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Asadi-Aghbolaghi M, Darbandsari A, Zhang A, Contreras-Sanz A, Boschman J, Ahmadvand P, Köbel M, Farnell D, Huntsman DG, Churg A, Black PC, Wang G, Gilks CB, Farahani H, Bashashati A. Learning generalizable AI models for multi-center histopathology image classification. NPJ Precis Oncol 2024; 8:151. [PMID: 39030380 PMCID: PMC11271637 DOI: 10.1038/s41698-024-00652-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Accepted: 07/11/2024] [Indexed: 07/21/2024] Open
Abstract
Investigation of histopathology slides by pathologists is an indispensable component of the routine diagnosis of cancer. Artificial intelligence (AI) has the potential to enhance diagnostic accuracy, improve efficiency, and patient outcomes in clinical pathology. However, variations in tissue preparation, staining protocols, and histopathology slide digitization could result in over-fitting of deep learning models when trained on the data from only one center, thereby underscoring the necessity to generalize deep learning networks for multi-center use. Several techniques, including the use of grayscale images, color normalization techniques, and Adversarial Domain Adaptation (ADA) have been suggested to generalize deep learning algorithms, but there are limitations to their effectiveness and discriminability. Convolutional Neural Networks (CNNs) exhibit higher sensitivity to variations in the amplitude spectrum, whereas humans predominantly rely on phase-related components for object recognition. As such, we propose Adversarial fourIer-based Domain Adaptation (AIDA) which applies the advantages of a Fourier transform in adversarial domain adaptation. We conducted a comprehensive examination of subtype classification tasks in four cancers, incorporating cases from multiple medical centers. Specifically, the datasets included multi-center data for 1113 ovarian cancer cases, 247 pleural cancer cases, 422 bladder cancer cases, and 482 breast cancer cases. Our proposed approach significantly improved performance, achieving superior classification results in the target domain, surpassing the baseline, color augmentation and normalization techniques, and ADA. Furthermore, extensive pathologist reviews suggested that our proposed approach, AIDA, successfully identifies known histotype-specific features. This superior performance highlights AIDA's potential in addressing generalization challenges in deep learning models for multi-center histopathology datasets.
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Affiliation(s)
| | - Amirali Darbandsari
- Department of Electrical and Computer Engineering, University of British Columbia, Vancouver, BC, Canada
| | - Allen Zhang
- Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, BC, Canada
- Vancouver General Hospital, Vancouver, BC, Canada
| | | | - Jeffrey Boschman
- School of Biomedical Engineering, University of British Columbia, Vancouver, BC, Canada
| | - Pouya Ahmadvand
- School of Biomedical Engineering, University of British Columbia, Vancouver, BC, Canada
| | - Martin Köbel
- Department of Pathology and Laboratory Medicine, University of Calgary, Calgary, AB, Canada
| | - David Farnell
- Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, BC, Canada
- Vancouver General Hospital, Vancouver, BC, Canada
| | - David G Huntsman
- Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, BC, Canada
- BC Cancer Research Institute, Vancouver, BC, Canada
| | - Andrew Churg
- Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, BC, Canada
- Vancouver General Hospital, Vancouver, BC, Canada
| | - Peter C Black
- Department of Urologic Sciences, University of British Columbia, Vancouver, BC, Canada
| | - Gang Wang
- Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, BC, Canada
| | - C Blake Gilks
- Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, BC, Canada
- Vancouver General Hospital, Vancouver, BC, Canada
| | - Hossein Farahani
- School of Biomedical Engineering, University of British Columbia, Vancouver, BC, Canada
| | - Ali Bashashati
- School of Biomedical Engineering, University of British Columbia, Vancouver, BC, Canada.
- Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, BC, Canada.
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Vlachou E, Johnson BA, Baraban E, Nadal R, Hoffman-Censits J. Current Advances in the Management of Nonurothelial Subtypes of Bladder Cancer. Am Soc Clin Oncol Educ Book 2024; 44:e438640. [PMID: 38870453 DOI: 10.1200/edbk_438640] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/15/2024]
Abstract
Urothelial cancer (UC) is the most common histology seen in bladder tumors. The 2022 WHO classification of urinary tract tumors includes a list of less common subtypes (formerly known as variants) for invasive UC which are considered high-grade tumors. This review summarizes the most recent advances in the management of selected nonurothelial subtypes of bladder cancer: squamous cell carcinoma, small cell carcinoma, sarcomatoid urothelial carcinoma, micropapillary carcinoma, plasmacytoid carcinoma, adenocarcinoma, and urachal carcinoma. The role of neoadjuvant and adjuvant chemotherapy has not been well characterized for most of these histologies, and prospective data are extremely limited. Participation in clinical trials is recommended in advanced disease.
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Affiliation(s)
- Evangelia Vlachou
- Johns Hopkins University Sidney Kimmel Comprehensive Cancer Center, Baltimore, MD
- The Johns Hopkins Greenberg Bladder Cancer Institute, Baltimore, MD
| | - Burles Avner Johnson
- Johns Hopkins University Sidney Kimmel Comprehensive Cancer Center, Baltimore, MD
- The Johns Hopkins Greenberg Bladder Cancer Institute, Baltimore, MD
| | - Ezra Baraban
- Department of Pathology, Johns Hopkins Hospital, Baltimore, MD
| | - Rosa Nadal
- Cellular and Molecular Therapeutics Branch, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD
| | - Jean Hoffman-Censits
- Johns Hopkins University Sidney Kimmel Comprehensive Cancer Center, Baltimore, MD
- The Johns Hopkins Greenberg Bladder Cancer Institute, Baltimore, MD
- Department of Pathology, Johns Hopkins Hospital, Baltimore, MD
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Sangoi AR, Pivovarcikova K, Akgul M, Williamson SR, Ulamec M, Rogala JD, Martinek P, Vanecek T, Hes O, Alaghehbandan R. Chromophobe Renal Cell Carcinoma With Extensive Retraction Artifact: A Potential Diagnostic Pitfall From Micropapillary Urothelial Carcinoma. Int J Surg Pathol 2024:10668969241239678. [PMID: 38567430 DOI: 10.1177/10668969241239678] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/04/2024]
Abstract
In addition to "classic" and eosinophilic subtype, chromophobe renal cell carcinoma (RCC) is well-known to demonstrate various morphological patterns including adenomatoid, microcystic, pigmented, multicystic, papillary, neuroendocrine-like, and small cell-like, all of which are important to appreciate for accurate diagnosis. Herein, we expand on a unique chromophobe RCC morphology not previously described consisting of tumor cells with extensive stromal retraction, mimicking upper urothelial tract micropapillary carcinoma (MPC). Twelve MPC-like chromophobe RCC nephrectomies were reviewed with clinicopathological features recorded; molecular testing was performed on 7 of 12 tumors. Patients were mostly men (n=10) with a mean age of 65 years. Mean tumor size was 6.4 cm with pathological stage distribution as follows: 4 (33%) T1a, 2 (17%) T1b, 1 (8%) T2b, and 3 (25%) T3a. The extent of MPC-like chromophobe RCC foci ranged from 10% to 40% (mean=26%; there was no correlation between the extent of MPC-like chromophobe RCC foci and tumor stage). Other chromophobe RCC morphological patterns were not identified. When performed, all (100%) tumors depicted prototypic chromophobe RCC staining pattern of KIT positivity/KRT7 positivity. Molecular showed 6 of 7 (86%) with multiple chromosomal losses. Clinically significant mutations were identified in NF1, TP53, FLCN (likely somatic), CHEK2, and ZFHX3 genes. Follow up available in 9 patients showed no evidence of disease (mean=23 months). Although the etiology behind the extensive stromal retraction in our tumors is unknown, this may likely be artifactual in nature. Nonetheless, it is important to include MPC-like chromophobe RCC in the spectrum of "variant" morphologies to avoid diagnostic pitfalls from micropapillary carcinoma.
