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Russell DH, Epstein JI, Kryvenko ON, Schlumbrecht M, Jorda M, Pinto A. Adenocarcinomas of the Gynecologic Tract Involving the Urinary Bladder: A Series of 16 Cases Potentially Mimicking Urothelial Malignancy. Arch Pathol Lab Med 2024; 148:705-714. [PMID: 37948107 DOI: 10.5858/arpa.2022-0469-oa] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/30/2023] [Indexed: 11/12/2023]
Abstract
CONTEXT.— There is limited literature describing gynecologic adenocarcinomas involving the urinary bladder and potential diagnostic pitfalls. OBJECTIVE.— To describe key features distinguishing metastatic (or extension of) gynecologic adenocarcinomas from urothelial carcinomas with glandular differentiation. DESIGN.— Retrospective review of surgical pathology cases of gynecologic adenocarcinomas involving the bladder from 2 different institutions, retrieved from surgical pathology archives, was performed. Morphologic features were recorded, along with immunohistochemistry results when available. Electronic medical records were reviewed for clinical and radiographic information. RESULTS.— Sixteen cases of gynecologic adenocarcinomas (9 endometrial endometrioid adenocarcinomas, 4 endometrial serous carcinomas, 2 high-grade tubo-ovarian serous carcinomas, and 1 cervical adenosquamous carcinoma) involving the bladder were identified. All included cases had mucosal involvement potentially mimicking primary bladder neoplasms, including 4 cases originally diagnosed as urinary carcinomas. Tumors expressed keratin 7 (12 of 13; 92%), PAX8 (11 of 12; 92%), estrogen receptor (11 of 15; 73%), p16 (8 of 11; 73%), progesterone receptor (8 of 14; 57%), GATA3 (5 of 12; 42%), and p63 (3 of 11; 27%); all tumors were negative for keratin 20 (0 of 12). Features supportive of Müllerian origin included prior history of gynecologic malignancy, lack of morphologic heterogeneity in nonendometrioid tumors, and immunophenotypic coexpression of PAX8 and estrogen receptor with absent GATA3. Potential pitfalls seen in a subset of cases included misleading radiologic and cystoscopic findings, replacement of the overlying urothelial mucosa by tumor mimicking precursor lesions, focal GATA3 and/or p63 positivity, and areas of squamous differentiation in tumors of endometrioid histology. CONCLUSIONS.— A combination of clinical history, certain morphologic features, and proper selection of immunohistochemical stains is key for the correct diagnosis of secondary gynecologic adenocarcinomas involving the urinary bladder.
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MESH Headings
- Humans
- Female
- Middle Aged
- Aged
- Diagnosis, Differential
- Retrospective Studies
- Urinary Bladder Neoplasms/pathology
- Urinary Bladder Neoplasms/diagnosis
- Urinary Bladder Neoplasms/metabolism
- Biomarkers, Tumor/analysis
- Biomarkers, Tumor/metabolism
- Adenocarcinoma/diagnosis
- Adenocarcinoma/pathology
- Adenocarcinoma/metabolism
- Immunohistochemistry
- Aged, 80 and over
- Genital Neoplasms, Female/pathology
- Genital Neoplasms, Female/diagnosis
- Genital Neoplasms, Female/metabolism
- Carcinoma, Endometrioid/pathology
- Carcinoma, Endometrioid/diagnosis
- Carcinoma, Endometrioid/metabolism
- Endometrial Neoplasms/pathology
- Endometrial Neoplasms/diagnosis
- Endometrial Neoplasms/metabolism
- PAX8 Transcription Factor/metabolism
- PAX8 Transcription Factor/analysis
- GATA3 Transcription Factor/metabolism
- GATA3 Transcription Factor/analysis
- Adult
- Keratin-7/metabolism
- Receptors, Estrogen/metabolism
- Urinary Bladder/pathology
- Urinary Bladder/metabolism
- Urothelium/pathology
- Urothelium/metabolism
- Ovarian Neoplasms/pathology
- Ovarian Neoplasms/diagnosis
- Ovarian Neoplasms/metabolism
- Receptors, Progesterone/metabolism
- Carcinoma, Adenosquamous/pathology
- Carcinoma, Adenosquamous/diagnosis
- Carcinoma, Adenosquamous/metabolism
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Affiliation(s)
- Daniel H Russell
