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Rare Subentities of Urothelial Bladder Carcinoma. Urol Oncol 2019. [DOI: 10.1007/978-3-319-42603-7_27-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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2
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Rare Subentities of Urothelial Bladder Carcinoma. Urol Oncol 2019. [DOI: 10.1007/978-3-319-42623-5_27] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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3
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Mantica G, Simonato A, Du Plessis DE, Maffezzini M, De Rose AF, van der Merwe A, Terrone C. The pathologist's role in the detection of rare variants of bladder cancer and analysis of the impact on incidence and type detection. MINERVA UROL NEFROL 2018; 70:594-597. [PMID: 30203936 DOI: 10.23736/s0393-2249.18.03175-2] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Histology is one of the most important factors determining the prognosis of bladder cancers and rare variants are generally associated with decreased disease specific survival compared to pure transitional cell carcinomas. We believe that rare bladder cancer variants are likely underdiagnosed in the absence of a dedicated uro-pathologist in many centers. The objective of this study is to evaluate the contribution of a dedicated uro-pathologist on the identification of rare bladder cancer variants. METHODS We retrospectively analyzed the clinical and histological records of all patients which underwent a radical cystectomy and lymph node dissection between January 2000 and September 2015. The sample was divided in two groups: Group A, consists of patients who underwent radical cystectomy in the absence of a dedicated uro-pathologist at our institution, whereas the Group B consists of patients who underwent surgery when a dedicated uro-pathology service was available. We then evaluated the impact of a dedicated uro-pathologist on rare variants detection. RESULTS One hundred thirty-seven out of 551 (24.9%) of patients who underwent RC had at least one rare variant. In Group A 38/238 (16%) of patients showed a rare variant, while 99/313 (31.6%; P<0.001) in group B. Furthermore, the diagnosis of sarcomatoid variant was statistically significantly less common in group A (P=0.0026). The concordance between final radical cystectomy histology and previous transurethral resection of bladder tumor (TURBT) histology was poor in both groups (overall 50.4%). CONCLUSIONS The presence of a dedicated urological anatomical pathologist is of paramount importance and significantly increases the detection rate of non-transitional cell carcinoma bladder cancer types, but it does not increase the concordance rate between histological diagnoses in TURBT and radical cystectomy specimens.
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Affiliation(s)
- Guglielmo Mantica
- Department of Urology, Policlinico San Martino Hospital, University of Genoa, Genoa, Italy - .,Department of Urology, Tygerberg Hospital and Stellenbosch University, Cape Town, South Africa -
| | | | - Danelo E Du Plessis
- Department of Urology, Tygerberg Hospital and Stellenbosch University, Cape Town, South Africa
| | - Massimo Maffezzini
- Department of Urology, Policlinico San Martino Hospital, University of Genoa, Genoa, Italy
| | - Aldo F De Rose
- Department of Urology, Policlinico San Martino Hospital, University of Genoa, Genoa, Italy
| | - André van der Merwe
- Department of Urology, Tygerberg Hospital and Stellenbosch University, Cape Town, South Africa
| | - Carlo Terrone
- Department of Urology, Policlinico San Martino Hospital, University of Genoa, Genoa, Italy
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Rashid S, Akhtar M. Sarcomatoid Variant of Urothelial Carcinoma of the Renal Pelvis with Inferior Vena Cava Tumour Thrombus: A Case Report and Literature Review. Case Rep Pathol 2018; 2018:1837510. [PMID: 29581908 PMCID: PMC5822868 DOI: 10.1155/2018/1837510] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2017] [Accepted: 12/20/2017] [Indexed: 11/24/2022] Open
Abstract
Sarcomatoid variant of urothelial carcinoma (SVUC) of the renal pelvis is a rare entity. To the best of our knowledge, around 25 cases of this neoplasm have been reported in the literature to date, most of which were of high stage. The inferior vena cava tumour thrombus, which is a hallmark of renal cell carcinoma (RCC), may rarely be found in urothelial carcinoma of renal pelvis. In this report, a case of SVUC associated with tumour extension to inferior vena cava is documented. This association has been encountered in only one previously reported case. The possibility of urothelial carcinoma of the renal pelvis should therefore be included in the differential diagnosis of tumour thrombus of the inferior vena cava.