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Affiliation(s)
- Ankur R Sangoi
- Department of Pathology, Stanford Medical Center, Stanford, CA, USA
| | - Kristyna Pivovarcikova
- Department of Pathology, Charles University Hospital and Medical Facility Plzen, Plzen, Czech Republic
| | - Mahmut Akgul
- Department of Pathology and Laboratory Medicine, Albany Medical Center, Albany, NY, USA
| | - Sean R Williamson
- Department of Anatomic Pathology, Robert J. Tomsich Pathology and Laboratory Medicine Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Monica Ulamec
- Department of Pathology, Sestre Milosrdnice University Hospital Center, Department of Pathology and Scientific Centre of Excellence for Reproductive and Regenerative Medicine, School of Medicine, University of Zagreb, Zagreb, Croatia
| | - Joanna Dominica Rogala
- Department of Pathology, Regional Specialist Hospital, Wrocław; Department of Pathology, Public Specialist Hospital, Nowa Sól, Poland
| | - Petr Martinek
- Department of Pathology, Charles University Hospital and Medical Facility Plzen, Plzen, Czech Republic
| | - Tomas Vanecek
- Department of Pathology, Charles University Hospital and Medical Facility Plzen, Plzen, Czech Republic
| | - Ondrej Hes
- Department of Pathology, Charles University Hospital and Medical Facility Plzen, Plzen, Czech Republic
| | - Reza Alaghehbandan
- Department of Anatomic Pathology, Robert J. Tomsich Pathology and Laboratory Medicine Institute, Cleveland Clinic, Cleveland, OH, 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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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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Cannon E, Ntala C, Joss N, Rahilly M, Metcalfe W, O'Donnell M, Phelan PJ. High grade urothelial carcinoma in kidney transplant patients with a history of BK viremia - Just a coincidence? Clin Transplant 2023; 37:e15113. [PMID: 37650442 DOI: 10.1111/ctr.15113] [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: 05/30/2023] [Revised: 07/17/2023] [Accepted: 08/20/2023] [Indexed: 09/01/2023]
Abstract
INTRODUCTION Kidney transplant recipients (KTR) have a three-to-four-fold increased risk of developing urothelial carcinoma (UC) compared to the general population. BK polyoma virus (BKV) infection is known to affect approximately 15% of KTR. In vitro models support a potential pathogenic role for BKV in the development of UC. We describe a series of UC in kidney transplant recipients. METHODS Electronic patient records were searched to identify KTR with UC who had undergone kidney only or simultaneous kidney and pancreas transplantation in a single UK center between 2009 and 2015. Where available, stored pathological samples were retrieved, re-examined and stained for SV40 as a marker of BKV using standard staining protocols for kidney biopsy samples. RESULTS Fourteen KTR had developed UC post-transplant. Of these, 10 KTR had a history of BKV infection post-transplant. Six of these 10 KTR developed a rare micropapillary tumor subtype of UC which is typically only found in <1% of UC cases. All six micropapillary tumor samples stained positive for SV40, including samples from metastases. Three tumor samples were available from the four KTR with no history of BKV infection and were not micropapillary subtype and were negative for SV40. Three micropapillary tumors from immunocompetent patients were examined as controls and were negative for SV40. CONCLUSIONS These findings would support a pathogenic role for BK virus in the development of rare micropapillary subtype urothelial tumors in the kidney transplant population.
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Affiliation(s)
- Emma Cannon
- The Department of Renal Medicine, The Royal Infirmary of Edinburgh, Edinburgh, UK
| | - Chara Ntala
- The Department of Pathology, Western General Hospital, Edinburgh, UK
| | - Nicola Joss
- The Department of Renal Medicine, Raigmore Hospital, Inverness, UK
| | - Maeve Rahilly
- The Department of Pathology, Victoria Hospital, Kirkaldy, Fife, UK
| | - Wendy Metcalfe
- The Department of Renal Medicine, The Royal Infirmary of Edinburgh, Edinburgh, UK
| | - Marie O'Donnell
- The Department of Pathology, Western General Hospital, Edinburgh, UK
| | - Paul J Phelan
- The Department of Renal Medicine, The Royal Infirmary of Edinburgh, Edinburgh, UK
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Nishida H, Kusaba T, Kawamura K, Oyama Y, Daa T. Histopathological Aspects of the Prognostic Factors for Salivary Gland Cancers. Cancers (Basel) 2023; 15:cancers15041236. [PMID: 36831578 PMCID: PMC9954716 DOI: 10.3390/cancers15041236] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2022] [Revised: 01/31/2023] [Accepted: 02/13/2023] [Indexed: 02/17/2023] Open
Abstract
Salivary gland cancers (SGCs) are diagnosed using histopathological examination, which significantly contributes to their progression, including lymph node/distant metastasis or local recurrence. In the current World Health Organization (WHO) Classification of Head and Neck Tumors: Salivary Glands (5th edition), malignant and benign epithelial tumors are classified into 21 and 15 tumor types, respectively. All malignant tumors have the potential for lymph node/distant metastasis or local recurrence. In particular, mucoepidermoid carcinoma (MEC), adenoid cystic carcinoma (AdCC), salivary duct carcinoma, salivary carcinoma, not otherwise specified (NOS, formerly known as adenocarcinoma, NOS), myoepithelial carcinoma, epithelial-myoepithelial carcinoma, and carcinoma ex pleomorphic adenoma (PA) are relatively prevalent. High-grade transformation is an important aspect of tumor progression in SGCs. MEC, AdCC, salivary carcinoma, and NOS have a distinct grading system; however, a universal histological grading system for SGCs has not yet been recommended. Conversely, PA is considered benign; nonetheless, it should be cautiously treated to avoid the development of metastasizing/recurrent PA. The aim of this review is to describe the current histopathological aspects of the prognostic factors for SGCs and discuss the genes or molecules used as diagnostic tools that might have treatment target potential in the future.
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Gandhi J, Chen JF, Al-Ahmadie H. Urothelial Carcinoma: Divergent Differentiation and Morphologic Subtypes. Surg Pathol Clin 2022; 15:641-659. [PMID: 36344181 PMCID: PMC9756812 DOI: 10.1016/j.path.2022.07.003] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
Urothelial carcinoma (UC) is known to encompass a wide spectrum of morphologic features and molecular alterations. Approximately 15% to 25% of invasive UC exhibits histomorphologic features in the form of "divergent differentiation" along other epithelial lineages, or different "subtypes" of urothelial or sarcomatoid differentiation. It is recommended that the percentage of divergent differentiation and or subtype(s) be reported whenever possible. Recent advances in molecular biology have led to a better understanding of the molecular underpinning of these morphologic variations. In this review, we highlight histologic characteristics of the divergent differentiation and subtypes recognized by the latest version of WHO classification, with updates on their molecular and clinical features.
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Affiliation(s)
- Jatin Gandhi
- Department of Pathology and Laboratory Medicine, Emory University School of Medicine, 1364 Clifton Rd, Atlanta, GA 30322, USA
| | - Jie-Fu Chen
- Department of Pathology and Laboratory Medicine, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY 10065, USA
| | - Hikmat Al-Ahmadie
- Department of Pathology and Laboratory Medicine, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY 10065, USA.
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9
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Compérat E, Amin MB, Berney DM, Cree I, Menon S, Moch H, Netto GJ, Rao V, Raspollini MR, Rubin MA, Srigley JR, Tan PH, Tickoo SK, Turajlic S, Tsuzuki T. What's new in WHO fifth edition - urinary tract. Histopathology 2022; 81:439-446. [PMID: 35942645 DOI: 10.1111/his.14764] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Revised: 08/01/2022] [Accepted: 08/03/2022] [Indexed: 11/30/2022]
Abstract
The fifth edition of the WHO Blue Book on urological tumours, specifically in the bladder chapter, represents a refinement and update in the classification of bladder tumours building on the aggregate major changes made in previous editions. Progress in the molecular underpinnings of urothelial tumours, particularly with promising stratifiers for more precision-based treatment approaches, have been made. Special attention has been paid to burning questions in bladder pathology, such as grading, heterogeneous lesions, inverted tumours and substaging. The concept of neuroendocrine tumours will be explained precisely.
