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Akbas P, Bektas S, Yazici G. The association between variant histology and prognostic, histomorphological and clinical aspects of bladder urothelial carcinoma. Ann Diagn Pathol 2024; 73:152373. [PMID: 39182466 DOI: 10.1016/j.anndiagpath.2024.152373] [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: 06/01/2024] [Revised: 08/12/2024] [Accepted: 08/19/2024] [Indexed: 08/27/2024]
Abstract
This study underscores the imperative consideration of histological subtypes and divergent differentiation in accurately estimating bladder urothelial carcinoma prognosis and guiding treatment decisions. A comparative analysis was conducted, examining clinical, histological, and prognostic factors between conventional urothelial carcinoma and urothelial carcinoma with variant histology in a clinical sample. A retrospective analysis of slides and other clinicopathologic data was conducted these cases, with an emphasis on key diagnostic elements. We examined 829 cases of urothelial carcinoma of the bladder, comprising of 744 transurethral resection (TUR) and 85 radical cystectomy (RS) specimens, an analysis that showed that 80.5 % (667 cases) were conventional urothelial carcinoma (CUC) and that 19.5 % (162 cases) exhibited variant histology (hereafter "urothelial carcinoma with subtype histology" [UCSH]). TNM classifications for the RS cases were as follows: 2 cases were stage group 0a, 11 stage group 1, 16 stage group 2, 45 stage group 3a, 2 stage group 3b, 1 stage group 4a, and 8 stage group 4b. Only 2 of the RS cases were found to be non-invasive. Among 744 TUR specimens, 387 were found to have a non-invasive tumor whereas 357 had invasive tumors. The most prevalent subtype in the UCSH group was urothelial carcinoma with squamous differentiation, accounting for 54.3 % (88 cases). Notably, 8.02 % (13 cases) exhibited more than one histological subtype. Papillary configuration, histological grade, lamina propria, muscularis mucosa and serosa invasion, lymphovascular invasion, presence of urothelial carcinoma in situ, and overall survival significantly differed between the UCSH and CUC groups (p < 0.05). However, mean age, gender, tumor size, lymphocytic response, disease-free survival, and survival status did not differ significantly (p > 0.05). Among the UCSH group, lower levels of papillary configuration, higher histological grade, higher degree of lamina propria, muscularis mucosa and serosa invasion, and the presence of carcinoma in situ corresponded to higher percentage of histological subtype morphology (p < 0.05). No significant difference in survival status was observed between the groups with and without subtype histology (p = 0.083). This study found that clinical and histopathological prognostic factors associated with a more aggressive disease were linked to the presence and percentage of histological subtypes. Recognizing histological subtype is crucial for treatment decisions and prognosis prediction in urothelial carcinoma cases with these subtypes.
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Affiliation(s)
- Pelin Akbas
- Pathology, Gaziosmanpasa Research and Training Hospital, University of Health Sciences, Istanbul, Turkey.
| | - Sibel Bektas
- Pathology, Gaziosmanpasa Research and Training Hospital, University of Health Sciences, Istanbul, Turkey
| | - Gokhan Yazici
- Urology, Arnavutkoy State Hospital, Republic of Turkey Ministry of Health, Istanbul, Turkey
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Zheng L, Chen H, Zhao J, Roy-Chowdhuri S, Kamat AM, Alhalabi O, Gao J, Siefker-Radtke A, Hansel DE, Czerniak B, Guo CC. Plasmacytoid urothelial carcinoma of the urinary bladder-A clinicopathological and molecular analysis of 52 cases. Hum Pathol 2024; 148:1-6. [PMID: 38679207 DOI: 10.1016/j.humpath.2024.04.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2024] [Revised: 04/20/2024] [Accepted: 04/22/2024] [Indexed: 05/01/2024]
Abstract
Plasmacytoid urothelial carcinoma (UC) is a rare histologic subtype of bladder cancer that is associated with an aggressive clinical behavior. We analyzed the clinicopathologic and molecular features of plasmacytoid UC in 52 patients from a single institute. The patients included 44 men and 8 women, with a mean age of 64 years (range, 41-91 years). All bladder cancers were high-grade UC, and plasmacytoid component accounted for a mean of 47% of bladder tumors (range, 5-100%). Distinct gene mutations were found in most plasmacytoid UCs (n = 49); the most common mutations were TP53 (n = 30), followed by TERT (n = 20), and CDH1 (n = 18). Copy number analysis was performed in 34 patients, and 13 of them showed copy number variations. Expression of HER2 was analyzed in 18 patients by immunohistochemistry, and 3 of them showed HER2 overexpression, which was confirmed by fluorescence in situ hybridization analysis. Thirty-two patients died of disease in a median of 15 months (range, 1-45 months). No individual gene mutations were significantly associated with clinical outcome, but mutations in the mammalian target of rapamycin (mTOR) pathway, including PICK3CA and PIK3R1 mutations, were associated with a significantly shorter survival duration (p < 0.05). Plasmacytoid UC is an aggressive histologic subtype that demonstrates frequent somatic gene mutations and CNVs, which may underlie its oncogenesis and progression. Gene mutations of the mTOR pathway are associated with poor outcome in a subset of patients with plasmacytoid UC.
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Affiliation(s)
- Lan Zheng
- The University of Texas MD Anderson Cancer Center, Department of Pathology, Houston, TX, USA
| | - Hui Chen
- The University of Texas MD Anderson Cancer Center, Department of Pathology, Houston, TX, USA
| | - Jianping Zhao
- The University of Texas MD Anderson Cancer Center, Department of Pathology, Houston, TX, USA
| | - Sinchita Roy-Chowdhuri
- The University of Texas MD Anderson Cancer Center, Department of Pathology, Houston, TX, USA
| | - Ashish M Kamat
- The University of Texas MD Anderson Cancer Center, Department of Urology, Houston, TX, USA
| | - Omar Alhalabi
- The University of Texas MD Anderson Cancer Center, Department of Genitourinary Medical Oncology, Houston, TX, USA
| | - Jianjun Gao
- The University of Texas MD Anderson Cancer Center, Department of Genitourinary Medical Oncology, Houston, TX, USA
| | - Arlene Siefker-Radtke
- The University of Texas MD Anderson Cancer Center, Department of Genitourinary Medical Oncology, Houston, TX, USA
| | - Donna E Hansel
- The University of Texas MD Anderson Cancer Center, Department of Pathology, Houston, TX, USA
| | - Bogdan Czerniak
- The University of Texas MD Anderson Cancer Center, Department of Pathology, Houston, TX, USA
| | - Charles C Guo
- The University of Texas MD Anderson Cancer Center, Department of Pathology, Houston, TX, USA.
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Kim JM, Choi E, Sung SH, Jo J, Lee DH, Park S. Does Bladder Cancer Subtype Influence Pathologic Complete Response (pCR) and Pelvic Diffusion-Weighted Magnetic Resonance Imaging (DW-MRI) Response Evaluation After Neoadjuvant Chemotherapy? Pathological Perspective. Clin Genitourin Cancer 2024; 22:224-236. [PMID: 38042728 DOI: 10.1016/j.clgc.2023.11.003] [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] [Received: 09/20/2023] [Revised: 11/04/2023] [Accepted: 11/04/2023] [Indexed: 12/04/2023]
Abstract
INTRODUCTION We aimed to provide a pathological perspective on the management of muscle-invasive bladder cancer (MIBC) by correlating the prechemotherapy transurethral resection of bladder tumor findings and postchemotherapy radiologic evaluation with final radical cystectomy (RC) findings. MATERIALS AND METHODS This retrospective study included 79 MIBC patients treated with neoadjuvant chemotherapy (NAC) and RC. Pelvic diffusion-weighted magnetic resonance imaging (DW-MRI) and pathologic reports were retrieved from our institutional database. All pathology slides were reviewed based on diagnostic criteria with high interobserver reproducibility. RESULTS Pathologic complete response (pCR) was confirmed in 32 patients (40.5%). The concordance and discordance between MRI and RC findings occurred in 68.3% and 31.7% of cases, respectively. The 21.5% of cases that were clinical CR (cCR) on MRI actually achieved pCR on RC specimens and 46.8% of cases that were non-cCR on MRI were actually non-pCR on RC specimens. In 19.0% of cases, RC findings were pCR, but MRI demonstrated residual tumor and the opposite was 12.7%. The greatest discrepancy between the 2 methods (75%, 3/4) was for the plasmacytoid subtype. Plasmacytoid histology was the most common histological subtype identified in RC specimens after NAC, followed by micropapillary and squamous histologies. CONCLUSIONS We found that all cases with plasmacytoid and micropapillary subtypes, and squamous differentiation did not show pCR. In particular, the largest discrepancy between MRI findings and RC pathology after NAC was seen in the plasmacytoid subtype. An accurate pathologic diagnosis based on strict criteria to identify histological subtypes of MIBC is necessary for proper treatment.
