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Su W, Sui W, Cheng X, Zong Y, Qin Y, Cui F. Morphology, immunohistochemistry characteristics, and clinical presentation of microcystic urothelial carcinoma: a series of 10 cases. Diagn Pathol 2023; 18:94. [PMID: 37598154 PMCID: PMC10439560 DOI: 10.1186/s13000-023-01381-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Accepted: 08/10/2023] [Indexed: 08/21/2023] Open
Abstract
BACKGROUND Microcystic urothelial carcinoma (MUC) is a rare variant of urothelial carcinoma with histological appearances similar to begin lesions. Thus far, approximately 50 cases have been reported. Here, we investigated the clinicopathological features of MUC. METHODS Clinical data and paraffin-embedded tissue blocks were collected. Immunohistochemical staining and polymerase chain reaction-Sanger sequencing were performed to detect the phenotype and TERT mutation status of MUC, respectively. RESULTS The mean patient age was 58.8 ± 14.5 years, with a male predominance (8:2). The pathological stage was T1 in one case, T2 in three cases, T3 in four cases, and T4 in two cases. Tumor metastases or death occurred in all five patients who were followed up within 1-3 years. Histological analyses revealed microcystic, tubular, cribriform, and occasionally cord-like structures, which generally lacked interstitial reactions. The lumens were empty, contained eosinophilic secretion, or were filled with mucin. The microcysts/tubules/cribriform patterns were lined by flat, cuboid, signet ring, or columnar types of epithelia. The cuboid, signet ring, and columnar types represented "glandular metaplasia" or glandular differentiation of urothelial carcinoma. Immunohistochemistry analyses revealed distinct co-expression patterns involving the luminal markers FOXA1 and GATA3, as well as the basal markers CK5/6 and CD44. All 10 cases exhibited a luminal phenotype according to the GATA3+/CK14- criterion, whereas nine cases exhibited a luminal phenotype according to the FOXA1+/CK14- criterion. The telomerase reverse transcriptase-C228T mutation was detected in seven cases. CONCLUSIONS MUC is a rare variant with a deceptively benign form of urothelial carcinoma, which is generally identified as a late-stage tumor with a poor prognosis. It exhibits distinct co-expression of luminal and basal markers, along with the TERT-C228T mutation.
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Affiliation(s)
- Wenjing Su
- Department of Pathology, Shandong Provincial Hospital affiliated to Shandong First Medical University, Jinan, 250021, Shandong, P.R. China
| | - Wenwen Sui
- Department of Pathology, Dongying District People's Hospital, Dongying, 257000, Shandong, P.R. China
| | - Xiankui Cheng
- Department of Pathology, Shandong Provincial Hospital affiliated to Shandong First Medical University, Jinan, 250021, Shandong, P.R. China
| | - Yuanyuan Zong
- Department of Pathology, Shandong Provincial Hospital affiliated to Shandong First Medical University, Jinan, 250021, Shandong, P.R. China
| | - Yejun Qin
- Department of Pathology, Shandong Provincial Hospital affiliated to Shandong First Medical University, Jinan, 250021, Shandong, P.R. China
| | - Fengyun Cui
- Department of Pathology, Shandong Provincial Hospital affiliated to Shandong First Medical University, Jinan, 250021, Shandong, P.R. China.
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Ma T, Wang X, Tian Z, Meng L, Zhang W, Wang J, Liu X, Zhang Y. Nomograms to predict individual prognosis of patients with primary signet ring cell carcinoma of the urinary bladder. Transl Cancer Res 2022; 10:3948-3962. [PMID: 35116694 PMCID: PMC8797849 DOI: 10.21037/tcr-21-929] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2021] [Accepted: 08/06/2021] [Indexed: 12/24/2022]
Abstract
Background Signet ring cell carcinoma (SRCC) is a rare but highly malignant variant of bladder carcinoma. Nomograms have demonstrated good accuracy in predicting the prognosis and guiding the management of pure urothelial carcinoma (UC). However, no accurate and applicable nomogram has been formulated for primary SRCC cases. This study aimed to determine significant prognostic factors and to construct nomograms for predicting the survival outcomes of patients with primary SRCCs of the urinary bladder. Methods A total of 317 eligible patients diagnosed with SRCC were analyzed using the 2004–2016 data from the Surveillance, Epidemiology, and End Results database. Univariate and multivariate analyses were performed to explore the prognostic values. Nomograms were established to estimate the overall survival (OS) and cancer-specific survival (CSS) based on the Cox regression results. The performance of SRCC nomograms was evaluated using the concordance index and calibration curves. Survival curves were applied according to various surgical methods, lymph node status, and risk groups distinguished by nomograms. Results Two nomograms included common indicators that were significantly associated with OS and CSS, including T stage, M stage, tumor size, surgery, and the lymph node ratio (LNR). The nomograms indicated appreciable accuracy in predicting the OS and CSS, with concordance index of 0.723 [95% confidence interval (95% CI: 0.692–0.754] and 0.740 (95% CI: 0.701–0.779), respectively. The calibration curves revealed satisfactory consistency between the prediction of deviation correction and ideal reference line. Conclusions The two nomograms developed in this study showed high accuracy and reliability in predicting the survival outcomes of patients with SRCC and could be used to comprehensively assess the risk of SRCC. Moreover, they could assist in the optimal treatment selection for such patients.