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Affiliation(s)
- Eva Compérat
- Department of Pathology, General Hospital, Medical University Vienna, Vienna, Austria
- Department of Pathology, Hôpital Tenon, Sorbonne University, Paris, France
| | - Mahul B Amin
- Department of Pathology and Laboratory Medicine, University of Tennessee Health Sciences Center, Knoxville, TN, USA
- Department of Urology, University of Southern California, Keck School of Medicine, Los Angeles, CA, USA
| | - Dan M Berney
- Department of Cellular Pathology, Barts Cancer Institute, Queen Mary University of London, London, UK
- Barts Health NHS Trust, London, UK
| | - Ian Cree
- International Agency for Research on Cancer (IARC), World Health Organisation, Lyon, France
| | - Santosh Menon
- Department of Pathology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | - Holger Moch
- Department of Pathology and Molecular Pathology, University Hospital Zurich and University Zurich, Zurich, Switzerland
| | - George J Netto
- Department of Medicine, The University of Alabama at Birmingham, Birmingham, AL, USA
| | - Vishal Rao
- Department of Pathology and Molecular Pathology, University Hospital Zurich and University Zurich, Zurich, Switzerland
| | - Maria Rosaria Raspollini
- Histopathology and Molecular Diagnostics, Careggi Hospital, University of Florence, Florence, Italy
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Mark A Rubin
- Bern Center for Precision Medicine and Department for Biomedical Research, Bern, Switzerland
| | - John R Srigley
- Trillium Health Partners and University of Toronto, Mississauga, ON, Canada
| | - Puay Hoon Tan
- Division of Pathology, Singapore General Hospital, Singapore
| | - Satish Kumar Tickoo
- Department of Pathology and Laboratory Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Samra Turajlic
- Cancer Dynamics Laboratory, The Francis Crick Institute, London and Renal and Skin Units, The Royal Marsden NHS Foundation Trust, London, UK
| | - Toyonori Tsuzuki
- Department of Surgical Pathology, School of Medicine, Aichi Medical University, Nagoya, Japan
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10
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Brief update of the new WHO classification for urothelial carcinoma. Curr Opin Urol 2022; 32:511-516. [DOI: 10.1097/mou.0000000000001020] [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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11
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Cimadamore A, Lonati C, Di Trapani E, De Cobelli O, Rink M, Zamboni S, Simeone C, Soria F, Briganti A, Montorsi F, Afferi L, Mattei A, Carando R, Ornaghi PI, Tafuri A, Antonelli A, Karnes RJ, Colomer A, Sanchez-Salas R, Contieri R, Hurle R, Poyet C, Simone G, D'Andrea D, Shariat SF, Galfano A, Umari P, Francavilla S, Roumiguie M, Terrone C, Hendricksen K, Krajewski W, Buisan O, Laukhtina E, Xylinas E, Alvarez-Maestro M, Rouprêt M, Montironi R, Moschini M. Variant histologies in bladder cancer: Does the centre have an impact in detection accuracy? Urol Oncol 2022; 40:273.e11-273.e20. [DOI: 10.1016/j.urolonc.2022.01.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Revised: 12/23/2021] [Accepted: 01/15/2022] [Indexed: 10/19/2022]
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12
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Abstract
PURPOSE OF REVIEW This review will discuss micropapillary urothelial carcinoma with respect to biology, histopathologic characteristics, genetic and molecular features, diagnosis, clinical management, and future directions of research. RECENT FINDINGS Recent consensus opinion study showed only moderate interobserver reproducibility in the diagnostic criteria. The most reproducible criteria with the highest consensus were multiple nests in the same lacunar spaces. There are recent reports of high rates of intratumoral heterogeneity of ERBB2 amplification within tumor containing both micropapillary and classic urothelial components. Micropapillary urothelial carcinoma is a well-documented highly aggressive variant of urothelial carcinoma with proven worse outcomes. Accurate recognition and reporting of this pattern is critical for optimal management. Newer therapeutic strategies related to the molecular and genetic findings seen in MPUC remain to be explored further.
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13
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Mamede AP, Santos IP, Batista de Carvalho ALM, Figueiredo P, Silva MC, Marques MPM, Batista de Carvalho LAE. Breast cancer or surrounding normal tissue? A successful discrimination by FTIR or Raman microspectroscopy. Analyst 2022; 147:4919-4932. [DOI: 10.1039/d2an00622g] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
Breast cancer is a type of cancer with the highest incidence worldwide in 2021, with early diagnosis and rapid treatment intervention being the reasons for the decreasing mortality rate associated with the disease.
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Affiliation(s)
- Adriana P. Mamede
- “Unidade de I&D Química-Física Molecular” (QFM-UC) Department of Chemistry, University of Coimbra, Coimbra, Portugal
| | - Inês P. Santos
- “Unidade de I&D Química-Física Molecular” (QFM-UC) Department of Chemistry, University of Coimbra, Coimbra, Portugal
| | - Ana L. M. Batista de Carvalho
- “Unidade de I&D Química-Física Molecular” (QFM-UC) Department of Chemistry, University of Coimbra, Coimbra, Portugal
| | - Paulo Figueiredo
- Pathology Department, Portuguese Institute of Oncology Francisco Gentil (IPOFG), Coimbra, Portugal
| | - Maria C. Silva
- Surgery Department, Portuguese Institute of Oncology Francisco Gentil (IPOFG), Coimbra, Portugal
| | - Maria P. M. Marques
- “Unidade de I&D Química-Física Molecular” (QFM-UC) Department of Chemistry, University of Coimbra, Coimbra, Portugal
- Department of Life Sciences, University of Coimbra, Coimbra, Portugal
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14
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Jia L, Deng FM, Kong MX, Wu CL, Yang XJ. Common Diagnostic Challenges and Pitfalls in Genitourinary Organs, With Emphasis on Immunohistochemical and Molecular Updates. Arch Pathol Lab Med 2021; 145:1387-1404. [PMID: 34673910 DOI: 10.5858/arpa.2021-0107-ra] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/11/2021] [Indexed: 11/06/2022]
Abstract
CONTEXT.— Lesions in the genitourinary (GU) organs, both benign and malignant, can demonstrate overlapping morphology, and practicing surgical pathologists should be aware of these potential pitfalls and consider a broad differential diagnosis for each specific type of lesion involving the GU organs. The following summary of the contents presented at the 6th Annual Chinese American Pathologists Association (CAPA) Diagnostic Course (October 10-11, 2020), supplemented with relevant literature review, exemplifies the common diagnostic challenges and pitfalls for mass lesions of the GU system of adults, including adrenal gland, with emphasis on immunohistochemical and molecular updates when relevant. OBJECTIVE.— To describe the common mass lesions in the GU system of adults, including adrenal gland, with emphasis on the diagnostic challenges and pitfalls that may arise in the pathologic assessment, and to highlight immunohistochemical workups and emerging molecular findings when relevant. DATA SOURCES.— The contents presented at the course and literature search comprise our data sources. CONCLUSIONS.— The diagnostic challenges and pitfalls that arise in the pathologic assessment of the mass lesions in the GU system of adults, including adrenal gland, are common. We summarize the contents presented at the course, supplemented with relevant literature review, and hope to provide a diagnostic framework to evaluate these lesions in routine clinical practice.