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Affiliation(s)
- Ji Min Kim
- Department of Pathology, Ewha Womans University Mokdong Hospital, Ewha Womans University College of Medicine, Yangcheon-Gu, Seoul, Republic of Korea
| | - Euno Choi
- Department of Pathology, Ewha Womans University Mokdong Hospital, Ewha Womans University College of Medicine, Yangcheon-Gu, Seoul, Republic of Korea
| | - Sun Hee Sung
- Department of Pathology, Ewha Womans University Mokdong Hospital, Ewha Womans University College of Medicine, Yangcheon-Gu, Seoul, Republic of Korea
| | - Jungmin Jo
- Division of Hematology-Oncology, Department of Internal Medicine, Ewha Womans University Mokdong Hospital, Seoul, Republic of Korea
| | - Dong-Hyeon Lee
- Department of Urology, Ewha Womans University Medical Center, Ewha Womans University School of Medicine, Seoul, Republic of Korea
| | - Sanghui Park
- Department of Pathology, Ewha Womans University Mokdong Hospital, Ewha Womans University College of Medicine, Yangcheon-Gu, Seoul, Republic of Korea.
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Arshia A, Hassan FA, Hensley PJ, Allison DB. Urinary tract cytology showing variant morphology and divergent differentiation. Cytopathology 2024; 35:199-212. [PMID: 37919868 DOI: 10.1111/cyt.13322] [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] [Received: 07/31/2023] [Revised: 10/08/2023] [Accepted: 10/13/2023] [Indexed: 11/04/2023]
Abstract
Urothelial carcinoma represents a diverse group of tumours with distinct histologic subtypes, each exhibiting unique cytomorphologic features, architectural growth patterns, and/or well-developed aberrant differentiation. In fact, there are more than 13 subtypes of urothelial carcinoma recognized in the 2022 WHO classification of tumours in the urinary tract. The identification of these subtypes is crucial for an accurate diagnosis of urothelial carcinoma, and many have important clinical implications. Variant/divergent features may coexist with conventional high-grade urothelial carcinoma (HGUC) or present with 100% variant morphology. In urinary tract cytology (UTC), urothelial carcinoma can display divergent differentiation, such as squamous, glandular, or small cell carcinoma differentiation. The use of cell block preparations and immunohistochemistry with available residual urine can enhance diagnostic accuracy. On the other hand, identifying urothelial carcinoma variants, including nested, micropapillary, and plasmacytoid subtypes, poses significant challenges in UTC. Many cases of these variants are only detected retrospectively after variant histology has been established from resection specimens. Moreover, some variants exhibit features inconsistent with the diagnostic criteria for HGUC according to the Paris System for Reporting Urinary Tract Cytology. Nevertheless, the rarity of pure variant morphology and the occurrence of some false negatives for these variant cases are essential to maintain the specificity of UTC overall. This review covers the histology, cytomorphology, and important clinical aspects observed in urothelial carcinoma exhibiting divergent differentiation and various urothelial carcinoma variants detected in UTC.
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Affiliation(s)
- Asma Arshia
- Department of Pathology and Laboratory Medicine, University of Kentucky College of Medicine, Lexington, Kentucky, USA
| | - Faisal A Hassan
- Department of Pathology and Laboratory Medicine, University of Kentucky College of Medicine, Lexington, Kentucky, USA
| | - Patrick J Hensley
- Markey Cancer Center, Lexington, Kentucky, USA
- Department of Urology, University of Kentucky College of Medicine, Lexington, Kentucky, USA
| | - Derek B Allison
- Department of Pathology and Laboratory Medicine, University of Kentucky College of Medicine, Lexington, Kentucky, USA
- Markey Cancer Center, Lexington, Kentucky, USA
- Department of Urology, University of Kentucky College of Medicine, Lexington, Kentucky, USA
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Paner GP, Kamat A, Netto GJ, Samaratunga H, Varma M, Bubendorf L, van der Kwast TH, Cheng L. International Society of Urological Pathology (ISUP) Consensus Conference on Current Issues in Bladder Cancer. Working Group 2: Grading of Mixed Grade, Invasive Urothelial Carcinoma Including Histologic Subtypes and Divergent Differentiations, and Non-Urothelial Carcinomas. Am J Surg Pathol 2024; 48:e11-e23. [PMID: 37382156 DOI: 10.1097/pas.0000000000002077] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/30/2023]
Abstract
The 2022 International Society of Urological Pathology (ISUP) Consensus Conference on Urinary Bladder Cancer Working Group 2 was tasked to provide evidence-based proposals on the applications of grading in noninvasive urothelial carcinoma with mixed grades, invasive urothelial carcinoma including subtypes (variants) and divergent differentiations, and in pure non-urothelial carcinomas. Studies suggested that predominantly low-grade noninvasive papillary urothelial carcinoma with focal high-grade component has intermediate outcome between low- and high-grade tumors. However, no consensus was reached on how to define a focal high-grade component. By 2004 WHO grading, the vast majority of lamina propria-invasive (T1) urothelial carcinomas are high-grade, and the rare invasive low-grade tumors show only limited superficial invasion. While by 1973 WHO grading, the vast majority of T1 urothelial carcinomas are G2 and G3 and show significant differences in outcome based on tumor grade. No consensus was reached if T1 tumors should be graded either by the 2004 WHO system or by the 1973 WHO system. Because of the concern for underdiagnosis and underreporting with potential undertreatment, participants unanimously recommended that the presence of urothelial carcinoma subtypes and divergent differentiations should be reported. There was consensus that the extent of these subtypes and divergent differentiations should also be documented in biopsy, transurethral resection, and cystectomy specimens. Any distinct subtype and divergent differentiation should be diagnosed without a threshold cutoff, and each type should be enumerated in tumors with combined morphologies. The participants agreed that all subtypes and divergent differentiations should be considered high-grade according to the 2004 WHO grading system. However, participants strongly acknowledged that subtypes and divergent differentiations should not be considered as a homogenous group in terms of behavior. Thus, future studies should focus on individual subtypes and divergent differentiations rather than lumping these different entities into a single clinicopathological group. Likewise, clinical recommendations should pay attention to the potential heterogeneity of subtypes and divergent differentiations in terms of behavior and response to therapy. There was consensus that invasive pure squamous cell carcinoma and pure adenocarcinoma of the bladder should be graded according to the degree of differentiation. In conclusion, this summary of the International Society of Urological Pathology Working Group 2 proceedings addresses some of the issues on grading beyond its traditional application, including for papillary urothelial carcinomas with mixed grades and with invasive components. Reporting of subtypes and divergent differentiation is also addressed in detail, acknowledging their role in risk stratification. This report could serve as a guide for best practices and may advise future research and proposals on the prognostication of these tumors.
