexia, dizziness, and melena for one month. Endoscopic examination at a local clinic revealed a duodenal hemorrhagic and ulcerative lesion, and the patient was referred. He noted dark-colored stools with increasing frequency, but he denied hematochezia, coffee ground emesis, weight changes, or abdominal pain. Gastroduodenoscopic examination at our hospital demonstrated an ulcerofungating lesion of the second portion of the duodenum. Colonoscopic findings showed no abnormality. Computed tomography showed a 6.7 cm sized mass abutting the inferior vena cava, second portion of the duodenum, lower pole of the right kidney, and right iliopsoas. The mass showed heterogeneous enhancement and internal hemorrhagic necrosis and infiltrated the perinephric soft tissues, the second portion of the duodenum, the right psoas muscle, the right renal vein, and the right adrenal gland. Duodenal biopsy showed moderately differentiated squamous cell carcinoma. Immunohistochemistry (IHC) showed diffuse and strong positivity for CK5/6. Tissue from the liver biopsy showed similar histopathologic features and showed GATA3 positivity on IHC. The imprint cytology smears of the liver tissue showed "cercariform" cell features. We confirmed the diagnosis as MUCP. This case illustrated a rare cause of a secondary duodenal tumor, MUCP.
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Affiliation(s)
- Yoo Dong Won
- Department of Radiology, Uijeongbu St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul 06591, Republic of Korea
| | - Su Lim Lee
- Department of Radiology, Uijeongbu St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul 06591, Republic of Korea
| | - Kyung Jin Seo
- Department of Hospital Pathology, Uijeongbu St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul 06591, Republic of Korea
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Baban F, Auen T, Eschbacher KL, Swanson AA, Hartley CP. Invasive urothelial carcinoma with squamous differentiation and associated high-risk human papilloma virus infection: Clinical, cytologic, and histologic features of a rare entity. Ann Diagn Pathol 2023; 63:152103. [PMID: 36640642 DOI: 10.1016/j.anndiagpath.2022.152103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2022] [Accepted: 12/30/2022] [Indexed: 01/07/2023]
Abstract
We correlate the fine needle aspiration (FNA) cytologic findings with the histologic features of an invasive high-grade urothelial carcinoma showing squamous differentiation in the setting of high-risk Human Papilloma Virus (hrHPV) infection. To our knowledge, only extensive urinary bladder catheterization has been associated with hrHPV-positive urothelial carcinoma with squamous differentiation, and rarely at that. Herein, we present a case arising in a patient with only sparse and intermittent catheterization. A 69-year-old woman presented with voiding difficulties, and after continued symptoms, a Foley catheter was placed, and a cystoscopy procedure revealed two 1-2 cm inflammatory masses. Excisional biopsies were interpreted as papillary urothelial carcinoma. One month follow-up pelvic imaging demonstrated a new mass involving the urinary bladder neck, with irregular wall thickening and perivesical fat stranding, as well as probable vaginal involvement. CT-guided FNA (CT-FNA) to collect smears and core biopsies revealed an invasive urothelial carcinoma with squamous differentiation. HPV-cytopathic changes amid squamous metaplasia and dysplasia were noted on FNA smears with HPV E6/E7 RNA in situ hybridization (ISH) showing on the FNA core biopsy specimen. Immunostains showed that the tumor cells were positive for P16 (strong, diffuse), CK7, p63, ER, and GATA3 (patchy). Subsequent radical cystectomy revealed the extent of the patient's carcinoma, with direct extension to the vaginal wall, and involvement of the radial soft tissue resection margins. Describing the cytomorphologic features of a hrHPV positive urothelial carcinoma with squamous differentiation, without an extensive history of urinary catheterization or prior known history of HPV infection, emphasizes the role of cytopathology as a powerful diagnostic tool for recognizing a unique and unexpected lesion.