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Affiliation(s)
- Liwei Jia
- From the Department of Pathology, University of Texas Southwestern Medical Center, Dallas (Jia)
| | - Fang-Ming Deng
- the Department of Pathology, New York University Grossman School of Medicine, New York City (Deng)
| | - Max X Kong
- Northern California Kaiser, Kaiser Sacramento Medical Center, Sacramento (Kong)
| | - Chin-Lee Wu
- the Department of Pathology and Urology, Massachusetts General Hospital, Boston (Wu)
| | - Ximing J Yang
- the Department of Pathology, Northwestern University, Chicago, Illinois (Yang)
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15
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A New Look into Cancer-A Review on the Contribution of Vibrational Spectroscopy on Early Diagnosis and Surgery Guidance. Cancers (Basel) 2021; 13:cancers13215336. [PMID: 34771500 PMCID: PMC8582426 DOI: 10.3390/cancers13215336] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2021] [Revised: 10/14/2021] [Accepted: 10/18/2021] [Indexed: 02/05/2023] Open
Abstract
Simple Summary Cancer is a leading cause of death worldwide, with the detection of the disease in its early stages, as well as a correct assessment of the tumour margins, being paramount for a successful recovery. While breast cancer is one of most common types of cancer, head and neck cancer is one of the types of cancer with a lower prognosis and poor aesthetic results. Vibrational spectroscopy detects molecular vibrations, being sensitive to different sample compositions, even when the difference was slight. The use of spectroscopy in biomedicine has been extensively explored, since it allows a broader assessment of the biochemical fingerprint of several diseases. This literature review covers the most recent advances in breast and head and neck cancer early diagnosis and intraoperative margin assessment, through Raman and Fourier transform infrared spectroscopies. The rising field of spectral histopathology was also approached. The authors aimed at expounding in a more concise and simple way the challenges faced by clinicians and how vibrational spectroscopy has evolved to respond to those needs for the two types of cancer with the highest potential for improvement regarding an early diagnosis, surgical margin assessment and histopathology. Abstract In 2020, approximately 10 million people died of cancer, rendering this disease the second leading cause of death worldwide. Detecting cancer in its early stages is paramount for patients’ prognosis and survival. Hence, the scientific and medical communities are engaged in improving both therapeutic strategies and diagnostic methodologies, beyond prevention. Optical vibrational spectroscopy has been shown to be an ideal diagnostic method for early cancer diagnosis and surgical margins assessment, as a complement to histopathological analysis. Being highly sensitive, non-invasive and capable of real-time molecular imaging, Raman and Fourier transform infrared (FTIR) spectroscopies give information on the biochemical profile of the tissue under analysis, detecting the metabolic differences between healthy and cancerous portions of the same sample. This constitutes tremendous progress in the field, since the cancer-prompted morphological alterations often occur after the biochemical imbalances in the oncogenic process. Therefore, the early cancer-associated metabolic changes are unnoticed by the histopathologist. Additionally, Raman and FTIR spectroscopies significantly reduce the subjectivity linked to cancer diagnosis. This review focuses on breast and head and neck cancers, their clinical needs and the progress made to date using vibrational spectroscopy as a diagnostic technique prior to surgical intervention and intraoperative margin assessment.
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16
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Compérat E, Amin MB, Epstein JI, Hansel DE, Paner G, Al-Ahmadie H, True L, Bayder D, Bivalacqua T, Brimo F, Cheng L, Cheville J, Dalbagni G, Falzarano S, Gordetsky J, Guo C, Gupta S, Hes O, Iyer G, Kaushal S, Kunju L, Magi-Galluzzi C, Matoso A, McKenney J, Netto GJ, Osunkoya AO, Pan CC, Pivovarcikova K, Raspollini MR, Reis H, Rosenberg J, Roupret M, Shah RB, Shariat SF, Trpkov K, Weyerer V, Zhou M, Reuter V. The Genitourinary Pathology Society Update on Classification of Variant Histologies, T1 Substaging, Molecular Taxonomy, and Immunotherapy and PD-L1 Testing Implications of Urothelial Cancers. Adv Anat Pathol 2021; 28:196-208. [PMID: 34128484 DOI: 10.1097/pap.0000000000000309] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
The Genitourinary Pathology Society (GUPS) undertook a critical review of the recent advances in bladder cancer focusing on important topics of high interest for the practicing surgical pathologist and urologist. This review represents the second of 2 manuscripts ensuing from this effort. Herein, we address the effective reporting of bladder cancer, focusing particularly on newly published data since the last 2016 World Health Organization (WHO) classification. In addition, this review focuses on the importance of reporting bladder cancer with divergent differentiation and variant (subtypes of urothelial carcinoma) histologies and the potential impact on patient care. We provide new recommendations for reporting pT1 staging in diagnostic pathology. Furthermore, we explore molecular evolution and classification, emphasizing aspects that impact the understanding of important concepts relevant to reporting and management of patients.
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Affiliation(s)
- Eva Compérat
- Department of Pathology, Medical University Vienna, Vienna General Hospital
- Department of Pathology, Hôpital Tenon, Sorbonne University
| | - Mahul B Amin
- Department of Pathology and Laboratory Medicine, University of Tennessee Health Science, Memphis
- Department of Urology, University of Southern California Keck School of Medicine, Los Angeles, CA
| | - Jonathan I Epstein
- Departments of Pathology
- Urology
- Oncology, The Johns Hopkins Medical Institutions, Baltimore, MD
| | - Donna E Hansel
- Department of Pathology & Laboratory Medicine, Oregon Health Science University, OR
| | - Gladell Paner
- Department of Pathology, University of Chicago, Chicago, IL
| | | | - Larry True
- Department of Pathology, University of Washington School of Medicine, Seattle, Washington, DC
| | - Dilek Bayder
- Department of Pathology, Koc Univiversity School of Medicine, Istanbul, Turkey
| | | | | | - Liang Cheng
- Department of Pathology and Laboratory Medicine, Indiana University School of Medicine, Indianapolis, IN
| | | | | | - Sara Falzarano
- Department of Pathology and Laboratory Medicine, University of South Florida, Gainesville, FL
| | - Jennifer Gordetsky
- Departments of Pathology, Microbiology, and Immunology
- Urology, Vanderbilt University Medical Center, Nashville, TN
| | - Charles Guo
- Department of Pathology, MD Anderson Cancer Center, Houston
| | - Sounak Gupta
- Department of Pathology, Mayo Clinic, Rochester, MN
| | - Ondrej Hes
- Department of Pathology, Charles University in Prague, Faculty of Medicine and University Hospital in Plzen, Plzen, Czech Republic
| | | | - Seema Kaushal
- Department of Pathology, All India Institute of Medical Sciences, New Delhi, Delhi, India
| | - Lakshmi Kunju
- Department of Pathology, University of Michigan Medical School, Ann Arbor, MI
| | | | | | - Jesse McKenney
- Robert J Tomsich Pathology and Laboratory Medicine Institute, Cleveland Clinic, Cleveland, OH
| | - George J Netto
- Department of Pathology, The University of Alabama at Birmingham, Birmingham, AL
| | - Adeboye O Osunkoya
- Departments of Pathology
- Urology, Emory University School of Medicine, Atlanta, GA
| | - Chin Chen Pan
- Department of Pathology, Taipei Veterans General Hospital, Tapeh, Taiwan
| | - Kristina Pivovarcikova
- Department of Pathology, Charles University in Prague, Faculty of Medicine and University Hospital in Plzen, Plzen, Czech Republic
| | - Maria R Raspollini
- Department of Histopathology and Molecular Diagnostics, University Hospital Careggi, Florence, Italy
| | - Henning Reis
- Department of Pathology, West German Cancer Center/University Hospital Essen, University of Duisburg-Essen, Duisburg
| | | | - Morgan Roupret
- Department of Urology, APHP Sorbonne University, Paris, France
| | - Rajal B Shah
- Departments of Pathology
- Urology, Simmons Comprehensive Cancer Center, University of Texas Southwestern Medical Center, Dallas, TX
| | - Shahrokh F Shariat
- Department of Urology, Comprehensive Cancer Center, Medical University Vienna, Vienna, Austria
| | - Kiril Trpkov
- Department of Pathology and Laboratory Medicine, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Veronika Weyerer
- Department of Pathology, University of Erlangen-Nuremberg, Erlangen, Germany
| | - Ming Zhou
- Department of Pathology, Tufts Medical Center, Boston, MA
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17
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Lievore E, Runza L, Ghidini M, Galassi B, Gallioli A, Bebi C, Boeri L, Blundo C, Rossi CF, Longo F, Albo G, Montanari E, DE Lorenzis E. Micropapillary Bladder Cancer Metastatic to the Breast: A Case Report and Brief Literature Review. In Vivo 2021; 35:453-459. [PMID: 33402496 DOI: 10.21873/invivo.12278] [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: 09/24/2020] [Revised: 10/14/2020] [Accepted: 10/15/2020] [Indexed: 11/10/2022]
Abstract
BACKGROUND Bladder cancer (BC) usually metastasizes to the lymph nodes, bone, lung, liver and peritoneum, but rarely in the breast. CASE REPORT We present a case of a 66-year-old female diagnosed with a massive bladder tumor, who presented a right mammary nodule after neo-adjuvant chemotherapy. A biopsy of the nodule did not permit a definite diagnosis of metastatic spread, which was confirmed by excision of the nodule. In the literature, we found only 7 other similar cases of BC metastasis to the breast. Currently, a non-invasive method for differentiating a breast metastasis from primary cancer is lacking, although there are some clinical and radiological aspects that may help the diagnosis. Histological examination provides diagnostic certainty. CONCLUSION Breast metastases from BC are unusual and consequently difficult to identify without non-invasive tools. Clinical history and histological study play a pivotal role in determining the correct diagnosis.