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Affiliation(s)
- Tianming Ma
- Department of Urology, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, China.,Graduate School of Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
| | - Xiaonan Wang
- Graduate School of Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China.,Department of Radiology, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, China
| | - Zijian Tian
- Department of Urology, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, China.,Graduate School of Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
| | - Lingfeng Meng
- Department of Urology, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, China.,Graduate School of Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
| | - Wei Zhang
- Department of Urology, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, China
| | - Jiawen Wang
- Department of Urology, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, China
| | - Xiaodong Liu
- Department of Urology, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, China.,Graduate School of Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
| | - Yaoguang Zhang
- Department of Urology, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, China.,Graduate School of Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
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Terauchi T, Nakada S, Takenaka M, Mizuguchi S, Okanemasa Y, Tsubata Y, Miyazawa K, Kinjo M, Shioya A, Guo X, Kurose N, Yamada S. Intracytoplasmic Lumen in Urine Cytology Predicts Worse Prognosis in Non-Muscle-Invasive Bladder Cancers. Acta Cytol 2020; 64:360-367. [PMID: 32097951 DOI: 10.1159/000505955] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2019] [Accepted: 01/13/2020] [Indexed: 12/21/2022]
Abstract
BACKGROUND Intracytoplasmic lumina (ICL) are observed in several cancers, including urothelial carcinoma (UC). We have reported that ICL in urine cytology (cICL) is more frequent in high-grade UCs than in low-grade UCs; however, the correlation between the presence of ICL and prognosis is unclear. OBJECTIVES The aim of this work was to determine the association between cICL and prognosis in bladder cancer. METHOD We retrospectively investigated 87 patients with bladder cancer who received a histological diagnosis within 3 months of urine cytology at Kanazawa Medical University between 2003 and 2007. The cytological diagnosis and the number of cICL, histological diagnosis, tumor grade or variant, pT stage, ICL in histological specimens, and immunohistochemistry for mucins were evaluated. Data on the treatment type, recurrence, survival, cause of death, and length of follow-up were collected from electronic medical records. RESULTS Muscle invasion, high-grade UC, lymph node metastasis, distant metastasis, adjuvant therapy, and disease-related mortality were more frequent in patients with cICL-positive bladder cancer than in those without cICL-positive bladder cancer. Immunohistochemistry revealed the expression of Muc-1 and Muc-4 in patients with cICL-positive bladder cancer. Univariate analysis revealed that cytological diagnosis by the Paris system and the 2015 version of the Japanese reporting system, muscle invasion, high-grade UC, lymph node metastasis, distant metastasis, and adjuvant chemotherapy and/or radiotherapy were significant factors associated with prognosis. Furthermore, survival was shorter in patients with cICL-positive non-muscle-invasive bladder cancer than in those with cICL-negative non-muscle-invasive bladder cancer. In the multivariate analysis, only distant metastasis was significantly associated with survival. CONCLUSIONS cICL predicted shorter survival in patients with non-muscle-invasive bladder cancer, suggesting that ICL is one of the important diagnostic features of high-grade UC with a worse prognosis in urine cytology.