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Affiliation(s)
- Sameera Rashid
- Department of Laboratory Medicine and Pathology, Hamad Medical Corporation, Doha, Qatar
| | - Mohammed Akhtar
- Department of Laboratory Medicine and Pathology, Hamad Medical Corporation, Doha, Qatar
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Immunohistochemical Analysis of Rat Renal Tumours Caused by Ochratoxin A. Toxins (Basel) 2017; 9:toxins9120384. [PMID: 29182526 PMCID: PMC5744104 DOI: 10.3390/toxins9120384] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2017] [Revised: 11/21/2017] [Accepted: 11/24/2017] [Indexed: 11/16/2022] Open
Abstract
Experimental renal cancer caused by ochratoxin A (OTA) in rats was first defined in the US National Toxicology Program (1989) and raised questions about any aetiological role in human urinary tract tumours. A review of histopathology in several rat kidney tumours from dietary OTA in recently described London studies, augmented by clinical immunohistochemistry for the first time for this mycotoxin, establishes their renal tubular cell origin. It had been assumed that the toxin might cause the human urothelial tumours associated with Balkan endemic nephropathy, but the present study could not support this. Comparison with a similar review of a metastasising renal tumour from a female rat of the NTP study consistently shows the kidney as the primary carcinogenic site for OTA. Morphological heterogeneity of these kidney tumours as epithelioid and/or sarcomatoid is revealed. Leiomyosarcoma was also diagnosed, and rhabdomyosarcoma differentiation was observed in the exceptionally aggressive NTP female tumour. The present pilot study involving immunohistochemistry indicates need for wider review of archived tumours for experimental evidence before formulating any epidemiological basis from a rat model for OTA's relevance to idiopathic human renal cell carcinoma. Although the NTP study concluded that females are less sensitive to OTA than males, some female tumours still had heterogeneous morphology.
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Lisa M, Singh GR, Madhawi R, Kumar B, Imam ZS. Sarcomatoid Carcinoma of Renal Pelvis with Abundant Heterologous Osteosarcomatous Element: A Case Report. J Clin Diagn Res 2017; 11:ED31-ED32. [PMID: 28892918 DOI: 10.7860/jcdr/2017/28312.10268] [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: 03/15/2017] [Accepted: 04/17/2017] [Indexed: 11/24/2022]
Abstract
A 47-year-old male presented with haematuria and flank pain for two weeks. Ultrasonography and renal scan revealed a poorly functioning left kidney with multiple calculi. Simple nephrectomy was performed and the specimen revealed a mass in his renal pelvis which showed both carcinomatous and sarcomatous components on microscopy. The sarcomatous component consisted of diffuse pleomorphic osteoblasts with intervening lacy osteoid, giving an osteosarcoma-like appearance. These areas of tumour were strongly positive for vimentin and osteopontin. The carcinomatous component was transitional cell carcinoma. Patchy areas of squamous cell carcinoma which were positive for pancytokeratin on immunostaining were also seen. Few weeks later, the patient presented with metastatic lesions in the sacrum. After nephrectomy, the patient underwent palliative radiotherapy of the spine followed by sunitinib therapy. A month later, there was recurrence at the site of surgery. The patient succumbed to his illness within five months of diagnosis. This report describes an extremely rare case of carcinoma, renal pelvis with predominantly osteosarcomatous areas.
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Affiliation(s)
- Mona Lisa
- Senior Resident, Department of Pathology, Indira Gandhi Institute of Medical Science, Patna, Bihar, India
| | - Guddi Rani Singh
- Senior Resident, Department of Pathology, Indira Gandhi Institute of Medical Science, Patna, Bihar, India
| | - Richa Madhawi
- Assistant Professor, Department of Radiotherapy, Regional Cancer Center, Indira Gandhi Institute of Medical Science, Patna, Bihar, India
| | - Bipin Kumar
- Professor and Head, Department of Pathology, Indira Gandhi Institute of Medical Science, Patna, Bihar, India
| | - Zeenat Sarmadi Imam
- Senior Resident, Department of Pathology, Indira Gandhi Institute of Medical Science, Patna, Bihar, India
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Wu J, Wang X, Lin C, Yu S, Cai L, Gao Z. Carcinosarcoma of native renal pelvis in recipient after a renal transplant: a case report. World J Surg Oncol 2014; 12:407. [PMID: 25551692 PMCID: PMC4320576 DOI: 10.1186/1477-7819-12-407] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2014] [Accepted: 12/03/2014] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND Carcinosarcoma is a malignancy that rarely occurs in the renal pelvis. MATERIALS AND METHODS We present a case of histologically proven, native renal pelvis carcinosarcoma in a 65-year-old woman who had accepted a renal transplant. We performed a laparoscopic ureterectomy, combined with lymph node dissection and immunosuppression with sirolimus (SRL), which was alternated with the conventional immunosuppressant--cyclosporine. RESULTS This patient was still alive 34 months after renal transplantation. CONCLUSIONS Operation is still the best choice, and the SRL may be beneficial for preventing the progression of a tumor.