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Affiliation(s)
- Gladell P Paner
- Departments of Pathology and Surgery (Urology), University of Chicago, Chicago, IL
| | - Ashish Kamat
- Department of Urology, University of Texas MD Anderson Cancer Center, Houston, TX
| | - George J Netto
- Heersink School of Medicine, The University of Alabama at Birmingham, Birmingham, AL
| | - Hemamali Samaratunga
- Aquesta Uropathology, Brisbane, Queensland, Australia; University of Queensland, Brisbane, Queensland, Australia
| | - Murali Varma
- Department of Cellular Pathology, University Hospital of Wales, Cardiff, Wales, UK
| | - Lukas Bubendorf
- Institute of Medical Genetics and Pathology, University Hospital Basel, Basel, Switzerland
| | - Theodorus H van der Kwast
- Department of Pathology, Laboratory Medicine Program, University Health Network, Toronto, ON, Canada
| | - Liang Cheng
- Department of Pathology and Laboratory Medicine, Brown University Warren Alpert Medical School; Lifespan Academic Medical Center, and the Legorreta Cancer Center at Brown University, Providence, RI
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6
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Weiss K, Gessner KH, Demzik A, Moreton E, Kim WY, Wobker SE, Rose TL, Milowsky MI, Bjurlin MA. Molecular characterization of plasmacytoid urothelial carcinoma and the impact on treatment implications. Cancer Treat Res Commun 2023; 37:100779. [PMID: 37988935 PMCID: PMC11315140 DOI: 10.1016/j.ctarc.2023.100779] [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: 02/28/2023] [Revised: 11/10/2023] [Accepted: 11/11/2023] [Indexed: 11/23/2023]
Abstract
Bladder cancer researchers and clinicians have increasingly viewed tumor biology through the lens of genomic and molecular alterations, drastically improving our knowledge of the underlying disease biology. This understanding has led to significant advances in treatment options that allow implementation of a personalized approach to cancer treatment. Large-scale genomic studies initially focused on the most common forms of bladder cancer. However, as genomic and molecular technologies become more widespread and are applied to less common variant histologies, we are gaining additional insight into the unique molecular and genomic characteristics driving the biology of variant histologies of bladder cancer. In this review, we summarize the current state of knowledge of molecular alterations underlying the distinct tumor biology of plasmacytoid urothelial carcinoma and how these alterations may impact treatment options.
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Affiliation(s)
- Kristin Weiss
- University of North Carolina School of Medicine, Chapel Hill, NC, USA
| | - Kathryn H Gessner
- University of North Carolina Department of Urology, Chapel Hill, NC, USA
| | - Alysen Demzik
- University of North Carolina Department of Urology, Chapel Hill, NC, USA
| | | | - William Y Kim
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, NC, USA; Department of Pharmacology, University of North Carolina at Chapel Hill, NC, USA; Division of Hematology/Oncology, Department of Medicine, University of North Carolina at Chapel Hill, NC, USA; Department of Genetics, University of North Carolina at Chapel Hill, NC, USA
| | - Sara E Wobker
- University of North Carolina Department of Urology, Chapel Hill, NC, USA; Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, NC, USA; Department of Pathology and Laboratory Medicine, University of North Carolina at Chapel Hill, NC, USA
| | - Tracy L Rose
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, NC, USA; Division of Hematology/Oncology, Department of Medicine, University of North Carolina at Chapel Hill, NC, USA
| | - Matthew I Milowsky
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, NC, USA; Division of Hematology/Oncology, Department of Medicine, University of North Carolina at Chapel Hill, NC, USA
| | - Marc A Bjurlin
- University of North Carolina Department of Urology, Chapel Hill, NC, USA; Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, NC, USA.
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7
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Yoo D, Min KW, Pyo JS, Kim NY. Diagnostic and Prognostic Roles of GATA3 Immunohistochemistry in Urothelial Carcinoma. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:1452. [PMID: 37629741 PMCID: PMC10456966 DOI: 10.3390/medicina59081452] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/16/2023] [Revised: 08/10/2023] [Accepted: 08/10/2023] [Indexed: 08/27/2023]
Abstract
This study aimed to evaluate the diagnostic and prognostic roles of GATA-binding protein 3 (GATA3) immunohistochemistry in urothelial carcinoma (UC) using a meta-analysis. We investigated GATA3 immunohistochemical expression rates and performed a subgroup analysis based on tumor site, study location, and histological subtypes. The overall survival rates of patients with GATA3-positive and -negative UC were compared. The estimated GATA3 expression rate was 0.748 (95% confidence interval [CI]: 0.704-0.787). GATA3 expression rates in the urinary bladder and urinary tract were 0.775 (95% CI: 0.727-0.818) and 0.614 (95% CI: 0.426-0.774), respectively. The GATA3 expression rates of noninvasive and invasive UCs were 0.965 (95% CI: 0.938-0.980) and 0.644 (95% CI: 0.581-0.702), respectively. In invasive UCs, there was a significant difference in GATA3 expression between non-muscular invasion and muscular invasion subgroups (0.937, 95% CI: 0.883-0.967 vs. 0.753, 95% CI: 0.645-0.836). GATA3 expression was the highest in the microcytic subtype among the histologic subtypes (0.952, 95% CI: 0.724-0.993). There was a significant correlation between GATA3 expression and better prognosis (hazard ratio: 0.402, 95% CI: 0.311-0.521). Taken together, GATA3 expression significantly correlated with low-stage and better prognosis in UC. GATA3 expression is highly variable across histological subtypes, and one should be careful while interpreting GATA3 expression.
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Affiliation(s)
- Daeseon Yoo
- Department of Urology, Daejeon Eulji University Hospital, Eulji University School of Medicine, Daejeon 35233, Republic of Korea;
| | - Kyueng-Whan Min
- Department of Pathology, Uijeongbu Eulji Medical Center, Eulji University School of Medicine, Uijeongbu-si 11759, Republic of Korea;
| | - Jung-Soo Pyo
- Department of Pathology, Uijeongbu Eulji Medical Center, Eulji University School of Medicine, Uijeongbu-si 11759, Republic of Korea;
| | - Nae Yu Kim
- Department of Internal Medicine, Uijeongbu Eulji Medical Center, Eulji University School of Medicine, Uijeongbu-si 11759, Republic of Korea
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8
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Mir AS, Mouchli M, Lebel DP, Grider D. Metastatic Plasmacytoid Urothelial Carcinoma Masquerading as a Primary Signet Ring Cell Carcinoma of the Duodenum. Cureus 2023; 15:e44454. [PMID: 37791187 PMCID: PMC10544159 DOI: 10.7759/cureus.44454] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/31/2023] [Indexed: 10/05/2023] Open
Abstract
Plasmacytoid urothelial carcinoma can histologically mimic gastrointestinal signet ring cell carcinoma, a potential diagnostic pitfall resulting in improper clinical management. We present a rare case of a malignant duodenal ulcer due to metastasis from plasmacytoid urothelial carcinoma. Only by histological and retrospective immunohistochemical comparison with the primary bladder tumor was this revealed as a metastasis from a plasmacytoid urothelial carcinoma. This case report highlights the importance of clinical correlation and comparison with any previous pathology specimens, the limitations of immunohistochemical staining, and the utilization of both old and new immunohistochemical tools when differentiating signet ring cell carcinomas of primary sites versus potential metastases.
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Affiliation(s)
- Adil S Mir
- Gastroenterology, Virginia Tech Carilion School of Medicine, Roanoke, USA
| | - Mohamad Mouchli
- Gastroenterology and Hepatology, Cleveland Clinic Foundation, Cleveland, USA
| | - David P Lebel
- Pathology, Dominion Pathology Associates, Roanoke, USA
- Basic Science Education, Virginia Tech Carilion School of Medicine, Roanoke, USA
| | - Douglas Grider
- Pathology, Carilion Roanoke Memorial Hospital, Roanoke, USA
- Basic Science Education, Virginia Tech Carilion School of Medicine, Roanoke, USA
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9
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Alshahwan MI, Bin Dukhi MM, Alotaibi SN, Aldarrab R, Alhefdhi NA, Al Oudah N, Abumelha S. Plasmacytoid Variant Urothelial Cell Carcinoma: A Case of a Histological Variant of Urinary Bladder Cancer With Aggressive Behavior. Cureus 2023; 15:e36278. [PMID: 36937121 PMCID: PMC10022250 DOI: 10.7759/cureus.36278] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/17/2023] [Indexed: 03/19/2023] Open
Abstract
This paper presents a case report of plasmacytoid variant urothelial carcinoma (PVUC), a rare form of transitional cell carcinoma. PVUC is known for its unique clinical features, aggressive behavior, and poor survival rates. PVUC comprises less than 3% of all bladder tumors, and its diagnosis is often difficult due to its resemblance to other forms of bladder cancer. It requires a staging workup to rule out metastasis, relies heavily on immunostaining and histopathological analysis for diagnosis, and requires a multidisciplinary approach with early aggressive treatment, including cisplatin-based chemotherapy following surgery. This report highlights the importance of understanding rare variants of bladder cancer to ensure timely and accurate diagnosis and appropriate treatment planning. We report here a case of a 75-year-old male with multiple comorbidities who presented with hematuria and was diagnosed with urothelial carcinoma plasmacytoid type, which was initially treated with transurethral resection but later found to be unresectable and treated with palliative chemotherapy and radiation therapy. Eventually, the patient passed away three years after the diagnosis.