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Affiliation(s)
- Farah Baban
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA
| | - Thomas Auen
- Department of Pathology and Microbiology, University of Nebraska Medical Center, NE, USA
| | - Kathryn L Eschbacher
- Department of Pathology, University of Iowa Hospitals and Clinics, Iowa City, IA, USA
| | - Amy A Swanson
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA
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El Hussein S, Colanta A, Khader SN. Revisiting cercariform cells: Small cell carcinoma masquerading as cercariform cells. Diagn Cytopathol 2019; 47:1072-1075. [PMID: 31386301 DOI: 10.1002/dc.24296] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2019] [Revised: 07/09/2019] [Accepted: 07/23/2019] [Indexed: 11/09/2022]
Abstract
Cercariform cells are slender cells with a bulbous end and a unipolar long cytoplasmic process, resembling Schistosoma cercariae. Since their first description in urothelial carcinoma, multiple studies have attempted to explore their utility in distinguishing metastatic urothelial carcinoma from other common malignant neoplasms, such as adenocarcinoma and squamous-cell carcinoma. Although not pathognomonic, they are most commonly encountered in urothelial carcinoma, but they can also be seen in other neoplasms, raising the possibility that this cytomorphological feature can be exploited to aid in diagnosis.
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Affiliation(s)
- Siba El Hussein
- The Leopold G. Koss Department of Cytopathology, Montefiore Medical Center/Albert Einstein College of Medicine, New York, New York
| | - Agnes Colanta
- The Leopold G. Koss Department of Cytopathology, Montefiore Medical Center/Albert Einstein College of Medicine, New York, New York
| | - Samer N Khader
- The Leopold G. Koss Department of Cytopathology, Montefiore Medical Center/Albert Einstein College of Medicine, New York, New York
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Manucha V, Hansen JT, Gonzalez MF, Akhtar I. Role of cytology and immunochemistry in diagnosis of metastatic malignancies in the lung: A critical appraisal. Diagn Cytopathol 2018; 46:936-944. [PMID: 30353676 DOI: 10.1002/dc.24034] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2018] [Revised: 06/04/2018] [Accepted: 06/07/2018] [Indexed: 12/19/2022]
Abstract
BACKGROUND Lung is one of the most common sites for primary and metastatic malignancies and a challenging site to diagnose primary versus a metastatic origin of the tumor on cytology. Pathologic diagnosis of the site of origin of cancer has major implications in the management and staging purposes and may have to be followed by testing for predictive/prognostic markers. The clinical history of a known extrapulmonary primary and the radiologic findings of multiple nodules in the lung are useful in arriving at the right diagnosis but is not always available. Rarely pulmonary metastasis may be the first manifestation of an extrapulmonary tumor or may even present as a single nodule. METHOD In this study, we reviewed cytomorphologic features of tumors metastatic to the lung (2014-2017) in conjunction with immunochemistry and evaluation of needle core biopsy when available. The review of the slides was performed with an emphasis on our ability to identify the site of origin in the tumors. RESULTS We identified 47 cases of metastatic tumors in the lung diagnosed on cytology. Clinical history was available in 83% cases and with aid of immunostains, a definitive diagnosis on the origin of the tumor was made in all these cases. In the remaining 8 cases, a primary origin could only be suggested. The use of immunochemistry facilitated the diagnosis but could be misleading. CONCLUSION The approach to the diagnosis of metastatic tumors in the lung on cytology should be largely guided by the previous clinical history and comparison with previous tissue/cellular material if available.
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Affiliation(s)
- Varsha Manucha
- Department of Pathology, University of Mississippi Medical Center, Jackson, Mississippi
| | - Jeffery T Hansen
- Department of Pathology, University of Mississippi Medical Center, Jackson, Mississippi
| | - Maria F Gonzalez
- Department of Pathology, University of Mississippi Medical Center, Jackson, Mississippi
| | - Israh Akhtar
- Department of Pathology, University of Mississippi Medical Center, Jackson, Mississippi
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Hiensch R, Belete H, Rashidfarokhi M, Galperin I, Shakil F, Epelbaum O. Unusual Patterns of Thoracic Metastasis of Urinary Bladder Carcinoma. J Clin Imaging Sci 2017; 7:23. [PMID: 28584690 PMCID: PMC5450457 DOI: 10.4103/jcis.jcis_9_17] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2017] [Accepted: 02/05/2017] [Indexed: 12/19/2022] Open
Abstract
Urinary bladder carcinoma (UBC) is the ninth most common malignancy and the second most common urological malignancy after prostate cancer in men. Thoracic metastases occur in more than half of those with muscle-invasive disease, and these generally assume the form of multiple solid parenchymal lesions characteristic of hematogenous seeding of the lung. Unusual patterns of thoracic spread of UBC have also been described albeit sporadically in the form of case reports and series. The aim of our case series is to provide illustrations of several atypical patterns of thoracic involvement by UBC such as isolated mediastinal lymphadenopathy, cavitary lung metastases, malignant pleural effusion, endobronchial disease, and pulmonary tumor embolism. This review is meant to highlight the intersection of the fields of urological oncology and thoracic radiology in the care of patients with UBC.