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Affiliation(s)
| | | | | | | | - Li Cai
- Department of Urology, Yantai Yuhuangding Hospital, No,20 East Yuhuangding Road, Yantai, Shandong Province 264000, China.
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Tian X, Zhao J, Wang Y, Xing N. Sarcomatoid carcinoma of the renal pelvis: A case report. Oncol Lett 2014; 8:1208-1210. [PMID: 25120689 PMCID: PMC4114623 DOI: 10.3892/ol.2014.2240] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2013] [Accepted: 05/15/2014] [Indexed: 11/06/2022] Open
Abstract
Sarcomatoid carcinoma is a high-grade malignant neoplasm which exhibits morphological and/or immunohistochemical evidence of bidirectional epithelial and mesenchymal differentiation. Sarcomatoid carcinoma occurring in the upper urinary tract is rare. The present study reports a case of primary sarcomatoid carcinoma of the renal pelvis. A 49-year-old female patient was admitted to Beijing Chao-Yang Hospital for experiencing two weeks of intermittent hematuria. A computed tomography scan revealed a mass of 2 cm in diameter in the left renal pelvis. A retroperitoneoscopic nephroureterectomy combined with a bladder cuff excision was performed, and the final pathological diagnosis was sarcomatoid carcinoma of the renal pelvis. The patient did not receive systemic chemotherapy and radiotherapy. Regular follow-up was performed for 30 months, and there was no evidence of tumor local recurrence or distant metastasis.
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Affiliation(s)
- Xiquan Tian
- Department of Urology, Beijing Chao-Yang Hospital, Capital Medical University, Beijing 100020, P.R. China
| | - Jiyu Zhao
- Department of Urology, Beijing Chao-Yang Hospital, Capital Medical University, Beijing 100020, P.R. China
| | - Yue Wang
- Department of Pathology, Beijing Chao-Yang Hospital, Capital Medical University, Beijing 100020, P.R. China
| | - Nianzeng Xing
- Department of Urology, Beijing Chao-Yang Hospital, Capital Medical University, Beijing 100020, P.R. China
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Fernández-Pello S, Venta V, González I, Gil R, Menéndez CL. Pyonephrosis as a sign of sarcomatoid carcinoma of the renal pelvis. World J Clin Cases 2014; 2:215-218. [PMID: 24945010 PMCID: PMC4061312 DOI: 10.12998/wjcc.v2.i6.215] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2013] [Revised: 01/06/2014] [Accepted: 05/08/2014] [Indexed: 02/05/2023] Open
Abstract
We report the case of an urgent nephrectomy because of a pyonephrosis and sepsis due to an unsuspected sarcomatoid transitional cell carcinoma, an infrequent subtype with a bad oncological prognosis. We present a 58-year-old man assessed by internal medicine for a general syndrome and weakness many months previously. A pyonephrotic kidney was observed at abdominal computed tomography in the context of septic shock, without suspecting the underlying cause. The pathology report described a sarcomatoid transitional cell carcinoma. Sarcomatoid transitional cell carcinoma is an invasive and infrequent subtype of urothelial tumors. The symptoms are often the same as other renal masses; however, in this case, sepsis and pyonephrosis were the rare initial symptoms.
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Dong B, Zhang JJ, Chen C, Wang YT, Zhai XY, Fu YW, Zhou HL. Diagnosis and treatment of carcinosarcoma of the renal pelvis: A case report. Oncol Lett 2014; 8:467-469. [PMID: 24959298 PMCID: PMC4063624 DOI: 10.3892/ol.2014.2145] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2013] [Accepted: 04/29/2014] [Indexed: 11/06/2022] Open
Abstract
Carcinosarcoma is a rare type of renal pelvis malignancy, the diagnosis of which requires the presence of malignant epithelial and mesenchymal components. The prognosis of this disease is extremely poor due to its rapid progression and widespread metastases. The present study describes a case of carcinosarcoma involving the right renal pelvis in a 73-year-old female who presented with intermittent hematuria and right-flank pain that had persisted for one month. Computed tomography revealed a 2.4×2.5 cm mass in the right renal pelvis, which was diagnosed as a right renal pelvic tumor. Laparoscopic radical resection of the right kidney and ureter was performed. Following surgery, immunohistochemical analysis showed positive reactions for epithelial and mesenchymal markers. Based on these findings, the patient was diagnosed with carcinosarcoma. Thus, immunohistochemical analysis is a critical method for the accurate diagnosis of carcinosarcoma.