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Affiliation(s)
- Elena Lievore
- Department of Urology, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Letterio Runza
- Department of Anatomical Pathology, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Michele Ghidini
- Department of Urology, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Barbara Galassi
- Department of Oncology, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Andrea Gallioli
- Department of Urology, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Carolina Bebi
- Department of Urology, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Luca Boeri
- Department of Urology, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Concetta Blundo
- Department of Breast Surgery, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Claudia Francesca Rossi
- Department of Breast Surgery, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Fabrizio Longo
- Department of Urology, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Giancarlo Albo
- Department of Urology, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.,Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Emanuele Montanari
- Department of Urology, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.,Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Elisa DE Lorenzis
- Department of Urology, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy; .,Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
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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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Sanguedolce F, Calò B, Mancini V, Zanelli M, Palicelli A, Zizzo M, Ascani S, Carrieri G, Cormio L. Non-Muscle Invasive Bladder Cancer with Variant Histology: Biological Features and Clinical Implications. Oncology 2021; 99:345-358. [PMID: 33735905 DOI: 10.1159/000514759] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2020] [Accepted: 12/30/2020] [Indexed: 12/24/2022]
Abstract
BACKGROUND The most common bladder cancer (BC) histotype is pure urothelial carcinoma (UC), which may undergo divergent differentiation in some cases. Variant histology (VH) presents along variable morphologies, either single or combined between them or with pure UC. From a clinical standpoint, the vast majority of BC is diagnosed at non-invasive or minimally invasive stages, namely as non-muscle invasive BC (NMIBC). There is a wide range of therapeutic options for patients with NMIBC, according to their clinical and pathological features. However, current risk stratification models do not show optimal effectiveness. Evidence from the literature suggests that VH has peculiar biological features, and may be associated with poorer survival outcomes compared to pure UC. SUMMARY In order to describe the biological features and prognostic/predictive role of VH in NMIBC, and to discuss current treatment options, we performed a systematic literature search through multiple databases (PubMed/Medline, Google Scholar) for relevant articles according to the following terms, single and/or in combination: "non-muscle invasive bladder cancer," "variant histology," "micropapillary variant," "glandular differentiation," "squamous differentiation," "nested variant," "plasmacytoid variant," and "sarcomatoid variant." We extracted 99 studies including original articles, reviews, and systematic reviews, and subsequently analyzed data from 16 studies reporting on the outcome of NMIBC with VH. We found that the relative rarity of these forms as well as the heterogeneity in study populations and therapeutic protocols results in conflicting findings overall. Key Messages: The presence of VH should be taken into account when counseling a patient with NMIBC, since it may upgrade the disease to high-risk tumor and thus warrant a more aggressive treatment.
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Affiliation(s)
| | - Beppe Calò
- Urology Unit, University of Foggia, Bonomo Teaching Hospital, Foggia, Italy
| | - Vito Mancini
- Urology and Renal Transplantation Unit, University of Foggia, Foggia, Italy
| | - Magda Zanelli
- Pathology Unit, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Andrea Palicelli
- Pathology Unit, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Maurizio Zizzo
- Surgical Oncology Unit, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy.,Clinical and Experimental Medicine PhD Program, University of Modena and Reggio Emilia, Modena, Italy
| | - Stefano Ascani
- Pathology Unit, Azienda Ospedaliera S. Maria di Terni, University of Perugia, Terni, Italy
| | - Giuseppe Carrieri
- Urology and Renal Transplantation Unit, University of Foggia, Foggia, Italy
| | - Luigi Cormio
- Urology Unit, University of Foggia, Bonomo Teaching Hospital, Foggia, Italy
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20
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Compérat EM, Al-Ahmadie H. Pathology. Bladder Cancer 2021. [DOI: 10.1007/978-3-030-70646-3_4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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21
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Tiwari RV, Ngo NT, Lee LS. The optimal management of variant histology in muscle invasive bladder cancer. Transl Androl Urol 2020; 9:2965-2975. [PMID: 33457269 PMCID: PMC7807339 DOI: 10.21037/tau.2020.01.02] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
Bladder cancer is a heterogenous disease that is associated with tangible mortality in muscle invasive disease. The WHO 2016 classification of urothelial tumours reflects the contemporary approach towards histological variants in bladder cancer, including variants of urothelial carcinoma (UC) and non-urothelial variants. This review focuses on variant histology in UC, and discusses the importance of accurate histological diagnosis, and subsequent risk stratification and therapeutic decision making based on proper variant recognition. Most urothelial variants are associated with poorer outcomes compared to conventional UC, although some perform reasonably better. However, high quality evidence detailing optimal treatment and survival outcomes are still lacking in literature, due to the rarity of these cases.
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Affiliation(s)
| | - Nye Thane Ngo
- Department of Anatomical Pathology, Singapore General Hospital, Singapore
| | - Lui Shiong Lee
- Department of Anatomical Pathology, Singapore General Hospital, Singapore
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22
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Acosta AM, Barletta J, Sonpavde G, Schnitt S, Hirsch MS. p-120 Catenin is a Useful Diagnostic Biomarker for Distinguishing Plasmacytoid and Sarcomatoid Variants From Conventional Urothelial Carcinoma. Arch Pathol Lab Med 2020; 145:1000-1008. [PMID: 33237989 DOI: 10.5858/arpa.2020-0262-oa] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/21/2020] [Indexed: 11/06/2022]
Abstract
CONTEXT.— Plasmacytoid urothelial carcinoma (PC-UC) is an aggressive variant of urothelial carcinoma (UC), characterized by loss of E-cadherin (E-Cad)-mediated intercellular adhesion. Loss of E-Cad by immunohistochemistry can help diagnose PC-UC; however, sensitivity is limited. Expression of other cadherin-catenin adhesion complex members, that is, p-120 catenin (p-120) and β-catenin (B-Cat), which are diagnostically useful for lobular breast carcinoma, remains unknown in UC. OBJECTIVE.— To determine the utility of p-120 and B-Cat in conventional and variant UC. DESIGN.— E-cadherin, B-Cat, and p-120 immunohistochemistry was performed in 25 conventional UCs and 33 variant UCs, including 22 PC-UCs, 6 sarcomatoid UCs (SUCs), and 5 micropapillary UCs. Membranous staining for all biomarkers was considered normal; however, any cytoplasmic staining or an absence of staining was considered diagnostically abnormal. Next-generation sequencing was performed on 8 PC-UC cases. RESULTS.— E-cadherin, B-Cat, and p-120 showed membranous staining in all conventional and micropapillary UCs. In contrast, most PC-UCs were negative for E-Cad (17 of 22; 77%) with an additional 2 of 22 cases (9%) showing cytoplasmic with partial membranous staining. p-120 catenin demonstrated cytoplasmic or negative staining in 21 of 22 cases (95%). Most SUCs showed an absence of E-Cad (5 of 6; 83%) and cytoplasmic or negative p-120 in 5 of 6 cases (83%). Staining for B-Cat was also abnormal in a subset of PC-UCs and SUCs. Five PC-UC cases that harbored CDH1 gene variants were p-120 cytoplasmic positive. CONCLUSIONS.— p-120 catenin is a useful adjunct biomarker to E-Cad in the clinically important distinction of PC-UC and SUC from conventional UC. In particular, the combination of cytoplasmic p-120 and loss of E-Cad is strongly supportive of PC-UC and SUC.