- From the Departments of Pathology and Laboratory Medicine (Russell, Kryvenko, Jorda, Pinto), Desai Sethi Urology Institute (Kryvenko, Jorda), Department of Radiation Oncology (Kryvenko), Department of Obstetrics, Gynecology, and Reproductive Sciences (Schlumbrecht, Pinto), and Sylvester Comprehensive Cancer Center (Kryvenko, Schlumbrecht, Jorda, Pinto), University of Miami Miller School of Medicine, Miami, Florida
- the Departments of Pathology (Russell, Epstein), Urology (Epstein), and Oncology (Epstein), The Johns Hopkins Medical Institutions, Baltimore, Maryland
| | - Jonathan I Epstein
- From the Departments of Pathology and Laboratory Medicine (Russell, Kryvenko, Jorda, Pinto), Desai Sethi Urology Institute (Kryvenko, Jorda), Department of Radiation Oncology (Kryvenko), Department of Obstetrics, Gynecology, and Reproductive Sciences (Schlumbrecht, Pinto), and Sylvester Comprehensive Cancer Center (Kryvenko, Schlumbrecht, Jorda, Pinto), University of Miami Miller School of Medicine, Miami, Florida
- the Departments of Pathology (Russell, Epstein), Urology (Epstein), and Oncology (Epstein), The Johns Hopkins Medical Institutions, Baltimore, Maryland
| | - Oleksandr N Kryvenko
- From the Departments of Pathology and Laboratory Medicine (Russell, Kryvenko, Jorda, Pinto), Desai Sethi Urology Institute (Kryvenko, Jorda), Department of Radiation Oncology (Kryvenko), Department of Obstetrics, Gynecology, and Reproductive Sciences (Schlumbrecht, Pinto), and Sylvester Comprehensive Cancer Center (Kryvenko, Schlumbrecht, Jorda, Pinto), University of Miami Miller School of Medicine, Miami, Florida
| | - Matthew Schlumbrecht
- From the Departments of Pathology and Laboratory Medicine (Russell, Kryvenko, Jorda, Pinto), Desai Sethi Urology Institute (Kryvenko, Jorda), Department of Radiation Oncology (Kryvenko), Department of Obstetrics, Gynecology, and Reproductive Sciences (Schlumbrecht, Pinto), and Sylvester Comprehensive Cancer Center (Kryvenko, Schlumbrecht, Jorda, Pinto), University of Miami Miller School of Medicine, Miami, Florida
| | - Merce Jorda
- From the Departments of Pathology and Laboratory Medicine (Russell, Kryvenko, Jorda, Pinto), Desai Sethi Urology Institute (Kryvenko, Jorda), Department of Radiation Oncology (Kryvenko), Department of Obstetrics, Gynecology, and Reproductive Sciences (Schlumbrecht, Pinto), and Sylvester Comprehensive Cancer Center (Kryvenko, Schlumbrecht, Jorda, Pinto), University of Miami Miller School of Medicine, Miami, Florida
| | - Andre Pinto
- From the Departments of Pathology and Laboratory Medicine (Russell, Kryvenko, Jorda, Pinto), Desai Sethi Urology Institute (Kryvenko, Jorda), Department of Radiation Oncology (Kryvenko), Department of Obstetrics, Gynecology, and Reproductive Sciences (Schlumbrecht, Pinto), and Sylvester Comprehensive Cancer Center (Kryvenko, Schlumbrecht, Jorda, Pinto), University of Miami Miller School of Medicine, Miami, Florida
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2
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Briski LM, Aron M, Epstein JI, Russell DH, Assarzadegan N, Delma KS, O'Dell H, Rodriguez E, Montgomery EA, Kryvenko ON. Patterns of Immunoreactivity with TTF-1 Antibodies 8G7G3/1 and SPT24 Suggest Distinct Immunoprofiles Between Most Pulmonary and Nonpulmonary Small Cell Carcinomas. Int J Surg Pathol 2024; 32:230-238. [PMID: 37170625 DOI: 10.1177/10668969231171940] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/13/2023]
Abstract
Introduction. Small cell carcinoma can arise from various sites. Herein, we analyze the ability of 2 thyroid transcription factor-1 (TTF-1) antibodies (SPT24 and 8G7G3/1) to separate pulmonary from nonpulmonary small cell carcinoma. Materials and Methods. We analyzed 26 pulmonary and 83 nonpulmonary small cell carcinomas, and 14 Merkel cell carcinomas. Each tumor was stained with SPT24 and 8G7G3/1. Extent of nuclear staining was scored as diffuse (>50%), focal (11%-50%), rare (1%-10%), or negative (<1%). Results. All pulmonary small cell carcinomas were positive for SPT24 and 8G7G3/1. Four Merkel cell carcinomas (29%) were positive for SPT24 (ranging from rare-to-diffuse), while 