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Affiliation(s)
- Biao Dong
- Department of Urology, First Hospital of Jilin University, Jilin, Changchun 130021, P.R. China
| | - Jian-Jian Zhang
- Department of Hepatic Surgery, Renji Hospital, Shanghai Jiaotong University School of Medicine, Shanghai 200127, P.R. China
| | - Chao Chen
- Department of Critical Care Medicine, Henan Province People's Hospital, Zhengzhou, Henan 450003, P.R. China
| | - Yuan-Tao Wang
- Department of Urology, First Hospital of Jilin University, Jilin, Changchun 130021, P.R. China
| | - Xiu-Yu Zhai
- Department of Urology, First Hospital of Jilin University, Jilin, Changchun 130021, P.R. China
| | - Yao-Wen Fu
- Department of Urology, First Hospital of Jilin University, Jilin, Changchun 130021, P.R. China
| | - Hong-Lan Zhou
- Department of Urology, First Hospital of Jilin University, Jilin, Changchun 130021, P.R. China
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Sarcomatoid variant of urothelial carcinoma (carcinosarcoma, spindle cell carcinoma): a review of the literature. ISRN UROLOGY 2014; 2014:794563. [PMID: 24587922 PMCID: PMC3920806 DOI: 10.1155/2014/794563] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/23/2013] [Accepted: 11/09/2013] [Indexed: 01/09/2023]
Abstract
Background. Sarcomatoid variant of urothelial carcinoma (SVUC) was added to the WHO classification in 2004. Aims. To review the literature. Materials and Method. Various internet databases were used. Result. SVUCs are rare biphasic malignant neoplasms exhibiting morphologic/immunohistochemical evidence of epithelial and mesenchymal differentiation with the presence or absence of heterologous elements. Some cases of SVUC have been associated with radiation therapy and cyclophosphamide treatment. Patients' ages range from 50 to 77 years (mean age 66). Patients tend to be younger and they more commonly presented with high-grade histology and advanced stage disease, in comparison with patients who had conventional urothelial carcinoma (CUC). Results of molecular/genetic studies strongly argue for a common monoclonal cell origin of both the epithelial and mesenchymal components in SUVC. The cancer specific survival of SVUC is poor in comparison with CUC. Radical surgical excision and chemoradiation may be associated with improved prognosis; chemoradiation as an organ preserving alternative to radical excision may be associated with improved outcome. There is no consensus opinion on the best treatment modalities for SUVC. Conclusions. SVUC is rare and is associated with inferior outcome compared with CUC. A multicentre trial of various treatment options is required. Cases of SVUC should be reported.
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12
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Chen S, Chen G, Xia D, Li J, Wang S, Shen B, Jin B. Sarcomatoid carcinoma of the renal pelvis: Experience of multiple cases over a ten-year period. Oncol Lett 2013; 6:513-516. [PMID: 24137357 PMCID: PMC3788826 DOI: 10.3892/ol.2013.1396] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2013] [Accepted: 05/15/2013] [Indexed: 11/06/2022] Open
Abstract
Sarcomatoid carcinoma of the renal pelvis is a rare clinical entity. To the best of our knowledge, only 14 cases of this type of neoplasm have been reported in the literature to date. In the present study, the records at The First Affiliated Hospital, Medicine School of Zhejiang University (Hangzhou, Zhejiang, China) between 2000 and 2010 were reviewed to identify patients with primary renal pelvis sarcomatoid carcinoma (RPSC). A particular emphasis was placed on the treatment, recurrence and survival outcome. Eight patients with RPSC were identified and treated with nephrectomy or nephroureterectomy. All of the patients presented with Grade 3 RPSC. According to the TNM classification system, 2 patients were in stage pT2, 5 in stage pT3 and 1 in stage pT4. Adjuvant chemotherapy was administered to four patients, and the mean follow-up period was 27.5±41.0 months. In total, 6 patients succumbed to the disease with a mean survival time of 7.7±5.3 months (range, 1-18 months), while 2 patients were free of disease at 54 and 120 months, respectively, following treatment. The mean disease-specific survival time was 27.5±41.0 months and the 1-year recurrence-free survival, 1-year survival and overall survival rates were 37.5, 37.5 and 25%, respectively. The present analysis suggests a poor prognosis for the majority of RPSC patients, most likely resulting from the advanced stage of the disease at diagnosis and a poor response to systemic therapy. To improve the survival rate of RPSC, it is therefore essential to perform an early diagnosis and early radical surgery. Intravesical instillation is not essential following surgery.