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Affiliation(s)
- Toshie Terauchi
- Section of Pathology, Kanazawa Medical University Hospital, Uchinada, Japan
| | - Satoko Nakada
- Department of Laboratory Medicine and Pathology, Kanazawa Medical University, Uchinada, Japan,
- Department of Diagnostic Pathology, Kanazawa University Hospital, Kanazawa, Japan,
| | - Michiho Takenaka
- Section of Pathology, Kanazawa Medical University Hospital, Uchinada, Japan
| | - Seiya Mizuguchi
- Section of Pathology, Kanazawa Medical University Hospital, Uchinada, Japan
- Department of Pathology, Ishikawa Prefectural Central Hospital, Kanazawa, Japan
| | - Yoshiiku Okanemasa
- Section of Pathology, Kanazawa Medical University Hospital, Uchinada, Japan
| | - Yumi Tsubata
- Section of Pathology, Kanazawa Medical University Hospital, Uchinada, Japan
| | | | - Mitsuru Kinjo
- Department of Pathology, Steel Memorial Yawata Hospital, Kitakyusyu, Japan
| | - Akihiro Shioya
- Department of Laboratory Medicine and Pathology, Kanazawa Medical University, Uchinada, Japan
| | - Xin Guo
- Department of Laboratory Medicine and Pathology, Kanazawa Medical University, Uchinada, Japan
| | - Nozomu Kurose
- Department of Laboratory Medicine and Pathology, Kanazawa Medical University, Uchinada, Japan
| | - Sohsuke Yamada
- Department of Laboratory Medicine and Pathology, Kanazawa Medical University, Uchinada, Japan
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Povzun SA, Guseva EA, Konstantinova AM, Shelekhova KV. [Renal urothelial carcinoma mainly composed of signet-ring cells]. Arkh Patol 2016; 77:50-53. [PMID: 26841650 DOI: 10.17116/patol201577650-53] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Autopsy study of an 80-year-old man has identified his renal tumor metastasizing to the heart, lung, and liver as urothelial car- cinoma; at the same time some cells in the main tumor and all cells in the metastases had a signet-ring phenotype, but neither mucicarcimine nor alcian blue stained the cell cytoplasm. The paper provides the histological and immunohistochemical pattern of the tumor and emphasizes its exclusive rarity. Attention is drawn to the possibility of signet-ring cell transformation in the cells of different tumors, including nonepithelial ones.
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Affiliation(s)
- S A Povzun
- Department of Pathomorphology and Clinical Expertise, I.I. Janelidze Saint Petersburg Research Institute of Emergency Care; Saint Petersburg Bureau of Forensic Medical Examination
| | - E A Guseva
- Saint Petersburg Bureau of Forensic Medical Examination
| | - A M Konstantinova
- Department of Morbid Anatomy, Saint Petersburg Clinical Research-and-Practical Center for Specialized Medical Care; Pathology Department, Medical Faculty, Saint Petersburg State University
| | - K V Shelekhova
- Department of Morbid Anatomy, Saint Petersburg Clinical Research-and-Practical Center for Specialized Medical Care; Department of Tumor Morphology, N.N. Petrov Research Institute of Oncology, Russia
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Kojima Y, Takasawa A, Murata M, Akagashi K, Inoue T, Hara M, Tokunaga Y, Minase T, Hasegawa T, Sawada N. A case of urothelial carcinoma, lipid cell variant. Pathol Int 2013; 63:183-7. [DOI: 10.1111/pin.12027] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2012] [Accepted: 12/17/2012] [Indexed: 11/30/2022]
Affiliation(s)
- Yui Kojima
- Department of Pathology; Sapporo Medical University; Sapporo; Japan
| | - Akira Takasawa
- Department of Pathology; Sapporo Medical University; Sapporo; Japan
| | - Masaki Murata
- Department of Pathology; Sapporo Medical University; Sapporo; Japan
| | - Keigo Akagashi
- Department of Urology; Sanjukai Hospital; Sapporo; Japan
| | - Tomomi Inoue
- Department of Surgical Pathology; Sapporo Medical University Hospital; Sapporo; Japan
| | - Mamie Hara
- Sapporo Clinical Laboratory; Sapporo; Japan
| | | | | | - Tadashi Hasegawa
- Department of Surgical Pathology; Sapporo Medical University Hospital; Sapporo; Japan
| | - Norimasa Sawada
- Department of Pathology; Sapporo Medical University; Sapporo; Japan
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Marked infiltration of eosinophils in necrotizing granulomas in the resected hepatic bed after cholecystectomy resulting from gallbladder cancer and metastatic liver cancer is associated with peculiar peripheral eosinophilia. Med Mol Morphol 2012; 45:53-7. [PMID: 22431184 DOI: 10.1007/s00795-011-0555-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2011] [Accepted: 06/24/2011] [Indexed: 10/28/2022]
Abstract
It is known that after transurethral resection of the prostate (TUR-P) or a bladder tumor (TUR-BT), necrotizing granuloma formation associated with massive eosinophil accumulation can be detected at the site of the scar, revealing marked eosinophilia. This condition is called post-TUR prostatitis or cystitis. In the present study, we noticed a similar phenomenon in five patients who underwent cholecystectomy, of whom four had gallbladder adenocarcinoma and one had metastatic liver cancer originating from the rectum. We detected necrotizing granulomas with massive eosinophil accumulation, associated with marked eosinophilia. To induce these phenomena, the interval between the first operation (i.e., cholecystectomy) and the second operation (i.e., resection of the hepatic bed and extrahepatic bile duct) is very important. If the interval was 1 week, no granuloma formation was detected. On the other hand, if it was more than 2 weeks, the resected hepatic bed contained necrotizing granulomas with substantial eosinophil accumulation combined with an increase in peripheral eosinophilia (up to 34% in one case). Secondary resection was necessary to induce eosinophilia after cholecystectomy. In this sense, malignancies possessed a relationship with delayed eosinophilia. In the granulomas, some foreign body-type multinucleated giant cells were positive for both anti-interleukin (IL)-5 and CD68 antibodies. In sharp contrast, no eosinophilia was detected after cholecystectomy, with or without hepatic resection consequent to severe adhesion. Clinicians as well as pathologists should keep in mind that these peculiar phenomena of eosinophil accumulation surrounding the necrotizing granulomas and peripheral eosinophilia after cholecystectomy could occur.