2 (14%) showed rare expression with 8G7G3/1. For nonpulmonary small cell carcinomas, 69 (83%) were positive for SPT24 and 40 (48%) were positive for 8G7G3/1. For SPT24 positive tumors, the extent of 8G7G3/1 expression was equal in 17 (25%) and less in 52 tumors (75%), including 29 (42%) that were negative for 8G7G3/1. No nonpulmonary small cell carcinoma had more staining with 8G7G3/1 compared to SPT24. The differences in staining between 8G7G3/1 and SPT24 in the nonpulmonary cohort were statistically significant (P < 0.0001) with no significant difference between primary and metastatic lesions for 8G7G3/1 (P = 0.66) or SPT24 (P = 0.77). Conclusion. Most pulmonary small cell carcinomas are diffusely positive for both SPT24 and 8G7G3/1, whereas most nonpulmonary small cell carcinomas exhibit focal-to-no staining with 8G7G3/1 and significantly less staining with 8G7G3/1 compared to SPT24. However, these trends are not absolute and should be interpreted in conjunction with clinical and radiological findings.
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Affiliation(s)
- Laurence M Briski
- Department of Pathology and Laboratory Medicine, University of Miami Hospital, Miami, FL, USA
- Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Manju Aron
- Department of Pathology, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
- Department of Urology, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Jonathan I Epstein
- Department of Pathology, The Johns Hopkins Medical Institutions, Baltimore, MD, USA
- Department of Urology, The Johns Hopkins Medical Institutions, Baltimore, MD, USA
- Department of Oncology, The Johns Hopkins Medical Institutions, Baltimore, MD, USA
| | - Daniel H Russell
- Department of Pathology, The Johns Hopkins Medical Institutions, Baltimore, MD, USA
| | - Naziheh Assarzadegan
- Department of Pathology, The Johns Hopkins Medical Institutions, Baltimore, MD, USA
| | - Katiana S Delma
- Department of Pathology and Laboratory Medicine, University of Miami Hospital, Miami, FL, USA
| | - Henry O'Dell
- Department of Pathology, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Estelamari Rodriguez
- Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, FL, USA
- Department of Oncology, University of Miami Hospital, Miami, FL, USA
| | - Elizabeth A Montgomery
- Department of Pathology and Laboratory Medicine, University of Miami Hospital, Miami, FL, USA
- Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Oleksandr N Kryvenko
- Department of Pathology and Laboratory Medicine, University of Miami Hospital, Miami, FL, USA
- Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, FL, USA
- Desai Sethi Urology Institute, University of Miami Miller School of Medicine, Miami, FL, USA
- Department of Radiation Oncology, University of Miami Hospital, Miami, FL, USA
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3
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Lew M. An Approach to Nonurothelial Malignancies of the Urinary Bladder in Urine Cytology. Adv Anat Pathol 2022; 29:412-422. [PMID: 35687328 DOI: 10.1097/pap.0000000000000352] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Urine cytology is an economical and convenient method of triaging patients who present with urinary symptoms as well as surveying those who have previously been diagnosed with urothelial carcinoma for recurrent or persistent disease. While the vast majority of malignancies diagnosed in urine cytology are urothelial carcinomas, it is important to recognize nonurothelial elements to inform patient prognosis and raise the possibility of involvement by a urothelial carcinoma variant, nonurothelial malignancy of the bladder, or a nonbladder primary, which may alter patient management pathways. As such, becoming familiar with morphologic features of nonurothelial malignancies in urine cytology as well as their related clinical risk factors, radiologic and cystoscopic features, differential diagnostic considerations, and the utility and pitfalls of ancillary tests can facilitate optimal patient care.