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Affiliation(s)
- Shanwen Chen
- Departments of Urology, Medical School of Zhejiang University, Hangzhou, Zhejiang 310031, P.R. China
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Terada T. Synchronous squamous cell carcinoma of the kidney, squamous cell carcinoma of the ureter, and sarcomatoid carcinoma of the urinary bladder: A case report. Pathol Res Pract 2010; 206:379-83. [DOI: 10.1016/j.prp.2009.07.021] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2009] [Revised: 06/16/2009] [Accepted: 07/21/2009] [Indexed: 10/20/2022]
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Neoplasms of the upper urinary tract: a review with focus on urothelial carcinoma of the pelvicalyceal system and aspects related to its diagnosis and reporting. Adv Anat Pathol 2008; 15:127-39. [PMID: 18434765 DOI: 10.1097/pap.0b013e31817145a9] [Citation(s) in RCA: 91] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Tumors of the renal pelvis account for approximately 7% to 8% of all renal malignancies, greater than 90% of these are of urothelial (transitional cell) origin. These tumors more typically occur in the sixth to eight decade with a slight male preponderance. Varying risk factors for urothelial carcinomas of the upper tract are recognized including environmental and occupational hazards, chemotherapeutic exposure, and previous history of urinary bladder or ureteral carcinomas. Tumor multifocality is frequent and additional tumors may arise in the ureter, bladder, or on the contralateral side. The histopathologic nuances presented by urothelial carcinoma in this region are generally similar to those in the urinary bladder. Though the World Health Organization 2004/International Society of Urological Pathology system used in the bladder is customarily also employed for grading of urothelial tumors of this region, its prognostic significance at this site is not entirely clear as most tumors are treated with nephroureterectomy irrespective of the grade of the tumor. Histologic grade may be an independent prognostic factor in papillary pT1 tumors; however, most pT2 and higher stage tumors tend to be nonpapillary and of higher grade. Despite advances in treatment modalities with sophisticated endoscopic techniques, tumor stage remains the most important prognostic factor. There are several confounding issues related to staging such as the variable presence and thickness of subepithelial connective tissue and muscularis in the renal calyces, renal pelvis, and the ureter; intratubular pagetoid cancer spread (pTis vs. pT3); and assessing invasion in papillary neoplasms with endophytic or inverted growth. Careful gross examination with adequate sampling and understanding the microanatomy of the pelvicalyceal wall are crucial for accurate stage assignment. Poor fixation of large friable tumors and processing artifacts may compound difficulties in accurate staging. This review focuses on urothelial carcinoma of the upper tract highlighting issues related to its diagnosis, staging, and reporting.
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Lopez-Beltran A, Requena MJ, Cheng L, Montironi R. Pathological variants of invasive bladder cancer according to their suggested clinical significance. BJU Int 2008; 101:275-81. [DOI: 10.1111/j.1464-410x.2007.07271.x] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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16
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Perez-Montiel D, Suster S. Upper urinary tract carcinomas: histological types and unusual morphological variants. ACTA ACUST UNITED AC 2008. [DOI: 10.1016/j.mpdhp.2007.11.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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17
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Folpe AL, Cooper K. Best practices in diagnostic immunohistochemistry: pleomorphic cutaneous spindle cell tumors. Arch Pathol Lab Med 2007; 131:1517-24. [PMID: 17922587 DOI: 10.5858/2007-131-1517-bpidip] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/06/2007] [Indexed: 11/06/2022]
Abstract
CONTEXT Pleomorphic cutaneous spindle cell tumors can be difficult to distinguish solely on histologic grounds. The use of ancillary immunohistochemical studies can greatly assist in this differential diagnosis. OBJECTIVE To review histologic and immunohistochemical aspects of cutaneous spindle cell tumors and discuss a basic panel of markers to assist in the differential diagnosis. DATA SOURCES English-language literature published between 1981 and 2005. CONCLUSIONS A basic immunohistochemistry panel for high-molecular-weight cytokeratin, melanocytic markers (S100 protein, HMB-45, Melan-A), smooth muscle actin, desmin, and endothelial markers (CD31, CD34) is effective in diagnosing most cutaneous spindle cell tumors.
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Affiliation(s)
- Andrew L Folpe
- Division of Anatomic Pathology, Mayo Clinic, 200 1st St SW, Rochester, MN 55905, USA.