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Affiliation(s)
- Robert Hiensch
- Division of Pulmonary, Critical Care, and Sleep Medicine, Icahn School of Medicine at Mount Sinai, New York
| | - Habtamu Belete
- Division of Pulmonary and Sleep Medicine, Lenox Hill Hospital, Hofstra Northwell School of Medicine, Hofstra University, Hempstead, NY, USA
| | - Mahsan Rashidfarokhi
- Division of Pulmonary and Critical Care Medicine, Elmhurst Hospital Center, Icahn School of Medicine, Elmhurst, NY, USA
| | - Irene Galperin
- Division of Pulmonary and Sleep Medicine, Lenox Hill Hospital, Northwell Health, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Fouzia Shakil
- Department of Pathology, Westchester Medical Center, New York Medical College, Valhalla, NY, USA
| | - Oleg Epelbaum
- Division of Pulmonary, Critical Care, and Sleep Medicine, Westchester Medical Center, New York Medical College, Valhalla, NY, USA
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Raymond SLT, Au K, Fu R, Tauchi-Nishi PS. Metastatic genitourinary cancer diagnosed by body fluid cytology: clinicopathologic and cytomorphologic correlation. J Am Soc Cytopathol 2017; 6:48-58. [PMID: 31042634 DOI: 10.1016/j.jasc.2016.11.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2016] [Revised: 11/02/2016] [Accepted: 11/02/2016] [Indexed: 06/09/2023]
Abstract
INTRODUCTION Malignant effusions secondary to genitourinary cancers constitute less than 5% of metastatic malignancies. Because of their rarity, definitive cytodiagnosis may be challenging. Our study aims to examine the incidence of malignant fluids secondary to genitourinary cancers in our institution, and to characterize their clinicopathologic and cytomorphologic features. METHODS A search of our database was undertaken for all body fluids reviewed from January 2003 through April 2014 at our institution. RESULTS During this 11.3-year study period, our search revealed 8255 body fluids. Of these, 1341 (16.2%) were malignant with only 15 (0.2%) due to a genitourinary primary, constituting a mere 1.1% of all malignant fluids. Eight cases (53%) were urothelial carcinomas, 6 (40%) were renal cell carcinomas, and 1 was a bladder leiomyosarcoma (7%). No prostate cancers were found. Seven (47%) involved the pleura, 6 (40%) were in the peritoneum, and 2 (13%) were in the cerebrospinal fluid (CSF). None were detected in the pericardium. Genitourinary metastases comprised 1.9% of peritoneal, 0.8% of pleural, 1.9% of CSF malignant fluids. CONCLUSION Metastatic genitourinary cancers in body fluids are rare, comprising only 0.2% of all fluids and 1.1% of all malignancies. The cytomorphologic features of metastatic urothelial and renal cell carcinoma, although similar to those described in the literature, are nonspecific. To our knowledge, this is the first reported case of metastatic bladder leiomyosarcoma in ascites diagnosed by effusion cytology. Because leiomyosarcoma in body fluids can demonstrate epithelioid features and cohesiveness, it may be confused with metastatic carcinomas.