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Affiliation(s)
- Andres M Acosta
- From the Department of Pathology, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts (Acosta, Barletta, Schnitt, Hirsch)
| | - Justine Barletta
- From the Department of Pathology, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts (Acosta, Barletta, Schnitt, Hirsch)
| | - Guru Sonpavde
- The Department of Medical Oncology, Dana Farber Cancer Institute and Harvard Medical School, Boston, Massachusetts (Sonpavde)
| | - Stuart Schnitt
- From the Department of Pathology, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts (Acosta, Barletta, Schnitt, Hirsch)
| | - Michelle S Hirsch
- From the Department of Pathology, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts (Acosta, Barletta, Schnitt, Hirsch)
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23
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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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24
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Diamantopoulos LN, Holt SK, Khaki AR, Sekar RR, Gadzinski A, Nyame YA, Vakar-Lopez F, Tretiakova MS, Psutka SP, Gore JL, Lin DW, Schade GR, Hsieh AC, Lee JK, Yezefski T, Schweizer MT, Cheng HH, Yu EY, True LD, Montgomery RB, Grivas P, Wright JL. Response to Neoadjuvant Chemotherapy and Survival in Micropapillary Urothelial Carcinoma: Data From a Tertiary Referral Center and the Surveillance, Epidemiology, and End Results (SEER) Program. Clin Genitourin Cancer 2020; 19:144-154. [PMID: 33160889 DOI: 10.1016/j.clgc.2020.10.002] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Revised: 10/01/2020] [Accepted: 10/04/2020] [Indexed: 01/07/2023]
Abstract
BACKGROUND Micropapillary urothelial carcinoma (MPC) is a rare urothelial carcinoma variant with conflicting data guiding clinical practice. In this study, we explored oncologic outcomes in relation to neoadjuvant chemotherapy (NAC) in a retrospective cohort of patients with MPC, alongside data from Surveillance, Epidemiology, and End Results (SEER)-Medicare. PATIENTS AND METHODS We retrospectively identified patients with MPC or conventional urothelial carcinoma (CUC) without any variant histology undergoing radical cystectomy (RC) in our institution (2003-2018). SEER-Medicare was also queried to identify patients diagnosed with MPC (2004-2015). Clinicopathologic data and treatment modalities were extracted. Overall survival (OS) was estimated with the Kaplan-Meier method. Mann-Whitney-Wilcoxon and chi-square tests were used for comparative analysis and Cox regression for identifying clinical covariates associated with OS. RESULTS Our institutional database yielded 46 patients with MPC and 457 with CUC. In SEER-Medicare, 183 patients with MPC were identified, and 63 (34%) underwent RC. In the institutional cohort, patients with MPC had significantly higher incidence of cN+ (17% vs. 8%), pN+ stage (30% vs. 17%), carcinoma-in-situ (43% vs. 25%), and lymphovascular invasion (30% vs. 16%) at RC versus those with CUC (all P < .05). Pathologic complete response (ypT0N0) to NAC was 33% for MPC and 35% for CUC (P = .899). Median OS was lower for institutional MPC versus CUC in univariate analysis (43.6 vs. 105.3 months, P = .006); however, MPC was not independently associated with OS in the multivariate model. Median OS was 25 months in the SEER MPC cohort for patients undergoing RC, while NAC was not associated with improved OS in that group. CONCLUSION Pathologic response to NAC was not significantly different between MPC and CUC, while MPC histology was not an independent predictor of OS. Further studies are needed to better understand biological mechanisms behind its aggressive features as well as the role of NAC in this histology variant.
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Affiliation(s)
- Leonidas N Diamantopoulos
- Division of Oncology, Department of Medicine, University of Washington, Seattle Cancer Care Alliance, Seattle, WA
| | - Sarah K Holt
- Department of Urology, University of Washington, Seattle, WA
| | - Ali R Khaki
- Division of Oncology, Department of Medicine, University of Washington, Seattle Cancer Care Alliance, Seattle, WA
| | - Rishi R Sekar
- Department of Urology, University of Washington, Seattle, WA
| | - Adam Gadzinski
- Department of Urology, University of Washington, Seattle, WA
| | - Yaw A Nyame
- Department of Urology, University of Washington, Seattle, WA
| | | | | | - Sarah P Psutka
- Department of Urology, University of Washington, Seattle, WA
| | - John L Gore
- Department of Urology, University of Washington, Seattle, WA; Fred Hutchinson Cancer Research Center, Seattle, WA
| | - Daniel W Lin
- Department of Urology, University of Washington, Seattle, WA; Fred Hutchinson Cancer Research Center, Seattle, WA
| | - George R Schade
- Department of Urology, University of Washington, Seattle, WA; Fred Hutchinson Cancer Research Center, Seattle, WA
| | - Andrew C Hsieh
- Division of Oncology, Department of Medicine, University of Washington, Seattle Cancer Care Alliance, Seattle, WA; Fred Hutchinson Cancer Research Center, Seattle, WA
| | - John K Lee
- Division of Oncology, Department of Medicine, University of Washington, Seattle Cancer Care Alliance, Seattle, WA; Fred Hutchinson Cancer Research Center, Seattle, WA
| | - Todd Yezefski
- Division of Oncology, Department of Medicine, University of Washington, Seattle Cancer Care Alliance, Seattle, WA
| | - Michael T Schweizer
- Division of Oncology, Department of Medicine, University of Washington, Seattle Cancer Care Alliance, Seattle, WA; Fred Hutchinson Cancer Research Center, Seattle, WA
| | - Heather H Cheng
- Division of Oncology, Department of Medicine, University of Washington, Seattle Cancer Care Alliance, Seattle, WA; Fred Hutchinson Cancer Research Center, Seattle, WA
| | - Evan Y Yu
- Division of Oncology, Department of Medicine, University of Washington, Seattle Cancer Care Alliance, Seattle, WA; Fred Hutchinson Cancer Research Center, Seattle, WA
| | - Lawrence D True
- Department of Pathology, University of Washington, Seattle, WA
| | - Robert B Montgomery
- Division of Oncology, Department of Medicine, University of Washington, Seattle Cancer Care Alliance, Seattle, WA; Fred Hutchinson Cancer Research Center, Seattle, WA
| | - Petros Grivas
- Division of Oncology, Department of Medicine, University of Washington, Seattle Cancer Care Alliance, Seattle, WA; Fred Hutchinson Cancer Research Center, Seattle, WA.
| | - Jonathan L Wright
- Department of Urology, University of Washington, Seattle, WA; Fred Hutchinson Cancer Research Center, Seattle, WA.
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Ngo C, Cussenot O, Compérat E. Transurethral resection of bladder and radical cystectomy: Concordance of histology. Are we good enough? Turk J Urol 2020; 46:354-359. [PMID: 32497002 DOI: 10.5152/tud.2020.20121] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Accepted: 05/07/2020] [Indexed: 11/22/2022]
Abstract
OBJECTIVE Urothelial carcinoma (UC) is heterogeneous, and variant histologies (VH) are more frequent than initially reported. Reporting VH is recommended by several guidelines because of prognostic and therapeutic implications. We evaluated the concordance of VH between the first transurethral resections of the bladder (TURBs) and the following radical cystectomy (RC). This paper is the first to compare VH with a central pathology review between TURB and RC. MATERIAL AND METHODS In this retrospective study, we only included those patients who underwent TURB with VH and then RC between 01/2010 and 12/2013 at our institution. The presence of VH in both TURB and RC was assessed and compared according to the 2016 World Health Organization (WHO) classification by a central pathology review. RESULTS Among 110 patients who had the initial TURB/RC, 54 (49.1%) were diagnosed with VH, 48 (43%) had a single pattern, and six had (5%) multiple histological patterns. Squamous differentiation was the most common single VH (31%). Twenty patients with UC (18%) showed discordance between TURB and RC, especially in micropapillary versus nested (n=3) cases. Concordant histology between TURB/RC was seen in 82% of the cases. CONCLUSION Discrepancies can be seen between TURB and RC when reporting VH, which can be problematic for selection of therapy and management. TURB alone might be insufficient to evaluate the presence of VH, especially in VH with heavy therapeutic implications, such as micropapillary carcinomas. Nevertheless, concordance with a central review by an experienced uropathologist when applying the WHO 2016 classification is 82%.