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18
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Lott S, Lopez-Beltran A, Montironi R, MacLennan GT, Cheng L. Soft tissue tumors of the urinary bladder Part II: malignant neoplasms. Hum Pathol 2007; 38:963-977. [PMID: 17574946 DOI: 10.1016/j.humpath.2007.03.016] [Citation(s) in RCA: 65] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2007] [Accepted: 03/20/2007] [Indexed: 02/02/2023]
Abstract
Most bladder tumors arise from the urothelium. However, there are several uncommon but significant malignant bladder lesions that must be differentiated from urothelial carcinomas and from benign lesions of the bladder. The second half of this two-part review will describe rare nonurothelial malignant tumors of the urinary bladder including leiomyosarcoma, rhabdomyosarcoma, angiosarcoma, malignant fibrous histiocytoma (undifferentiated sarcoma), primitive neuroectodermal tumor, malignant peripheral nerve sheath tumor, hemangiopericytoma, and alveolar soft-parts sarcoma. Common clinical presentations, morphologic characteristics, and immunohistochemical features are described to aid the practicing pathologist in the identification of these entities. Because the distinction between malignant and benign lesions has significant therapeutic and prognostic implications, key factors for differentiating them are presented.
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Affiliation(s)
- Sarah Lott
- Department of Pathology and Laboratory Medicine, Indiana University School of Medicine, Indianapolis, IN 46202, USA
| | - Antonio Lopez-Beltran
- Department of Urology, Indiana University School of Medicine, Indianapolis, IN 46202, USA; Department of Pathology, Cordoba University, E-14004 Cordoba, Spain
| | - Rodolfo Montironi
- Institute of Pathological Anatomy and Histopathology, School of Medicine, Polytechnic University of the Marche Region (Ancona), United Hospitals, 60020 Ancona, Italy
| | - Gregory T MacLennan
- Department of Pathology, Case Western Reserve University, Cleveland, OH 44106, USA
| | - 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; Department of Pathology, Cordoba University, E-14004 Cordoba, Spain.
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Masue N, Hasegawa Y, Moriyama Y, Ikeda Y, Gotoh T, Deguchi T. Spontaneous disappearance of multiple lung metastases after nephroureterectomy from sarcomatoid carcinoma of the renal pelvis: A case report. Int J Urol 2006; 14:75-8. [PMID: 17199865 DOI: 10.1111/j.1442-2042.2006.01603.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
We report a case in which lung metastases disappeared spontaneously after nephroureterectomy from sarcomatoid carcinoma of the renal pelvis. A 58-year-old man presented with gross hematuria. Computed tomography (CT) revealed a left renal tumor and multiple lung metastases. Intravenous pyelography revealed a filling defect in the upper renal calyx. Urine cytology was positive. Left renal pelvic cancer was diagnosed and nephroureterectomy performed. The resected specimen was diagnosed pathologically as sarcomatoid carcinoma of the renal pelvis. Approximately 5 months later, CT revealed that the lung metastases had disappeared. There has been no evidence of disease for 46 months postoperatively.
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Affiliation(s)
- Naruyasu Masue
- Department of Urology, Matsunami General Hospital, Gifu University, Gifu, Japan.
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20
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Affiliation(s)
- Anastasia M Canacci
- Department of Pathology, Case University Hospitals of Cleveland, Cleveland, Ohio, USA
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21
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Perez-Montiel D, Wakely PE, Hes O, Michal M, Suster S. High-grade urothelial carcinoma of the renal pelvis: clinicopathologic study of 108 cases with emphasis on unusual morphologic variants. Mod Pathol 2006; 19:494-503. [PMID: 16474378 DOI: 10.1038/modpathol.3800559] [Citation(s) in RCA: 160] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
A clinicopathologic study of 108 cases of high-grade urothelial carcinomas of the renal pelvis is presented. Of the 108 tumors, 44 (40%) showed unusual morphologic features, including micropapillary areas (four cases), lymphoepithelioma-like carcinoma (two cases), sarcomatoid carcinoma (eight cases, including pseudoangiosarcomatous type), squamous differentiation and squamous cell carcinoma (15 cases), clear cells (two cases), glandular differentiation (two cases), rhabdoid, signet-ring or plasmacytoid cells (four cases), pseudosarcomatous stromal changes (four cases) and intratubular extension into the renal pelvis (three cases). Pathological staging was available in 62 patients; of these, 46 cases (74%) were in high stage (pT2-pT4) and 16 (26%) were in low stage (pTis, pTa, pT1). Clinical follow-up ranging from 1 to 256 months (median: 50 months) was available in 42 patients; of these, 26 (61%) died of tumor with a median survival of 31 months. The patients who did not die of their tumors showed only minimal or focal infiltration of the renal parenchyma by urothelial carcinoma, whereas those who died of their tumors showed massive infiltration of the kidney by the tumor. High-grade urothelial carcinomas of the renal pelvis can show a broad spectrum of histologic features similar to those seen in the urinary bladder. Our results support the finding that, unlike urothelial carcinomas of the bladder, the majority of primary urothelial carcinomas of the renal pelvis are of high histologic grade and present in advanced stages. Our study further highlights the fact that, in the renal pelvis, urothelial carcinomas show a tendency to frequently display unusual morphologic features and metaplastic phenomena. The importance of recognizing these morphologic variants of urothelial carcinoma in the renal pelvis is to avoid confusion with other conditions. The possibility of a high-grade urothelial carcinoma should always be considered in the evaluation of a tumor displaying unusual morphologic features in the renal pelvis, and attention to proper sampling as well as the use of immunohistochemical stains will be of importance to arrive at the correct diagnosis.