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Affiliation(s)
- Madelyn Lew
- Department of Pathology, University of Michigan Hospital and Health System, Ann Arbor, MI
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Insulinoma-associated Protein 1 (INSM1) Expression in Small Cell Neuroendocrine Carcinoma of the Urinary Tract. Appl Immunohistochem Mol Morphol 2021; 28:687-693. [PMID: 31876605 DOI: 10.1097/pai.0000000000000824] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Clinical guidelines state that neoadjuvant chemotherapy should be administered before surgery in muscle invasive urinary bladder small cell neuroendocrine carcinoma. Recently described marker insulinoma-associated protein 1 (INSM1) has been reported to be sensitive and specific for neuroendocrine differentiation, however, its efficacy in urinary tract small cell carcinoma is not well established. This study examines immunohistochemical expression of INSM1 on whole tissue sections of urinary tract small cell neuroendocrine carcinoma and compares INSM1 expression with established neuroendocrine markers. Immunohistochemical stains for CD56, INSM1, synaptophysin, and chromogranin were performed on 32 cases of small cell neuroendocrine carcinoma of the bladder. Staining was scored for intensity (0: no staining; 1: weak; 2: moderate; 3: strong) and proportion of cells stained (0: 0%; 1: >0% to ≤25%; 2: >25% to ≤50%; 3: >50% to ≤75%; 4: >75% to 100%). INSM1 was positive (intensity 1 to 3 or proportion 1 to 4) in 87% (28/32) of cases (20 with intensity 2 to 3, 17 with proportion 3 to 4). CD56, synaptophysin, and chromogranin were positive in 75% (24/32), 60% (19/32), and 44% (14/32) of cases, respectively. INSM1 was negative (n=4) or only showed weak intensity staining (n=7) in 34% (11/32) of cases. INSM1 is a sensitive marker of small cell neuroendocrine differentiation of the urinary tract. However, this study suggests that optimal utilization of INSM1 would be inclusion in a limited panel of stains rather than as a stand-alone screening marker given that it is negative or only shows weak intensity staining in a significant proportion of cases.
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5
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Shehabeldin AN, Ro JY. Neuroendocrine tumors of genitourinary tract: Recent advances. Ann Diagn Pathol 2019; 42:48-58. [DOI: 10.1016/j.anndiagpath.2019.06.009] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2019] [Accepted: 06/15/2019] [Indexed: 01/25/2023]
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6
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Chang N, Lee HW, Lim JE, Jeong DE, Song HJ, Kim S, Nam DH, Sung HH, Jeong BC, Seo SI, Jeon SS, Lee HM, Choi HY, Jeon HG. Establishment and antitumor effects of dasatinib and PKI-587 in BD-138T, a patient-derived muscle invasive bladder cancer preclinical platform with concomitant EGFR amplification and PTEN deletion. Oncotarget 2018; 7:51626-51639. [PMID: 27438149 PMCID: PMC5239502 DOI: 10.18632/oncotarget.10539] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2016] [Accepted: 06/29/2016] [Indexed: 11/25/2022] Open
Abstract
Muscle-invasive bladder cancer (MIBC) consists of a heterogeneous group of tumors with a high rate of metastasis and mortality. To facilitate the in-depth investigation and validation of tailored strategies for MIBC treatment, we have developed an integrated approach using advanced high-throughput drug screening and a clinically relevant patient-derived preclinical platform. We isolated patient-derived tumor cells (PDCs) from a rare MIBC case (BD-138T) that harbors concomitant epidermal growth factor receptor (EGFR) amplification and phosphatase and tensin homolog (PTEN) deletion. High-throughput in vitro drug screening demonstrated that dasatinib, a SRC inhibitor, and PKI-587, a dual PI3K/mTOR inhibitor, exhibited targeted anti-proliferative and pro-apoptotic effects against BD-138T PDCs. Using established patient-derived xenograft models that successfully retain the genomic and molecular characteristics of the parental tumor, we confirmed that these anti-tumor responses occurred through the inhibition of SRC and PI3K/AKT/mTOR signaling pathways. Taken together, these experimental results demonstrate that dasatinib and PKI-587 might serve as promising anticancer drug candidates for treating MIBC with combined EGFR gene amplification and PTEN deletion.