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Affiliation(s)
- Carine Ngo
- Department of Pathology, Tenon Hospital, APHP, Sorbonne University, Paris, France
| | - Olivier Cussenot
- Department of Urology, Tenon Hospital, APHP, Sorbonne University, Paris, France
| | - Eva Compérat
- Department of Pathology, Tenon Hospital, APHP, Sorbonne University, Paris, France
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Abstract
Urothelial carcinoma (UC) is the most common malignant neoplasm of the bladder that encompasses a wide spectrum of histopathologic features and various molecular alterations and subtypes, responsible for its significant morphologic and genomic heterogeneity. Morphologically, in addition to classic UC (not otherwise specified), many well documented variant histologies are a common finding in invasive UC, and include squamous, glandular, micropapillary, sarcomatoid, small cell/neuroendocrine, clear cell, lymphoepithelioma-like, and plasmacytoid types, among others. This review provides an update on the recent advances in the molecular characterization and novel molecular taxonomy of UC and variant histologies.
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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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Monroig-Bosque PDC, Morales-Rosado JA, Roden AC, Churg A, Barrios R, Cagle P, Ge Y, Allen TC, Smith ML, Larsen BT, Sholl LM, Beasley MB, Borczuk A, Raparia K, Ayala A, Tazelaar HD, Miller R, Kalhor N, Moran CA, Ro JY. Micropapillary adenocarcinoma of lung: Morphological criteria and diagnostic reproducibility among pulmonary pathologists. Ann Diagn Pathol 2019; 41:43-50. [PMID: 31132651 DOI: 10.1016/j.anndiagpath.2019.04.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2019] [Accepted: 04/22/2019] [Indexed: 12/21/2022]
Abstract
CONTEXT Invasive micropapillary adenocarcinoma (MPC) is an aggressive variant of lung adenocarcinoma, frequently manifesting with advanced stage lymph node metastasis and decreased survival. OBJECTIVE Identification of this morphology is important, as it is strongly correlated with poor prognosis regardless of the amount of MPC component. To date, no study has investigated the morphological criteria used to objectively diagnose it. DESIGN Herein, we selected 30 cases of potential MPC of lung, and distributed 2 digital images per case among 15 pulmonary pathology experts. Reviewers were requested to diagnostically interpret, assign the percentage of MPC component, and record the morphological features they identified. The noted features included: columnar cells, elongated slender cell nests, extensive stromal retraction, lumen formation with internal epithelial tufting, epithelial signet ring-like forms, intracytoplasmic vacuolization, multiple nests in the same alveolar space, back-to-back lacunar spaces, epithelial nest anastomosis, marked pleomorphism, peripherally oriented nuclei, randomly distributed nuclei, small/medium/large tumor nest size, fibrovascular cores, and spread through air-spaces (STAS). RESULTS Cluster analysis revealed three subgroups with the following diagnoses: "MPC", "combined papillary and MPC", and "others". The subgroups correlated with the reported median percentage of MPC. Intracytoplasmic vacuolization, epithelial nest anastomosis/confluence, multiple nests in the same alveolar space, and small/medium tumor nest size were the most common criteria identified in the cases diagnosed as MPC. Peripherally oriented nuclei and epithelial signet ring-like forms were frequently identified in both the "MPC" and "combined papillary and MPC" groups. CONCLUSIONS Our study provides objective diagnostic criteria to diagnose MPC of lung.
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Affiliation(s)
- Paloma Del C Monroig-Bosque
- Department of Pathology and Genomic Medicine, Houston Methodist Hospital, Weill Medical College of Cornell University, Houston, TX, USA
| | | | - Anja C Roden
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA
| | - Andrew Churg
- Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Roberto Barrios
- Department of Pathology and Genomic Medicine, Houston Methodist Hospital, Weill Medical College of Cornell University, Houston, TX, USA
| | - Philip Cagle
- Department of Pathology and Genomic Medicine, Houston Methodist Hospital, Weill Medical College of Cornell University, Houston, TX, USA
| | - Yimin Ge
- Department of Pathology and Genomic Medicine, Houston Methodist Hospital, Weill Medical College of Cornell University, Houston, TX, USA
| | - Timothy C Allen
- Department of Pathology, The University of Mississippi Medical Center, MS, USA
| | - Maxwell L Smith
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA
| | - Brandon T Larsen
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA
| | - Lynette M Sholl
- Department of Pathology, Harvard Medical School, Boston, MA, USA; Department of Pathology, Brigham and Women's Hospital, Boston, MA, USA
| | - Mary B Beasley
- Department of Anatomic Pathology, The Mount Sinai Hospital, New York, NY, USA
| | - Alain Borczuk
- Department of Pathology and Laboratory Medicine, Weill Medical College of Cornell University, New York, NY, USA
| | - Kirtee Raparia
- Kaiser Permanente, Santa Clara Medical Center and Medical Offices, Santa Clara, CA, USA
| | - Alberto Ayala
- Department of Pathology and Genomic Medicine, Houston Methodist Hospital, Weill Medical College of Cornell University, Houston, TX, USA
| | | | - Ross Miller
- Department of Pathology and Genomic Medicine, Houston Methodist Hospital, Weill Medical College of Cornell University, Houston, TX, USA
| | - Neda Kalhor
- Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Cesar A Moran
- Department of Pathology and Genomic Medicine, Houston Methodist Hospital, Weill Medical College of Cornell University, Houston, TX, USA; Health Sciences Research Department, Mayo Clinic, Rochester, MN, USA
| | - Jae Y Ro
- Department of Pathology and Genomic Medicine, Houston Methodist Hospital, Weill Medical College of Cornell University, Houston, TX, USA.
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Batista da Costa J, Gibb EA, Bivalacqua TJ, Liu Y, Oo HZ, Miyamoto DT, Alshalalfa M, Davicioni E, Wright J, Dall’Era MA, Douglas J, Boormans JL, Van der Heijden MS, Wu CL, van Rhijn BW, Gupta S, Grivas P, Mouw KW, Murugan P, Fazli L, Ra S, Konety BR, Seiler R, Daneshmand S, Mian OY, Efstathiou JA, Lotan Y, Black PC. Molecular Characterization of Neuroendocrine-like Bladder Cancer. Clin Cancer Res 2019; 25:3908-3920. [DOI: 10.1158/1078-0432.ccr-18-3558] [Citation(s) in RCA: 49] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2018] [Revised: 01/21/2019] [Accepted: 03/26/2019] [Indexed: 11/16/2022]
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30
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Sanguedolce F, Russo D, Mancini V, Selvaggio O, Calo B, Carrieri G, Cormio L. Prognostic and therapeutic role of HER2 expression in micropapillary carcinoma of the bladder. Mol Clin Oncol 2019; 10:205-213. [PMID: 30680196 PMCID: PMC6327213 DOI: 10.3892/mco.2018.1786] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2018] [Accepted: 11/22/2018] [Indexed: 12/18/2022] Open
Abstract
Micropapillary carcinoma of the bladder (MPBC) is a variant type of infiltrating urothelial carcinoma, which portends a poor biological behavior in terms of disease stage at first diagnosis and clinical outcome; its peculiar morphology raises issues concerning the ability of tumor detection by imaging techniques and proper biopsy procedure, and the appropriate treatment for non-muscle infiltrating and muscle-infiltrating MPBC remains a matter of debate. On the basis of its established prognostic and therapeutic role in breast and gastro-esophageal cancer in the first instance, the human epidermal growth factor receptor-2 (HER2) has been investigated in selected case series of MPBC over the last 10 years. The aim of the present review was to summarize the existing evidence on HER2 status in MPBC, and to discuss its present and future utility in risk assessment and treatment choice of this uncommon, yet aggressive, disease.