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Affiliation(s)
- Mosaad I Alshahwan
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, SAU
| | - Musaad M Bin Dukhi
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, SAU
| | - Sultan N Alotaibi
- Medicine, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, SAU
| | | | | | - Nourah Al Oudah
- Pathology and Laboratory Medicine, King Abdulaziz Medical City, Riyadh, SAU
| | - Saad Abumelha
- College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, SAU
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10
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Malinaric R, Balzarini F, Granelli G, Ferrari A, Trani G, Ambrosini F, Mantica G, Panarello D, De Rose AF, Terrone C. From women to women—hematuria during therapy for metastatic breast cancer, what to suspect and when to be alarmed; Bladder metastasis from breast cancer—our experience and a systematic literature review. Front Oncol 2022; 12:976947. [PMID: 36248976 PMCID: PMC9557997 DOI: 10.3389/fonc.2022.976947] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Accepted: 08/31/2022] [Indexed: 11/13/2022] Open
Abstract
Breast cancer is one of the most important causes of premature mortality in women worldwide. Around 12% of breast cancer patients will develop metastatic disease, a stage associated with poor prognosis, and only 26% of patients are likely to survive for at least 5 years after being diagnosed. Although the most common sites where breast cancer tends to spread are bones, lungs, brain, and liver, it is important that physicians consider other less frequent organs and viscera, like the bladder, as a target destination. In this article we report our experience with this rare form of metastases and a systematic literature review. We analyzed case reports, case series, and review articles present in PubMED/MEDLINE up to March 2022. We excluded the nonrelevant articles, editorials, letters to the editor, and articles written in other languages. We identified a total of 302 articles, with 200 articles being removed before screening; therefore, the total number of abstracts reviewed was 102. Fifty-five articles were excluded before full text review because they did not meet the inclusion criteria, and one article was not retrievable. Therefore, we included a total of 45 articles in this review. The intention of this review is to highlight the importance of the early detection of bladder metastases and to facilitate the diagnostic process for the responsible physician. The most common signs and symptoms and breast cancer subtype associated with bladder metastases, as well as overall survival after their detection, were all assessed. Bladder metastases from metastatic breast cancer are prevalent in the invasive, lobular breast cancer subtype; most patients present with hematuria (39.5%) and the relative 5-year survival rate is 2%. The main limitations of this review are the low number of cases reported in the literature, clinical and pathological differences between the individual cases, and absence of the control group. This study was not funded.
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Affiliation(s)
- Rafaela Malinaric
- Department of Urology, L'Istituto di ricovero e cura a carattere scientifico (IRCCS) Ospedale Policlinico San Martino, Genova, Italy
- Department of Surgical and Diagnostic Integrated Sciences (DISC), University of Genova, Genova, Italy
- *Correspondence: Rafaela Malinaric,
| | - Federica Balzarini
- Department of Urology, L'Istituto di ricovero e cura a carattere scientifico (IRCCS) Ospedale Policlinico San Martino, Genova, Italy
- Department of Surgical and Diagnostic Integrated Sciences (DISC), University of Genova, Genova, Italy
| | - Giorgia Granelli
- Department of Urology, L'Istituto di ricovero e cura a carattere scientifico (IRCCS) Ospedale Policlinico San Martino, Genova, Italy
- Department of Surgical and Diagnostic Integrated Sciences (DISC), University of Genova, Genova, Italy
| | - Arianna Ferrari
- Department of Urology, L'Istituto di ricovero e cura a carattere scientifico (IRCCS) Ospedale Policlinico San Martino, Genova, Italy
- Department of Surgical and Diagnostic Integrated Sciences (DISC), University of Genova, Genova, Italy
| | - Giorgia Trani
- Department of Urology, L'Istituto di ricovero e cura a carattere scientifico (IRCCS) Ospedale Policlinico San Martino, Genova, Italy
- Department of Surgical and Diagnostic Integrated Sciences (DISC), University of Genova, Genova, Italy
| | - Francesca Ambrosini
- Department of Urology, L'Istituto di ricovero e cura a carattere scientifico (IRCCS) Ospedale Policlinico San Martino, Genova, Italy
- Department of Surgical and Diagnostic Integrated Sciences (DISC), University of Genova, Genova, Italy
| | - Guglielmo Mantica
- Department of Urology, L'Istituto di ricovero e cura a carattere scientifico (IRCCS) Ospedale Policlinico San Martino, Genova, Italy
| | - Daniele Panarello
- Department of Urology, L'Istituto di ricovero e cura a carattere scientifico (IRCCS) Ospedale Policlinico San Martino, Genova, Italy
| | - Aldo Franco De Rose
- Department of Urology, L'Istituto di ricovero e cura a carattere scientifico (IRCCS) Ospedale Policlinico San Martino, Genova, Italy
| | - Carlo Terrone
- Department of Urology, L'Istituto di ricovero e cura a carattere scientifico (IRCCS) Ospedale Policlinico San Martino, Genova, Italy
- Department of Surgical and Diagnostic Integrated Sciences (DISC), University of Genova, Genova, Italy
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11
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Kelley JT, Fuller LD, Lai KK, Yantiss RK, Dzedzik S, Alapat D, Mashayekhi A, Alpert L, Gonzalez RS, Owens SR, Arber DA, Lamps LW. Gastrointestinal, Hepatic and Pancreatobiliary Involvement by Plasma Cell Neoplasms: Clinicopathologic Correlations in a Retrospective Cohort of 116 Cases. Histopathology 2022; 81:742-757. [PMID: 35984728 DOI: 10.1111/his.14778] [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: 04/29/2022] [Revised: 06/23/2022] [Accepted: 08/13/2022] [Indexed: 11/28/2022]
Abstract
AIMS Plasma cell neoplasms (PCNs) may involve the gastrointestinal (GI) tract in two forms: plasmacytoma (PC), an isolated lesion which lacks marrow involvement, and extramedullary myeloma (EMM). However, previous literature on PCNs involving the GI tract, liver and pancreas is limited. We evaluated the clinicopathologic features of the largest series of GI PCNs to date. METHODS AND RESULTS Six institutional archives were searched for GI, liver and pancreas cases involved by PCNs. Medical records were reviewed for clinical and imaging features. Histopathologic features evaluated included involved organ, tumor grade and marrow involvement. Overall, 116 cases from 102 patients were identified. Tumors most presented as incidental findings (29%). The liver was most involved (47%), and masses/polyps (29%) or ulcers (21%) were most common findings. Most cases had high-grade morphology (55%). The majority (74%) of GI PCNs were classified as EMM due to the presence of marrow involvement at some point during the disease course, occurring within a year of marrow diagnosis in 46% of patients. PC was classified in 26% of patients due to the lack of marrow involvement. Most (70%) patients died from disease within 10 years (median 14.1) of diagnosis and more than half (58%) died within 6 months. CONCLUSION PC and EMM involving the GI tract, liver and pancreas have a wide range of clinicopathologic presentations. Tumors may occur virtually anywhere in the GI tract or abdomen and may precede the diagnosis of marrow involvement. Both GI PC and EMM are associated with a poor prognosis.
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Affiliation(s)
- Justin T Kelley
- Department of Pathology, University of Michigan, Ann Arbor, MI, USA
| | | | - Keith K Lai
- Department of Pathology, Cleveland Clinic, Cleveland, OH, USA
| | - Rhonda K Yantiss
- Department of Pathology and Laboratory Medicine, Weill Cornell Medicine, New York, NY, USA
| | - Siarhei Dzedzik
- Department of Pathology and Laboratory Medicine, New York-Presbyterian Hospital, New York, NY, USA
| | - Daisy Alapat
- Department of Pathology, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Azin Mashayekhi
- Department of Pathology, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Lindsay Alpert
- Department of Pathology, University of Chicago School of Medicine, Chicago, IL, USA
| | - Raul S Gonzalez
- Department of Pathology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Scott R Owens
- Department of Pathology, University of Michigan, Ann Arbor, MI, USA
| | - Daniel A Arber
- Department of Pathology, University of Chicago School of Medicine, Chicago, IL, USA
| | - Laura W Lamps
- Department of Pathology, University of Michigan, Ann Arbor, MI, USA
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12
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Are We Ready to Implement Molecular Subtyping of Bladder Cancer in Clinical Practice? Part 2: Subtypes and Divergent Differentiation. Int J Mol Sci 2022; 23:ijms23147844. [PMID: 35887192 PMCID: PMC9317362 DOI: 10.3390/ijms23147844] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Revised: 07/09/2022] [Accepted: 07/12/2022] [Indexed: 11/16/2022] Open
Abstract
Following several attempts to achieve a molecular stratification of bladder cancer (BC) over the last decade, a "consensus" classification has been recently developed to provide a common base for the molecular classification of bladder cancer (BC), encompassing a six-cluster scheme with distinct prognostic and predictive characteristics. In order to implement molecular subtyping (MS) as a risk stratification tool in routine practice, immunohistochemistry (IHC) has been explored as a readily accessible, relatively inexpensive, standardized surrogate method, achieving promising results in different clinical settings. The second part of this review deals with the pathological and clinical features of the molecular clusters, both in conventional and divergent urothelial carcinoma, with a focus on the role of IHC-based subtyping.