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Affiliation(s)
- Nakho Chang
- Department of Health Sciences and Technology, SAIHST, Sungkyunkwan University, Seoul 06351, Korea.,Department of Neurosurgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Korea.,Institute for Refractory Cancer Research, Samsung Medical Center, Seoul 06351, Korea
| | - Hye Won Lee
- Institute for Refractory Cancer Research, Samsung Medical Center, Seoul 06351, Korea.,Institute for Future Medicine, Samsung Medical Center, Seoul 06351, Korea
| | - Joung Eun Lim
- Department of Urology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Korea
| | - Da Eun Jeong
- Department of Health Sciences and Technology, SAIHST, Sungkyunkwan University, Seoul 06351, Korea
| | - Hye Jin Song
- Department of Anatomy and Cell Biology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Korea
| | - Sudong Kim
- Institute for Refractory Cancer Research, Samsung Medical Center, Seoul 06351, Korea.,Samsung Advanced Institute of Technology, Samsung Electronics Co., Ltd., Seoul 06351, Korea
| | - Do-Hyun Nam
- Department of Health Sciences and Technology, SAIHST, Sungkyunkwan University, Seoul 06351, Korea.,Department of Neurosurgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Korea.,Institute for Refractory Cancer Research, Samsung Medical Center, Seoul 06351, Korea
| | - Hyun Hwan Sung
- Department of Urology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Korea
| | - Byong Chang Jeong
- Department of Urology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Korea
| | - Seong Il Seo
- Department of Urology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Korea
| | - Seong Soo Jeon
- Department of Urology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Korea
| | - Hyun Moo Lee
- Department of Urology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Korea
| | - Han-Yong Choi
- Department of Urology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Korea
| | - Hwang Gyun Jeon
- Department of Urology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Korea
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7
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Sjödahl G, Eriksson P, Liedberg F, Höglund M. Molecular classification of urothelial carcinoma: global mRNA classification versus tumour-cell phenotype classification. J Pathol 2017; 242:113-125. [PMID: 28195647 PMCID: PMC5413843 DOI: 10.1002/path.4886] [Citation(s) in RCA: 233] [Impact Index Per Article: 33.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2016] [Revised: 01/12/2017] [Accepted: 02/07/2017] [Indexed: 12/17/2022]
Abstract
Global mRNA expression analysis is efficient for phenotypic profiling of tumours, and has been used to define molecular subtypes for almost every major tumour type. A key limitation is that most tumours are communities of both tumour and non‐tumour cells. This problem is particularly pertinent for analysis of advanced invasive tumours, which are known to induce major changes and responses in both the tumour and the surrounding tissue. To identify bladder cancer tumour‐cell phenotypes and compare classification by tumour‐cell phenotype with classification by global gene expression analysis, we analysed 307 advanced bladder cancers (cystectomized) both by genome gene expression analysis and by immunohistochemistry with antibodies for 28 proteins. According to systematic analysis of gene and protein expression data, focusing on key molecular processes, we describe five tumour‐cell phenotypes of advanced urothelial carcinoma: urothelial‐like, genomically unstable, basal/SCC‐like, mesenchymal‐like, and small‐cell/neuroendocrine‐like. We provide molecular pathological definitions for each subtype. Tumours expressing urothelial differentiation factors show inconsistent and abnormal protein expression of terminal differentiation markers, suggesting pseudo‐differentiation. Cancers with different tumour‐cell phenotypes may co‐cluster (converge), and cases with identical tumour‐cell phenotypes may cluster apart (diverge), in global mRNA analyses. This divergence/convergence suggests that broad global commonalities related to the invasive process may exist between muscle‐invasive tumours regardless of specific tumour‐cell phenotype. Hence, there is a systematic disagreement in subtype classification determined by global mRNA profiling and by immunohistochemical profiling at the tumour‐cell level. We suggest that a combination of molecular pathology (tumour‐cell phenotype) and global mRNA profiling (context) is required for adequate subtype classification of muscle‐invasive bladder cancer. © 2017 The Authors. The Journal of Pathology published by John Wiley & Sons Ltd on behalf of Pathological Society of Great Britain and Ireland.