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Wang J, Wang FW, Kessinger A. The impact of signet-ring cell carcinoma histology on bladder cancer outcome. World J Urol 2011; 30:777-83. [PMID: 21706144 DOI: 10.1007/s00345-011-0718-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2011] [Accepted: 06/06/2011] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Signet-ring cell carcinoma (SRCC) of the urinary bladder is a rare entity. No previous studies have directly compared the cancer-specific survival of patients with SRCC to patients with urothelial carcinoma (UC) of the urinary bladder. MATERIALS AND METHODS Patients with diagnosis of urinary bladder SRCC and UC were identified in the Surveillance, epidemiology, and end results program (SEER) (2001-2004). Demographic of patients and clinical characteristics at diagnosis were compared. Differences in cancer-specific survival were compared using univariate and multivariate analysis. RESULTS A total of 103 patients with SRCC and 14,648 patients with UC were indentified. Patients with SRCC were younger (P < 0.001), more commonly presented with higher-grade histology (P < 0.001) and advanced stage disease (P < 0.001), in comparison with patients with UC. The 3-year cancer-specific survival rate was 67.0% for patients with UC and 33.2% for SRCC. On multivariate analysis, there was an increased mortality risk in patients with SRCC versus UC (HR 1.49, 95% CI 1.11-2.00, P < 0.01). CONCLUSIONS Even after adjusting for demographic, surgical, and pathological factors, cancer-specific survival rate was significantly worse in patients with SRCC compared to UC. Further research into the biology of this rare tumor is required to explain these results.
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Affiliation(s)
- Jue Wang
- Division of Oncology-Hematology, Department of Internal Medicine, University of Nebraska Medical Center, Omaha, NE 68198-7680, USA.
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Wang J, Wang FW. Clinical characteristics and outcomes of patients with primary signet-ring cell carcinoma of the urinary bladder. Urol Int 2011; 86:453-60. [PMID: 21525723 DOI: 10.1159/000324263] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2010] [Accepted: 12/31/2010] [Indexed: 11/19/2022]
Abstract
OBJECTIVE The aim of this study was to examine the epidemiology, natural history, treatment pattern and predictors of long-term survival of patients with signet-ring cell carcinoma (SRCC) of the urinary bladder based on the analysis of the national Surveillance, Epidemiology, and End Results (SEER) database. METHODS AND RESULTS In total, 230 patients with pathologically confirmed SRCC of the urinary bladder were identified between 1973 and 2004. The mean age was 65 ± 13 years. Overall, 75.7% of the patients had a poorly differentiated or undifferentiated histology grade, 26.5% presented with metastatic disease, 59 (25.7%) underwent transurethral resection for bladder tumor only and 107 (46.5%) had partial or radical cystectomy. The 1-, 3- and 10-year cancer-specific survival rates were 66.8, 40.6 and 25.8%, respectively. Using multivariable Cox proportional hazard model, age (HR 1.024; p = 0.004), stage (distant vs. local, HR 6.2; p < 0.001) and cystectomy (HR 0.53; p = 0.002) were identified as independent predictors for cancer-specific survival. CONCLUSIONS Receipt of cystectomy was strongly associated with improved survival in the patients with SRCC of urinary bladder. However, many patients with localized tumors did not receive potentially curative cystectomy. Further studies to address the barriers to the delivery of appropriate care to these patients are warranted.
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Affiliation(s)
- Jue Wang
- Division of Oncology/Hematology, Department of Internal Medicine, University of Nebraska Medical Center, Omaha, NE 68198-7680, USA.
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