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13
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Wang BG, Woodward K, Menezes G, Wang ZQ, He R, Li W. Pleural fluid metastasis of plasmacytoid urothelial carcinoma in comparison to micropapillary and conventional high-grade urothelial carcinoma: Cytologic and immuonohistochemical findings. Diagn Cytopathol 2022; 50:E248-E254. [PMID: 35560555 DOI: 10.1002/dc.24975] [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: 03/26/2022] [Revised: 04/27/2022] [Accepted: 04/29/2022] [Indexed: 11/10/2022]
Abstract
Plasmacytoid urothelial carcinoma (PUC) is a rare but clinically aggressive variant of high-grade urothelial carcinoma (HGUC). Cytological features include single plasmacytoid neoplastic cells with N:C ratio around 0.5, eccentric nuclei, nuclear hyperchromasia, irregular nuclear membrane, and vacuolated cytoplasm. Micropapillary urothelial carcinoma (MPUC) is another clinically aggressive variant of HGUC that shares some overlapping features of PUC. The diagnosis of these two aggressive variants in pleural effusions can be challenging due to features mimicking adenocarcinoma, unusual immunochemistry profile, and confusion with differential diagnoses, especially when pertinent clinical information is unavailable. We present report on one case each of pleural fluid metastasis of PUC and MPUC respectively, and compare the findings with that of a metastatic conventional HGUC originally thought to be metastatic adenocarcinoma. The diagnosis of PUC was confirmed with immunohistochemical studies showing expression for cytokeratin, GATA-3, uroplakin II, and CD138, diminished or loss of E-cadherin membranous expression, negative expression for p63, p53, Epicam-BerEP4, Epicam-MOC31, and p120. The diagnosis of MPUC was confirmed with immunostain profile similar to that of PUC except positive stain for E-cadherin, p120, and p53. The diagnosis of HGUC was confirmed with immunohistochemical studies showing expression for cytokeratin, GATA-3, uroplakin II, p63, Epicam-BerEP4 (focal weak), and Epicam-MOC31. Our cases of metastatic urothelial carcinoma showed features mimicking adenocarcinoma and others, especially the MPUC and HGUC were diagnosed without prior tissue diagnosis of urothelial carcinoma. This report emphasizes the cytohistological and immunohistochemical details of urothelial carcinoma involving effusion fluid and discusses potential pitfalls in diagnosis.
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Affiliation(s)
- Brant G Wang
- Department of Pathology, Inova Fairfax Hospital, Falls Church, Virginia, USA
| | - Kimberly Woodward
- Department of Pathology, Inova Fairfax Hospital, Falls Church, Virginia, USA
| | - Geetha Menezes
- Department of Pathology, Inova Fairfax Hospital, Falls Church, Virginia, USA
| | - Zoe Q Wang
- Department of Pathology, Inova Fairfax Hospital, Falls Church, Virginia, USA
| | - Rui He
- Department of Pathology, Inova Fairfax Hospital, Falls Church, Virginia, USA
| | - Wenping Li
- Department of Pathology, Inova Fairfax Hospital, Falls Church, Virginia, USA
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14
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Asano Y, Miyai K, Yoshimatsu S, Sasaki M, Ikewaki K, Matsukuma S. Clinically undetected plasmacytoid urothelial carcinoma of the urinary bladder with non-mass-forming metastases in multiple organs: an autopsy case. J Pathol Transl Med 2022; 56:217-224. [PMID: 35501670 PMCID: PMC9288892 DOI: 10.4132/jptm.2022.03.15] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Accepted: 03/15/2022] [Indexed: 11/17/2022] Open
Abstract
This case report outlines a clinically undetected urinary bladder plasmacytoid urothelial carcinoma (PUC) with multiple metastases detected at autopsy. An 89-year-old man presented with edema in the lower limbs. Pleural fluid cytology revealed discohesive carcinomatous cells, although imaging studies failed to identify the primary site of tumor. The patient died of respiratory failure. Autopsy disclosed a prostate tumor and diffusely thickened urinary bladder and rectum without distinct tumorous lesions. Histologically, the tumor consisted of acinar-type prostate adenocarcinoma with no signs of metastasis. Additionally, small, plasmacytoid tumor cells were observed in the urinary bladder/rectum as isolated or small clustering fashions. These metastasized to the lungs, intestine, generalized lymph nodes in a non-mass-forming manner. Combined with immunohistochemical studies, these tumor cells were diagnosed PUC derived from the urinary bladder. Both clinicians and pathologists should recognize PUC as an aggressive histological variant, which can represent a rapid systemic progression without mass-forming lesions.
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Affiliation(s)
- Yuya Asano
- National Defense Medical College, Saitama,
Japan
- Department of Pathology and Laboratory Medicine, National Defense Medical College, Saitama,
Japan
| | - Kosuke Miyai
- Department of Pathology and Laboratory Medicine, National Defense Medical College, Saitama,
Japan
- Department of Pathology, Japan Self-Defense Forces Central Hospital, Tokyo,
Japan
| | - Shinya Yoshimatsu
- Department of Laboratory Medicine, National Defense Medical College Hospital, Saitama,
Japan
| | - Makoto Sasaki
- Department of Anti-Aging and Vascular Medicine, National Defense Medical College, Saitama,
Japan
| | - Katsunori Ikewaki
- Department of Anti-Aging and Vascular Medicine, National Defense Medical College, Saitama,
Japan
| | - Susumu Matsukuma
- Department of Pathology and Laboratory Medicine, National Defense Medical College, Saitama,
Japan
- Department of Laboratory Medicine, National Defense Medical College Hospital, Saitama,
Japan
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15
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Plasmacytoid urothelial carcinoma (UC) are luminal tumors with similar CD8+ Tcell density and PD-L1 protein expression on immune cells as compared to conventional UC. Urol Oncol 2021; 40:12.e1-12.e11. [PMID: 34429252 DOI: 10.1016/j.urolonc.2021.07.014] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2021] [Revised: 07/08/2021] [Accepted: 07/10/2021] [Indexed: 12/20/2022]
Abstract
BACKGROUND Plasmacytoid urothelial carcinoma (UC) is a rare pathological variant of UC with low chemotherapeutic sensitivity and dismal outcomes. The molecular and immune profiles of such tumors remain poorly investigated. METHODS Herein, we investigated the phenotypical features of a cohort of plasmacytoid UC (n=32) by comparison to a control group of conventional high-grade UC with matched clinicopathological characteristics (n=30). Histopathological analysis included the following antibodies: p63, GATA3, CK5/6, CK20 and HER2. In addition, the density of intra-tumor CD8+ lymphocytes, and PD-L1 expression in tumor (TC) and immune cells (IC) were evaluated. RESULTS Plasmacytoid UC expressed GATA3 (97% vs 86% P=0.18), CK20 (59% vs 36% P=0.08) markers and showed a significantly higher rate of HER2 overexpression (2+ and 3+ score: 25% vs 0%, P<0.01) compared to controls. A significantly lower expression of CK5/6 (22% vs 56%, P<0.05) and p63 (41% vs 80%, P<0.05) was observed in plasmacytoid UC compared to controls. The density of tumor-infiltrating CD8+ cells was similar between plasmacytoid and conventional UC (P=0.9). PD-L1 expression on IC was similar compared to conventional UC (P=0.3). CONCLUSIONS Together, our study demonstrated that plasmacytoid UC belong to the luminal subtype and display a rather inflamed microenvironment similar to conventional UC. These data support the inclusion of plasmacytoid variant of UC in clinical trials evaluating immune checkpoint inhibitors monotherapy or combination immunotherapeutic strategies.