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Affiliation(s)
- Gottfrid Sjödahl
- Division of Urological Research, Department of Translational Medicine, Lund University, Skåne University Hospital, Malmö, Sweden
| | - Pontus Eriksson
- Division of Oncology and Pathology, Department of Clinical Sciences, Lund University, Lund, Sweden
| | - Fredrik Liedberg
- Division of Urological Research, Department of Translational Medicine, Lund University, Skåne University Hospital, Malmö, Sweden
| | - Mattias Höglund
- Division of Oncology and Pathology, Department of Clinical Sciences, Lund University, Lund, Sweden
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Mai KT, Truong LD, Ball CG, Olberg B, Lai CK, Purgina B. Lymphatic endothelial cancerization in papillary thyroid carcinoma: hidden evidence of lymphatic invasion. Pathol Int 2015; 65:220-30. [PMID: 25722068 DOI: 10.1111/pin.12272] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2014] [Accepted: 01/14/2015] [Indexed: 01/01/2023]
Abstract
We hypothesize that cystic structures in metastatic papillary thyroid carcinoma (PTC) develop along the framework of lymphatic channels. To investigate this phenomenon, different categories of PTC were immunostained for D2-40 and TTF1. In this study, reactivity for D2-40 was considered as positive when there is membranous staining as often seen in lymphatic endothelial cells. Thirty cases of PTC with lymph node metastasis or with potential for lymphatic invasion and 20 cases metastatic PTC in lymph nodes were reviewed and found to show double/mosaic immunoreactivity for TTF1/D2-40 in 40-100% of cases. PTC metastasis in lymph nodes with cysts and some branching lymphatic-like channels lined by follicular cells with or without nuclear features of PTC were diffusely reactive to TTF1, and focally to D2-40. For primary and metastatic PTC, focal membranous D2-40 reactivity was also demonstrated in cysts or cleft linings. For25 thyroid neoplasms with no known potential for lymphatic invasion, there was no such immunoreactivity. The mosaic or double immunoreactivity for TTF1/D2-40 suggests lymphatic cancerization and possible endothelial mimicry of follicular cells. Mosaic/double immunoreactivity is helpful to detect the hidden pattern of lymphatic invasion masquerading as 'benign-appearing' follicles and supports our hypothesis of malignant cells developing along the lymphatic framework.
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Affiliation(s)
- Kien T Mai
- Department of Anatomical Pathology, The Ottawa Hospital and University of Ottawa, Ottawa, Ontario, Canada
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Bezerra SM, Lotan TL, Faraj SF, Karram S, Sharma R, Schoenberg M, Bivalacqua TJ, Netto GJ. GATA3 expression in small cell carcinoma of bladder and prostate and its potential role in determining primary tumor origin. Hum Pathol 2014; 45:1682-7. [DOI: 10.1016/j.humpath.2014.04.011] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2014] [Revised: 04/04/2014] [Accepted: 04/09/2014] [Indexed: 11/15/2022]
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10
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Paner GP, Annaiah C, Gulmann C, Rao P, Ro JY, Hansel DE, Shen SS, Lopez-Beltran A, Aron M, Luthringer DJ, De Peralta-Venturina M, Cho Y, Amin MB. Immunohistochemical evaluation of novel and traditional markers associated with urothelial differentiation in a spectrum of variants of urothelial carcinoma of the urinary bladder. Hum Pathol 2014; 45:1473-82. [PMID: 24780825 DOI: 10.1016/j.humpath.2014.02.024] [Citation(s) in RCA: 86] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2013] [Revised: 02/24/2014] [Accepted: 02/28/2014] [Indexed: 02/03/2023]
Abstract