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MESH Headings
- Adult
- Aged
- Aged, 80 and over
- Carcinoma, Renal Cell/metabolism
- Carcinoma, Renal Cell/pathology
- Carcinoma, Renal Cell/virology
- Carcinoma, Squamous Cell/metabolism
- Carcinoma, Squamous Cell/pathology
- Carcinoma, Squamous Cell/virology
- Carcinoma, Transitional Cell/metabolism
- Carcinoma, Transitional Cell/pathology
- Carcinoma, Transitional Cell/virology
- Diagnosis, Differential
- Female
- Humans
- Immunohistochemistry
- In Situ Hybridization
- Keratin-7
- Keratins/analysis
- Kidney Neoplasms/metabolism
- Kidney Neoplasms/pathology
- Kidney Neoplasms/virology
- Kidney Pelvis
- Male
- Middle Aged
- RNA, Viral/genetics
- Urinary Bladder Neoplasms/metabolism
- Urinary Bladder Neoplasms/pathology
- Urinary Bladder Neoplasms/virology
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Affiliation(s)
- Delia Perez-Montiel
- Department of Pathology, Ohio State University Medical Center, The Ohio State University, University Hospital, Columbus, OH 43210, USA
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22
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Thiel DD, Igel TC, Wu KJ. Sarcomatoid carcinoma of transitional cell origin confined to renal pelvis. Urology 2006; 67:622.e9-11. [PMID: 16504263 DOI: 10.1016/j.urology.2005.09.026] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2004] [Revised: 08/22/2005] [Accepted: 09/20/2005] [Indexed: 10/25/2022]
Abstract
Thirteen reported cases of renal pelvic sarcomatoid carcinoma have been documented since 1961, and all patients presented with metastatic disease or advanced renal parenchyma involvement. The mean survival was shorter than 9 months, and adjuvant therapy appeared to offer no benefit. We present the case of a 61-year-old man with gross hematuria and a large filling defect on computed tomography excretory urography. Surgical pathologic examination after laparoscopic nephroureterectomy was consistent with renal pelvis-confined sarcomatoid carcinoma of transitional cell origin. Adjuvant therapy was not given secondary to the organ-confined nature of disease. The patient was without recurrence for more than 1 year.
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Affiliation(s)
- David D Thiel
- Department of Urology, Mayo Clinic Jacksonville, Florida 32224, USA
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23
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Shimasaki N, Inoue K, Nishigawa H, Kuroda N, Shuin T. Combined small cell carcinoma and sarcomatoid squamous cell carcinoma in the renal pelvis. Int J Urol 2006; 12:686-9. [PMID: 16045564 DOI: 10.1111/j.1442-2042.2005.01134.x] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
We report here a case of combined small cell carcinoma and sarcomatoid squamous cell carcinoma in the renal pelvis. A 61-year-old female presented with right flank discomfort, microhematuria and progressive renal dysfunction. Following diagnosis of right renal pelvic carcinoma, radical nephroureterectomy with lymph node dissection was performed through a midline incision. The tumor was pathologically diagnosed to be combined small cell carcinoma and sarcomatoid squamous cell carcinoma in the renal pelvis. The patient had no evidence of recurrence or metastasis, 16 months postoperatively. Small cell carcinoma or sarcomatoid squamous cell carcinoma of the renal pelvis is very rare. We believe this is the first such case to be reported in the world.
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Affiliation(s)
- Nobuyuki Shimasaki
- Department of Urology and Pathology I, Kochi Medical School, Kochi, Japan.