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16
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Agarwal PK, Sfakianos JP, Feldman A, Tagawa ST, Black PC. A 25-year perspective on advances in an understanding of the biology, evaluation, treatment and future directions/challenges of urothelial cancer. Urol Oncol 2021; 39:528-547. [PMID: 34332848 DOI: 10.1016/j.urolonc.2021.05.036] [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: 04/23/2021] [Revised: 05/25/2021] [Accepted: 05/28/2021] [Indexed: 11/16/2022]
Abstract
The Urologic Oncology Journal was founded 25 years ago and we reviewed the literature since that time in the area of urothelial cancer to see the progress and pitfalls we have made over this time period. A comprehensive literature search was conducted by the authors involved who are all actively involved in research, clinical trials, and treatment for urothelial cancer and the results were summarized over the past 25 years. The field of urothelial cancer has evolved tremendously in the last 25 years with the incorporation of molecular subtyping, novel imaging, immunotherapy, and robotic surgery. However, treatments such as BCG and radical cystectomy have remained steadfast over the last 25 years. Although we have a better understanding of the biology of bladder cancer, we still have a long way from being able to cure patients with bladder cancer and eliminate morbidity from treatments. Nevertheless, considerable progress has been made since the founding of the Urologic Oncology Journal 25 years ago.
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Affiliation(s)
- Piyush K Agarwal
- Section of Urology, Department of Surgery, UChicago Medicine, Chicago, IL.
| | - John P Sfakianos
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Adam Feldman
- Department of Urology, Massachusetts General Hospital, Boston, MA
| | - Scott T Tagawa
- Division of Hematology and Oncology, Departments of Medicine and Urology, Weill Cornell Medicine, New York, NY
| | - Peter C Black
- Department of Urologic Sciences, University of British Columbia, Vancouver, BC, Canada
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17
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Mammary Lobular Carcinoma-Like Salivary Gland Carcinoma: Report of a Rare Case. Head Neck Pathol 2021; 16:314-321. [PMID: 34115320 PMCID: PMC9018959 DOI: 10.1007/s12105-021-01344-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Accepted: 06/02/2021] [Indexed: 10/21/2022]
Abstract
Salivary and mammary glands are both exocrine organs sharing multiple tumorigenic processes. To the best of our knowledge, salivary gland tumors mimicking invasive lobular carcinoma of the breast have not yet been described. Herein, we report a case of a 62-year-old male who presented with progressive facial paralysis. Pathologic examination revealed an ill-defined epithelial neoplasm exhibiting discohesive growth set within an extensively fibrotic stroma. Both perineural and intraneural invasion were present. E-cadherin and p120 immunostaining showed aberrant cytoplasmic expression. Targeted next-generation sequencing detected a frameshift mutation of the CTNNA1 gene as the only known pathogenic variant. The patient was treated with surgical resection, immunotherapy, and chemotherapy. Currently, he is alive with disease twenty months after disease onset.
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18
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Lopez-Beltran A, Cimadamore A, Montironi R, Cheng L. Molecular pathology of urothelial carcinoma. Hum Pathol 2021; 113:67-83. [PMID: 33887300 DOI: 10.1016/j.humpath.2021.04.001] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Revised: 03/23/2021] [Accepted: 04/09/2021] [Indexed: 12/11/2022]
Abstract
The current personalized oncology era has witnessed significant efforts to integrate clinical, pathological, and molecular classifications. The growing need for molecular biomarkers to feed personalized oncology, together with the unprecedented wealth of knowledge on the molecular basis of bladder cancer, has led to a novel approach to this disease, incorporating molecularly generated data in clinical practice for locally advanced or metastatic disease. Translational research allows a better understanding of the early events in the development of urothelial carcinoma in the urinary bladder. Thus, mutations in the KMT2D and KDM6A chromatin-modifying genes confer competitive advantages that drive cells to colonize larger regions of the urothelium. Additional mutations in TP53, PIK3CA, FGFR3, or RB1 genes then trigger the process of malignant transformation in the urothelium. In the current review, we provide an overview of what could be the expected transition from the morphology-based classification to a combined, molecularly enriched reporting of clinically meaningful parameters aiming to promote personalized oncology of urothelial carcinoma.
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Affiliation(s)
- Antonio Lopez-Beltran
- Department of Morphological Sciences, Cordoba University Medical School, Cordoba, E-14004, Spain.
| | - Alessia Cimadamore
- Section of Pathological Anatomy, Polytechnic University of the Marche Region, School of Medicine, United Hospitals, Ancona, 60126, Italy
| | - Rodolfo Montironi
- Section of Pathological Anatomy, Polytechnic University of the Marche Region, School of Medicine, United Hospitals, Ancona, 60126, Italy
| | - Liang Cheng
- Department of Pathology and Laboratory Medicine, Indiana University School of Medicine, Indianapolis, IN, 46202, USA; Department of Urology, Indiana University School of Medicine, Indianapolis, IN, 46202, USA.
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19
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Lopez-Beltran A, Cheng L. Stage T1 bladder cancer: diagnostic criteria and pitfalls. Pathology 2020; 53:67-85. [PMID: 33153725 DOI: 10.1016/j.pathol.2020.09.014] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2020] [Revised: 08/31/2020] [Accepted: 09/02/2020] [Indexed: 12/11/2022]
Abstract
Accurate pathological staging is crucial for patient management. Patients with T1 bladder cancer are at risk of recurrence, progression, and death of cancer. Recognition of early invasion (stage T1 disease) in urothelial carcinoma remains one of the most challenging areas in urological surgical pathology practice. A logical roadmap to T1 diagnosis would include careful evaluation of histological grade, stromal epithelial interface, characteristics of the invading epithelium, and the stroma associated responses. Tangential sectioning, crush and cautery artifacts, and associated inflammatory infiltrate are commonly encountered problems and the source of pitfalls. In this review, we outline diagnostic criteria, common pitfalls, and different histological patterns of invasion into the lamina propria. Current recommendations on reporting of biopsy and transurethral resection specimens, molecular biomarkers, clinical implications of T1 cancer diagnosis and recent developments on the T1 substaging are also discussed. Most T1 bladder cancer patients will benefit from conservative management after restaging transurethral resection of bladder and bacillus Calmette-Guérin maintenance. Patients with high risk features, such as concurrent urothelial carcinoma in situ, increased depth of invasion, lymphovascular invasion, and variant histology among others, should be considered for early cystectomy.
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Affiliation(s)
- Antonio Lopez-Beltran
- Department of Morphological Sciences, Cordoba University Medical School, Cordoba, Spain
| | - Liang Cheng
- Department of Pathology, Indiana University School of Medicine, Indianapolis, USA; Department of Urology, Indiana University School of Medicine, Indianapolis, USA.
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20
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Urothelial carcinoma: variant histology, molecular subtyping, and immunophenotyping significant for treatment outcomes. Pathology 2020; 53:56-66. [PMID: 33070956 DOI: 10.1016/j.pathol.2020.09.004] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2020] [Revised: 08/26/2020] [Accepted: 09/01/2020] [Indexed: 12/20/2022]
Abstract
Although urothelial carcinoma (UC) has been recognised as a homogenous disease entity until recently, it exhibits widely diverse histological variants. Recent studies have revealed that some histological variants may serve as markers of very high risk for advanced cancers and poor prognoses. Certain histological variants can generate a pathological T stage, which may result in unnecessary surgery. Though platinum based chemotherapy is the standard treatment, the use of immune checkpoint inhibitors (ICIs) for UC treatment has become a major trend in oncology. UCs showing specific histological variants have responded exceptionally well to chemotherapy and ICIs. Currently, molecular studies base molecular classification on gene expression profile signatures in order to make diagnoses or predict responses to chemotherapies and ICIs. Notably, some histological variants correlate with specific molecular subtypes. The usefulness of immunophenotyping for classification purposes was recognised only recently. Immunophenotypes are classified into three categories according to lymphocyte distribution in or around the cancer cell nest: desert, excluded, and inflamed. This immunophenotyping has been increasingly shown to be of value in predicting the response to ICIs. This review describes the morphological characteristics of histological variants as well as the advantages and limitations in determining them, with particular reference to clinical benefits. Subsequently, we describe the concept of molecular classification and immunophenotypes, and their morphological features, which are easily interpreted and amenable to daily practice via hematoxylin and eosin staining. We also consider the clinical advantages, limitations, and issues encountered while using these in routine clinical practice.