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Affiliation(s)
| | - Kaylene Au
- Department of Pathology, The Queen's Medical Center, Honolulu, Hawaii
| | - Ryan Fu
- Department of Pathology, The Queen's Medical Center, Honolulu, Hawaii
| | - Pamela S Tauchi-Nishi
- Department of Pathology, University of Hawaii, Honolulu, Hawaii; Department of Pathology, The Queen's Medical Center, Honolulu, Hawaii.
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Wu HH, Kao CS, Grignon DJ. Fine-Needle Aspiration Cytology of Metastatic Plasmacytoid Urothelial Carcinoma: Report of Four Cases Including a Case of Mixed Plasmacytoid and Micropapillary Morphology. Acta Cytol 2015; 59:248-52. [PMID: 26279415 DOI: 10.1159/000435828] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2015] [Accepted: 06/08/2015] [Indexed: 11/19/2022]
Abstract
OBJECTIVES The aim of this study was to report a small series of fine-needle aspiration (FNA) cytology of the plasmacytoid variant of urothelial carcinoma (PVUC). STUDY DESIGN A computerized search of our laboratory information system was performed for the 5-year period between January 2008 and January 2013 to identify all FNA cases in which the corresponding surgical pathology cases were diagnosed as PVUC. RESULTS The 4 cases identified were from 2 men (aged 56 and 64 years) and 2 women (aged 72 and 46 years). The FNA smears demonstrated low-to-moderate cellularity and consisted predominantly of single and dyshesive, medium-sized tumor cells with eccentrically located nuclei and a moderate-to-abundant dense cytoplasm. The nuclei were oval with slightly irregular nuclear membranes and contained coarse granular chromatin with inconspicuous or small nucleoli. There was moderate nuclear variation in size. The nuclear-to-cytoplasmic ratio ranged from <1 to 3. Binucleation, cytoplasmic vacuoles, and perinuclear hof were occasionally seen. CONCLUSIONS FNA cytology of PVUC shares features with plasma cell neoplasms, lobular carcinoma of the breast, and signet ring cell carcinoma of the stomach. Being aware of the patient's clinical history and the potential diagnostic pitfall of this rare variant of urothelial carcinoma is important for an accurate diagnosis on FNA biopsy.
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Affiliation(s)
- Howard H Wu
- Department of Pathology and Laboratory Medicine, Indiana University School of Medicine, Indianapolis, Ind., USA
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Riley ER, Paquette C, Leiman G. What exactly are the cytoplasmic inclusions in metastatic urothelial carcinoma, and are they of diagnostic value? Diagn Cytopathol 2013; 42:816-8. [PMID: 23554301 DOI: 10.1002/dc.22994] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2012] [Accepted: 02/14/2013] [Indexed: 11/10/2022]
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Kaur G, Bakshi P, Verma K. Fine needle aspiration cytology of metastatic urothelial carcinoma: Study of seven cases with review of literature. J Cytol 2012; 29:116-20. [PMID: 22787291 PMCID: PMC3391791 DOI: 10.4103/0970-9371.97151] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Background: Metastatic urothelial carcinoma (UC) is rarely described in cytology literature. Appropriate cytological diagnosis is important in certain clinical scenarios to exclude a second primary. Aims: To delineate cytological features that are helpful in diagnosing metastatic UC. Materials and Methods: The study included seven male patients with age range of 48 – 72 years. These patients were diagnosed cases of UC and had now presented with lesions in liver, lungs, bones or lymph nodes. Computed tomographic (CT)/ultrasonographic (USG) guided fine needle aspiration cytology (FNAC) was available from one of these sites. Results: Cercariform cells (CCs) could be identified in five out of seven cases. In four cases, multilayered papillary fragments (MPFs) were identified which were reminiscent of histopathologic appearance of UC. One of these two morphologic features was present in all the cases. However, both CC cells and MPFs were present only in two cases. Conclusion: Previous clinical history is indispensible while diagnosing metastatic UC. MPFs and CC cells are strong morphologic clues to urothelial origin. In poorly differentiated tumors, differentiation from other epithelial tumors may not be possible on the basis of morphology alone.
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Affiliation(s)
- Gagandeep Kaur
- Department of Cytopathology, Sir Gangaram Hospital, New Delhi, India
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