Data on immunohistochemical expression of novel and traditional urothelial markers in the wide range of urothelial carcinoma variants have so far been very limited. In this study, whole tissue sections from 130 bladder urothelial carcinoma and variants were stained with a panel of novel and traditional immunomarkers supportive of urothelial lineage. The positivity rates were as follows: (a) urothelial carcinomas with or without divergent differentiation: GATA3 (50%), S-100P (86%), uroplakin III (20%), thrombomodulin (40%), cytokeratin 7 (CK7) (80%), CK20 (55%), p63 (87%), and high molecular weight cytokeratin (HMCK) (89%); (b) urothelial carcinoma variants (micropapillary, plasmacytoid, nested, clear cell, and microcystic): GATA3 (88%), S-100P (96%), uroplakin III (33%), thrombomodulin (49%), CK7 (95%), CK20 (61%), p63 (69%), and HMCK (96%); and (c) undifferentiated carcinomas (lymphoepithelioma-like carcinoma, small cell carcinoma, sarcomatoid carcinoma and carcinoma with rhabdoid and giant cells): GATA3 (28%), S-100P (31%), uroplakin III (0%), thrombomodulin (22%), CK7 (50%), CK20 (3%), p63 (50%), and HMCK (49%). In urothelial carcinoma with squamous differentiation, GATA3 expression was lower (20%) in contrast to p63 and S-100P. In urothelial carcinoma with glandular differentiation, GATA3 (50%) and p63 (60%) expression was lower than S-100P (100%). p63 expression was relatively lower in micropapillary (54%) and plasmacytoid (50%) variants compared with the other urothelial carcinoma variants. This study provides comprehensive data for novel and traditionally used markers to support urothelial lineage in urothelial carcinoma variants. Our findings show that GATA3, S-100P, CK7, CK20, HMCK, and p63, in the appropriate differential diagnostic setting, are useful to support urothelial lineage of variant morphologies.
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Affiliation(s)
- Gladell P Paner
- Departments of Pathology and Surgery, Section of Urology, University of Chicago, Chicago, IL 60637, USA
| | - Chandrakanth Annaiah
- Pathology and Laboratory Medicine, Cedars-Sinai Medical Center, Los Angeles, CA 90048, USA
| | - Christian Gulmann
- Pathology and Laboratory Medicine, Cedars-Sinai Medical Center, Los Angeles, CA 90048, USA; Department of Pathology, Beaumont Hospital, Dublin, Ireland
| | - Priya Rao
- Department of Pathology, MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Jae Y Ro
- Department of Pathology and Genomic Medicine, The Methodist Hospital, Houston, TX 77030, USA
| | - Donna E Hansel
- Department of Pathology, University of California at San Diego, La Jolla, CA 92093, USA
| | - Steven S Shen
- Department of Pathology and Genomic Medicine, The Methodist Hospital, Houston, TX 77030, USA
| | | | - Manju Aron
- Pathology and Laboratory Medicine, Cedars-Sinai Medical Center, Los Angeles, CA 90048, USA
| | - Daniel J Luthringer
- Pathology and Laboratory Medicine, Cedars-Sinai Medical Center, Los Angeles, CA 90048, USA
| | | | - Yong Cho
- University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Mahul B Amin
- Pathology and Laboratory Medicine, Cedars-Sinai Medical Center, Los Angeles, CA 90048, USA.
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12
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Small cell carcinoma of the urinary bladder: a rare tumor with propensity for hepatic involvement. Am J Med Sci 2012; 345:155-7. [PMID: 22986616 DOI: 10.1097/maj.0b013e3182648759] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Small cell (neuroendocrine) carcinoma of the bladder is a rare entity, accounting for less than 1% of all bladder tumors. The authors report 2 new cases of the disease, both presenting with liver metastasis. In the first case, small cell carcinoma occurred in an 85-year-old woman as tumor recurrence of previous micropapillary carcinoma and urothelial carcinoma in situ, illustrating the common coexistence with conventional urothelial carcinoma. In the second case of a 58-year-old man, non-small cell tumor components were not observed. Accurate diagnosis of small cell carcinoma may be challenging. A panel of different antibodies, including neuron-specific enolase, chromogranin A, synaptophysin and CD56 (neural cell adhesion molecule) is recommended. In conclusion, small cell carcinoma represents a rare and aggressive form of bladder malignancy. As illustrated by the 2 cases and according to the literature review, the tumor shows a so far underrecognized propensity for hepatic involvement.
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