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21
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Takada-Owada A, Nozawa Y, Onozaki M, Noda S, Jamiyan T, Tokura Y, Nakazato Y, Kamai T, Ishida K. Plasmacytoid urothelial carcinoma of renal pelvis with positive zinc finger E-box-binding homeobox 1: a case report. Diagn Pathol 2020; 15:124. [PMID: 33032610 PMCID: PMC7545836 DOI: 10.1186/s13000-020-01043-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Accepted: 10/05/2020] [Indexed: 01/21/2023] Open
Abstract
Background The tumor transformation mechanism of a plasmacytoid urothelial carcinoma remains unexplained. We describe the case of a plasmacytoid urothelial carcinoma of the renal pelvis in which the expression of zinc finger E–box–binding homeobox 1 (ZEB1), a key nuclear transcription factor in an epithelial–mesenchymal transition, is involved in tumor transformation. Case presentation The patient had a left nephrectomy with the clinical diagnosis of left pelvic renal cancer. The resected specimen showed that the tumor surface comprised a noninvasive papillary urothelial carcinoma with the carcinoma in situ, and the invasive area comprised a plasmacytoid urothelial carcinoma characterized by the presence of single dyscohesive malignant cells that resembled plasma cells in a loose myxoid stroma. The noninvasive urothelial carcinoma was positive for cytokeratin and E–cadherin, and negative for vimentin and ZEB1. In contrast, the invasive plasmacytoid urothelial carcinoma was positive for cytokeratin and also vimentin and ZEB1, and negative for E–cadherin. Additionally, this component was immunoreactive for CD138 and CD38 that are immunohistochemical markers for plasma cells. Conclusion We suggest that ZEB1 is involved in the plasmacytoid transformation by repressing the E–cadherin in a plasmacytoid urothelial carcinoma.
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Affiliation(s)
- Atsuko Takada-Owada
- Department of Diagnostic Pathology, Dokkyo Medical University, 880 Kitakobayashi, Mibu, Tochigi, 321-0293, Japan
| | - Yumi Nozawa
- Department of Diagnostic Pathology, Dokkyo Medical University, 880 Kitakobayashi, Mibu, Tochigi, 321-0293, Japan
| | - Masato Onozaki
- Department of Diagnostic Pathology, Dokkyo Medical University, 880 Kitakobayashi, Mibu, Tochigi, 321-0293, Japan
| | - Shuhei Noda
- Department of Diagnostic Pathology, Dokkyo Medical University, 880 Kitakobayashi, Mibu, Tochigi, 321-0293, Japan
| | - Tsengelmaa Jamiyan
- Department of Diagnostic Pathology, Dokkyo Medical University, 880 Kitakobayashi, Mibu, Tochigi, 321-0293, Japan
| | - Yuumi Tokura
- Department of Urology, Dokkyo Medical University, Mibu, Tochigi, Japan
| | - Yoshimasa Nakazato
- Department of Diagnostic Pathology, Dokkyo Medical University, 880 Kitakobayashi, Mibu, Tochigi, 321-0293, Japan
| | - Takao Kamai
- Department of Urology, Dokkyo Medical University, Mibu, Tochigi, Japan
| | - Kazuyuki Ishida
- Department of Diagnostic Pathology, Dokkyo Medical University, 880 Kitakobayashi, Mibu, Tochigi, 321-0293, Japan.
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22
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Sangoi AR, Chan E, Stohr BA, Kunju LP. Invasive plasmacytoid urothelial carcinoma: A comparative study of E-cadherin and P120 catenin. Hum Pathol 2020; 102:54-59. [PMID: 32673685 DOI: 10.1016/j.humpath.2020.07.006] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Accepted: 07/05/2020] [Indexed: 10/23/2022]
Abstract
Invasive plasmacytoid urothelial carcinomas (PUCs) are an uncommon aggressive variant, which often shows immunohistochemical loss of E-cadherin, underlying its distinct discohesive histology. The marker P120 (well described in breast pathology as being a diagnostic tool alongside E-cadherin for lobular neoplasia) has not been evaluated in PUCs. Biopsies, transurethral resections, and cystectomies of PUCs were collected, and whole-slide immunohistochemical analysis of E-cadherin and P120 was applied. A subset of cases were also tested for CDH1 mutation. PUC cases were stratified into morphologic categories of classic, pleomorphic, or desmoplastic. For E-cadherin, 24 of 33 (73%) cases showed an abnormal staining pattern, consisting of complete absence of staining (17/24; 71%) or cytoplasmic staining (7/24; 29%). For P120, 24 of 33 (73%) cases showed an abnormal staining pattern, consisting of loss of membranous staining with cytoplasmic reactivity. Only 2 cases showed a discordant E-cadherin/P120 immunoprofile (94% concordance). Significant staining differences among the 3 morphologic categories were not found. CDH1 mutation was found in 4 of 8 (50%) of cases, with 3 of 4 (75%) cases showing matched molecular/immunoprofile reactivity. No cases with CDH1 mutation showed discordant pattern E-cadherin/P120 immunoreactivity. Our rate of aberrant E-cadherin immunoreactivity in PUCs (73%) is similar to a meta-analysis of published cases (74%). We also report an identical rate of aberrant P120 immunoreactivity in PUCs (73%). While PUC remains a histologic diagnosis, in a subset of cases showing a less appreciated pattern (such as desmoplastic) or confounding cytoplasmic E-cadherin reactivity, the utility of paired P120 staining may be a useful diagnostic tool.
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Affiliation(s)
| | - Emily Chan
- University of California San Francisco, Pathology, San Francisco, CA, USA
| | - Bradley A Stohr
- University of California San Francisco, Pathology, San Francisco, CA, USA
| | - L Priya Kunju
- University of Michigan, Pathology, Ann Arbor, MI, USA
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23
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Diamantopoulos LN, Khaki AR, Grivas P, Gore JL, Schade GR, Hsieh AC, Lee JK, Yezefski T, Yu EY, Schweizer MT, Cheng HH, Psutka SP, Lin DW, Tretiakova MS, Vakar-Lopez F, Montgomery RB, Wright JL. Plasmacytoid urothelial carcinoma: response to chemotherapy and oncologic outcomes. Bladder Cancer 2020; 6:71-81. [PMID: 34109262 DOI: 10.3233/blc-190258] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Plasmacytoid urothelial carcinoma is a rare bladder cancer variant with scarce data on outcomes and prognostic factors. OBJECTIVE We report our institutional experience with this histology to determine response to neoadjuvant chemotherapy, definitive surgery and survival. METHODS We conducted a retrospective chart review of consecutive patients with plasmacytoid, as well as conventional urothelial carcinoma (for comparison) seen in our institution (2007 - 2018). Baseline characteristics, clinicopathologic and treatment data were captured. T-test, chi-squared and log-rank test was used for group comparison. Kaplan Meier method was used for estimation of overall survival and Cox regression for identification of prognostic factors. RESULTS 64 patients with plasmacytoid and 418 with conventional urothelial histology were identified; 53% of those with plasmacytoid presented with cT3/4 stage and 67% underwent extirpative surgery. Patients with plasmacytoid histology had higher rates of pT3/4 (65% vs. 28%), nodal disease (37% vs. 16%) and positive surgical margins (23% vs. 5%) compared to urothelial group (p < 0.01), as well as higher incidence of post-operative recurrence (47% vs. 29%, p = 0.05) and lower ypT0N0 rates after neoadjuvant chemotherapy (10% vs. 33%, p = 0.03). Plasmacytoid histology was associated with lower median overall survival compared to conventional urothelial (24 vs. 154 months, p < 0.01). CONCLUSIONS Plasmacytoid urothelial carcinoma frequently presented with advanced stage at diagnosis and extirpative surgery, poor pathologic response to neoadjuvant chemotherapy, and inferior outcomes, when compared to conventional urothelial. Prospective trials evaluating upfront cystectomy versus preoperative chemotherapy and/or novel treatments should be considered.