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24
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Acikalin MF, Kabukcuoglu S, Can C. Sarcomatoid carcinoma of the renal pelvis with giant cell tumor-like features: Case report with immunohistochemical findings. Int J Urol 2005; 12:199-203. [PMID: 15733116 DOI: 10.1111/j.1442-2042.2005.01002.x] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Sarcomatoid transitional cell carcinoma is a rare entity, in which a malignant, overtly epithelial component coexists with areas having a sarcoma-like appearance. Histological distinction of sarcomatoid carcinomas from carcinosarcomas is often difficult and immunohistochemistry is a helpful diagnostic adjunct in the correct diagnosis. In the present report, we describe an uncommon case of sarcomatoid transitional cell carcinoma of the renal pelvis, associated with giant cell tumor-like features. Immunoperoxidase staining for cytokeratin was positive in spindle cell component, indicating an epithelial origin. The carcinomatous component showed a diffuse membranous reactivity for E-cadherin, whereas the reactivity was sporadic and weaker in the sarcomatoid component, suggesting that the decrease of E-cadherin expression might be associated with the acquisition of sarcomatous morphology. Osteoclast-like multinucleated giant cells were positive for CD68 and negative for p53 oncoprotein, suggesting that they represent a non-neoplastic component that is reactively induced in the tumor stroma.
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25
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Hisataki T, Takahashi A, Taguchi K, Shimizu T, Suzuki K, Takatsuka K, Iwaki H. Sarcomatoid transitional cell carcinoma originating from a duplicated renal pelvis. Int J Urol 2001; 8:704-6. [PMID: 11851772 DOI: 10.1046/j.1442-2042.2001.00396.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
A case of sarcomatoid transitional cell carcinoma of the renal pelvis is reported. It was distinguished from carcinosarcoma by immunohistochemical study. The tumor was difficult to distinguish from a renal parenchymal tumor in imaging studies because it originated from a duplicated renal pelvis.
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Affiliation(s)
- T Hisataki
- Department of Urology, Sunagawa City Medical Center, Sunagawa, Japan.
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26
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Abstract
Progress of molecular biology with regard to etiopathogeny of tumours in general, and cancer of the bladder in particular, is taking place at such a vertiginous pace that practising urologists find themselves overwhelmed in terms of their ability to learn and keep updated in so complex a subject. The understanding of certain molecular factors with critical influence on the formation, growth and progression of a tumour of the bladder, is forcing us to make unbiased assessments on the role they will play in the evolution and survival of this neoplasia. It is anticipate they will be much more reliable than traditionally established morphological factors such as grade and stage. We also include a literature review with an analysis and elucidation of the role played by oncogenes, tumor suppressor genes, vascular density markers, telomerase etc., in the formation and growth of cancer of the bladder and their likely relationships with already established clinico-pathological factors.
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27
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Abstract
A case of sarcomatoid carcinoma of the renal pelvis is reported. A 72-year-old male was admitted with a chief complaint of right flank pain. Clinical imaging studies revealed marked dilation of the right renal pelvis caused by a tumor at the pyeloureteric region. Right nephrectomy was performed in June 1999. The 8.4 x 6.5 cm tumor was grossly polypoid in appearance and protruded into the renal pelvis. Histologically, sarcomatoid spindle cells predominated over the carcinomatous component (mainly transitional cell carcinoma, partly associated with squamous cell and adenocarcinoma components). Osteoclast-like CD68-positive multinucleated giant cells were scattered. The sarcomatoid component was immunoreactive for both cytokeratin and vimentin. Sarcomatoid cells negative for cytokeratin were also noted. In both the sarcomatoid and carcinomatous components, nuclear overexpression of p53 oncoprotein was confirmed. The histogenesis of sarcomatoid carcinoma of the renal pelvis is discussed.
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Affiliation(s)
- Y Sekido
- Department of Pathology, Tokai University School of Medicine, Isehara, Japan
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28
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Luque Barona RJ, González Cámpora R, Vicioso Recio L, Requena Tapias MJ, López Beltrán A. [Synchronous prostatic carcinosarcoma: report of 2 cases and review of the literature]. Actas Urol Esp 2000; 24:173-8. [PMID: 10829449 DOI: 10.1016/s0210-4806(00)72425-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
OBJECTIVE Carcinosarcoma of the prostate is a biphasic tumor containing adenocarcinoma and recognisable sarcomatous components. It is a rare neoplasm with less than 40 reported cases. We describe two additional examples showing carcinosarcoma in the initial pathologic material (synchronous presentation). METHODS AND RESULTS The patients were 71 and 78 year-old, respectively. The primary prostatic tumour in case one was composed of adenocarcinoma admixed with a neoplastic mesenchymal component that displayed foci of chondrosarcoma, rhabdomyosarcoma and angiosarcoma. The adenocarcinoma in the second case was admixed with spindle cell sarcoma and chondrosarcoma. Both patients died of disease after surgery, 3 and 9 months respectively. CONCLUSION Synchronous carcinosarcoma of the prostate is a highly malignant neoplasm that may need an aggressive therapy.
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Affiliation(s)
- R J Luque Barona
- Departamento de Anatomía Patológica, Hospitales Universitarios Virgen del Rocío, Sevilla
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