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Affiliation(s)
- Leonidas N Diamantopoulos
- Division of Medical Oncology, Department of Medicine, University of Washington, Seattle Cancer Care Alliance, 825 Eastlake Ave E, Seattle, WA 98109-1024, USA
| | - Ali Raza Khaki
- Division of Medical Oncology, Department of Medicine, University of Washington, Seattle Cancer Care Alliance, 825 Eastlake Ave E, Seattle, WA 98109-1024, USA
| | - Petros Grivas
- Division of Medical Oncology, Department of Medicine, University of Washington, Seattle Cancer Care Alliance, 825 Eastlake Ave E, Seattle, WA 98109-1024, USA.,Fred Hutchinson Cancer Research Center, 1100 Fairview Ave N, Seattle, WA 98109, USA
| | - John L Gore
- Department of Urology, University of Washington, 1959 NE Pacific St, Seattle, WA 98195, USA
| | - George R Schade
- Department of Urology, University of Washington, 1959 NE Pacific St, Seattle, WA 98195, USA
| | - Andrew C Hsieh
- Division of Medical Oncology, Department of Medicine, University of Washington, Seattle Cancer Care Alliance, 825 Eastlake Ave E, Seattle, WA 98109-1024, USA.,Fred Hutchinson Cancer Research Center, 1100 Fairview Ave N, Seattle, WA 98109, USA
| | - John K Lee
- Division of Medical Oncology, Department of Medicine, University of Washington, Seattle Cancer Care Alliance, 825 Eastlake Ave E, Seattle, WA 98109-1024, USA.,Fred Hutchinson Cancer Research Center, 1100 Fairview Ave N, Seattle, WA 98109, USA
| | - Todd Yezefski
- Division of Medical Oncology, Department of Medicine, University of Washington, Seattle Cancer Care Alliance, 825 Eastlake Ave E, Seattle, WA 98109-1024, USA
| | - Evan Y Yu
- Division of Medical Oncology, Department of Medicine, University of Washington, Seattle Cancer Care Alliance, 825 Eastlake Ave E, Seattle, WA 98109-1024, USA.,Fred Hutchinson Cancer Research Center, 1100 Fairview Ave N, Seattle, WA 98109, USA
| | - Michael T Schweizer
- Division of Medical Oncology, Department of Medicine, University of Washington, Seattle Cancer Care Alliance, 825 Eastlake Ave E, Seattle, WA 98109-1024, USA.,Fred Hutchinson Cancer Research Center, 1100 Fairview Ave N, Seattle, WA 98109, USA
| | - Heather H Cheng
- Division of Medical Oncology, Department of Medicine, University of Washington, Seattle Cancer Care Alliance, 825 Eastlake Ave E, Seattle, WA 98109-1024, USA.,Fred Hutchinson Cancer Research Center, 1100 Fairview Ave N, Seattle, WA 98109, USA
| | - Sarah P Psutka
- Department of Urology, University of Washington, 1959 NE Pacific St, Seattle, WA 98195, USA
| | - Daniel W Lin
- Fred Hutchinson Cancer Research Center, 1100 Fairview Ave N, Seattle, WA 98109, USA.,Department of Urology, University of Washington, 1959 NE Pacific St, Seattle, WA 98195, USA
| | - Maria S Tretiakova
- Department of Pathology, University of Washington, 1959 NE Pacific St, Seattle, WA 98195, USA
| | - Funda Vakar-Lopez
- Department of Pathology, University of Washington, 1959 NE Pacific St, Seattle, WA 98195, USA
| | - Robert B Montgomery
- Division of Medical Oncology, Department of Medicine, University of Washington, Seattle Cancer Care Alliance, 825 Eastlake Ave E, Seattle, WA 98109-1024, USA.,Fred Hutchinson Cancer Research Center, 1100 Fairview Ave N, Seattle, WA 98109, USA
| | - Jonathan L Wright
- Fred Hutchinson Cancer Research Center, 1100 Fairview Ave N, Seattle, WA 98109, USA.,Department of Urology, University of Washington, 1959 NE Pacific St, Seattle, WA 98195, USA
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Aron M. Variant Histology in Bladder Cancer—Current Understanding of Pathologic Subtypes. Curr Urol Rep 2019; 20:80. [DOI: 10.1007/s11934-019-0949-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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25
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Simon CT, Skala SL, Killen PD, Siddiqui J, Cao X, Qiao Y, Al-Ahmadie H, Camelo-Piragua SI, Jentzen J, Chinnaiyan AM, Dhanasekaran SM, Reichert ZR, Mehra R. Plasmacytoid urothelial carcinoma: a rapid autopsy case report with unique clinicopathologic and genomic profile. Diagn Pathol 2019; 14:113. [PMID: 31638990 PMCID: PMC6802321 DOI: 10.1186/s13000-019-0896-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2019] [Accepted: 09/25/2019] [Indexed: 12/18/2022] Open
Abstract
Background Rapid (“warm”) autopsies of patients with advanced metastatic cancer provide important insight into the natural history, pathobiology and histomorphology of disease in treatment-resistant tumors. Plasmacytoid urothelial carcinoma (PUC) is a rare variant of urothelial carcinoma characterized by neoplastic cells morphologically resembling plasma cells. PUC is typically aggressive, high-stage at presentation, and associated with poor outcomes. Recurrence is common in PUC, with the majority of recurrences occurring in the peritoneum. Case presentation Here, we report rapid autopsy findings from a patient with recurrent PUC. The patient had persistent pain after cystoprostatectomy, although initial post-operative imaging showed no evidence of disease. Imaging obtained shortly before his death showed only subtle growth along vascular tissue planes; however, extensive disease was seen on autopsy. Plasmacytoid tumor cells formed sheets involving many serosal surfaces. Molecular interrogation confirmed a mutation in CDH1 exon 12 leading to early truncation of the CDH1 protein in the tumor cells. Conclusions The sheet-like growth pattern of PUC makes early phases of disease spread much more difficult to capture on cross-sectional imaging. Alternative forms of surveillance may be required for detection of recurrent PUC, and providers may need to treat based on symptoms and clinical suspicion.
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Affiliation(s)
- Caroline T Simon
- Department of Pathology, University of Michigan Medical School, 2800 Plymouth Rd, Building 35, Ann Arbor, MI, 48109, USA
| | - Stephanie L Skala
- Department of Pathology, University of Michigan Medical School, 2800 Plymouth Rd, Building 35, Ann Arbor, MI, 48109, USA
| | - Paul D Killen
- Department of Pathology, University of Michigan Medical School, 2800 Plymouth Rd, Building 35, Ann Arbor, MI, 48109, USA
| | - Javed Siddiqui
- Michigan Center for Translational Pathology, Ann Arbor, MI, USA
| | - Xuhong Cao
- Michigan Center for Translational Pathology, Ann Arbor, MI, USA
| | - Yuanyuan Qiao
- Michigan Center for Translational Pathology, Ann Arbor, MI, USA
| | - Hikmat Al-Ahmadie
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Sandra I Camelo-Piragua
- Department of Pathology, University of Michigan Medical School, 2800 Plymouth Rd, Building 35, Ann Arbor, MI, 48109, USA
| | - Jeffrey Jentzen
- Department of Pathology, University of Michigan Medical School, 2800 Plymouth Rd, Building 35, Ann Arbor, MI, 48109, USA
| | - Arul M Chinnaiyan
- Department of Pathology, University of Michigan Medical School, 2800 Plymouth Rd, Building 35, Ann Arbor, MI, 48109, USA.,Michigan Center for Translational Pathology, Ann Arbor, MI, USA.,Department of Urology, University of Michigan Medical School, Ann Arbor, MI, USA.,Rogel Cancer Center, Michigan Medicine, Ann Arbor, MI, USA.,Howard Hughes Medical Institute, Ann Arbor, MI, USA
| | | | - Zachery R Reichert
- Rogel Cancer Center, Michigan Medicine, Ann Arbor, MI, USA.,Department of Internal Medicine, Division of Hematology and Oncology, University of Michigan Medical School, Ann Arbor, MI, USA
| | - Rohit Mehra
- Department of Pathology, University of Michigan Medical School, 2800 Plymouth Rd, Building 35, Ann Arbor, MI, 48109, USA. .,Michigan Center for Translational Pathology, Ann Arbor, MI, USA. .,Rogel Cancer Center, Michigan Medicine, Ann Arbor, MI, USA.
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