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Affiliation(s)
| | - Davide Russo
- Department of Pathology, University Hospital, I-71121 Foggia, Italy
| | - Vito Mancini
- Department of Urology and Renal Transplantation, University Hospital, I-71121 Foggia, Italy
| | - Oscar Selvaggio
- Department of Urology and Renal Transplantation, University Hospital, I-71121 Foggia, Italy
| | - Beppe Calo
- Department of Urology and Renal Transplantation, University Hospital, I-71121 Foggia, Italy
| | - Giuseppe Carrieri
- Department of Urology and Renal Transplantation, University Hospital, I-71121 Foggia, Italy
| | - Luigi Cormio
- Department of Urology and Renal Transplantation, University Hospital, I-71121 Foggia, Italy
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Kulkarni GS, Black PC, Sridhar SS, Kapoor A, Zlotta AR, Shayegan B, Rendon RA, Chung P, van der Kwast T, Alimohamed N, Fradet Y, Kassouf W. Canadian Urological Association guideline: Muscle-invasive bladder cancer. Can Urol Assoc J 2019; 13:230-238. [PMID: 30763236 DOI: 10.5489/cuaj.5902] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Affiliation(s)
- Girish S Kulkarni
- Division of Urology, Departments of Surgery and Surgical Oncology, Princess Margaret Cancer Center, University Health Network, University of Toronto, Toronto, ON, Canada
| | - Peter C Black
- Department of Urologic Sciences, University of British Columbia, Vancouver, BC, Canada
| | - Srikala S Sridhar
- Division of Hematology and Medical Oncology, Princess Margaret Cancer Center, University Health Network, University of Toronto, Toronto, ON, Canada
| | - Anil Kapoor
- Section of Urology, Department of Surgery, McMaster University, Hamilton, ON, Canada
| | - Alexandre R Zlotta
- Division of Urology, Departments of Surgery and Surgical Oncology, Princess Margaret Cancer Center, University Health Network, University of Toronto, Toronto, ON, Canada
| | - Bobby Shayegan
- Section of Urology, Department of Surgery, McMaster University, Hamilton, ON, Canada
| | - Ricardo A Rendon
- Department of Urology, Dalhousie University, Halifax, NS, Canada
| | - Peter Chung
- Radiation Medicine Program, Princess Margaret Cancer Center, University Health Network, Department of Radiation Oncology, University of Toronto, Toronto, ON, Canada
| | | | - Nimira Alimohamed
- Division of Medical Oncology, Department of Oncology, University of Calgary, Calgary, AB, Canada
| | - Yves Fradet
- Division of Urology, Department of Surgery, Laval University, Quebec City, QC, Canada
| | - Wassim Kassouf
- Department of Urology, McGill University Health Center, Montreal, QC, Canada
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32
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Lopez-Beltran A, Henriques V, Montironi R, Cimadamore A, Raspollini MR, Cheng L. Variants and new entities of bladder cancer. Histopathology 2018; 74:77-96. [DOI: 10.1111/his.13752] [Citation(s) in RCA: 91] [Impact Index Per Article: 15.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2018] [Accepted: 09/03/2018] [Indexed: 12/14/2022]
Affiliation(s)
| | | | - Rodolfo Montironi
- Section of Pathological Anatomy; Polytechnic University of the Marche Region; School of Medicine; Ancona Italy
| | - Alessia Cimadamore
- Section of Pathological Anatomy; Polytechnic University of the Marche Region; School of Medicine; Ancona Italy
| | - Maria R Raspollini
- Histopathology and Molecular Diagnostics; University Hospital Careggi; Florence Italy
| | - Liang Cheng
- Department of Pathology and Laboratory Medicine; Indiana University School of Medicine; Indianapolis IN USA
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Cell Polarity Reversal Distinguishes True Micropapillary Growth From Retraction Artifact in Invasive Urothelial Carcinoma. Appl Immunohistochem Mol Morphol 2018; 26:e1-e6. [PMID: 28800010 DOI: 10.1097/pai.0000000000000566] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Focal micropapillary features in invasive urothelial carcinoma is sometimes difficult to distinguish from retraction artifact morphologically. Cell polarity reversal has been demonstrated in micropapillary tumors by epithelial membrane antigen (EMA) immunostaining. We have previously described the use of E-cadherin as a cell polarity marker in ovarian micropapillary serous borderline tumors. The aim of this study was to evaluate the utility of immunohistochemistry for EMA and E-cadherin in differentiating micropapillary urothelial carcinoma from retraction artifact. We identified 29 invasive urothelial carcinomas with micropapillary features and 30 invasive urothelial carcinomas without reported micropapillary features but with areas of retraction artifact. Cell polarity reversal was considered present if E-cadherin showed membranous apical cup-like staining or if EMA demonstrated a well-defined basal staining towards the stroma. Twenty-seven of 29 cases (93%) of urothelial carcinoma with micropapillary features demonstrated EMA or E-cadherin staining patterns consistent with cell polarity reversal. Staining consistent with micropapillary architecture was identified with both markers in 20 of these 27 cases (74%). Six cases showed reversal of polarity by E-cadherin alone, whereas 1 case showed polarity reversal by EMA alone. Retraction artifacts showed circumferential staining by E-cadherin and lacked well-defined basal staining by EMA. Three cases originally classified as with retraction artifact showed reversal of cell polarity by both EMA and E-cadherin and were reclassified as micropapillary. Our data show that pathologists can reliably make this distinction in most cases. However, in some cases with ambiguous features, EMA and E-cadherin immunostaining may aid in resolving this diagnostic dilemma.
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Updates on the Genetics and Molecular Subtypes of Urothelial Carcinoma and Select Variants. Surg Pathol Clin 2018; 11:713-723. [PMID: 30447837 DOI: 10.1016/j.path.2018.07.011] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Urothelial carcinoma is a morphologically and genomically heterogeneous disease that exhibits a wide spectrum of morphologic features and molecular alterations and subtypes. Classic urothelial carcinoma (not otherwise specified) is the most common tumor type that develops in the urinary bladder but many, well-documented, variant histologies are commonly encountered in approximately one-third of invasive urothelial carcinoma, including squamous, glandular, micropapillary, sarcomatoid, small cell/neuroendocrine, clear cell, lymphoepithelioma-like, and plasmacytoid types, among others. In this review, we provide an update on the molecular advances in urothelial carcinoma and some of its variant histologies.
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35
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Compérat E, Babjuk M, Algaba F, Amin M, Brimo F, Grignon D, Hansel D, Hes O, Malavaud B, Reuter V, van der Kwast T. SIU-ICUD on bladder cancer: pathology. World J Urol 2018; 37:41-50. [PMID: 30218308 DOI: 10.1007/s00345-018-2466-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2018] [Accepted: 08/23/2018] [Indexed: 12/26/2022] Open
Abstract
Many changes have been made during these last years and concepts for understanding bladder cancer have evolved. We make an update with the latest findings of the WHO (World Health Organistaion) 2016, ICCR (International Collaboration on Cancer Reporting) and other official organisms and try to show the latest developments. In this document we provide new consensus guidelines and insights. We kept this document short and concise providing consensus guidelines to clinicians for the best patient care, it should be easy to understand for a non pathologists. We focussed on several burning issues, such as the anatomical and histological understanding of the bladder wall, the prognostic significance of grading and the most challenging problems in staging, we underline our needs from the clinicians such as clinical information, we further discuss the histological subtypes of bladder cancer, which is an extremely important issue in the light of molecular classifications and give prognostic insights. Furthermore, we discuss the ICCR worldwide consensus reporting, urinary cytology with the Paris system and several issues such as frozen section specimen.
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Affiliation(s)
- Eva Compérat
- Department of Pathology, Hopital Tenon, HUEP, Sorbonne University, Paris, France.
| | - Marek Babjuk
- Department of Urology, Hospital Motol and 2nd Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Ferran Algaba
- Department of Pathology, Fundacio Puigvert, Barcelona, Spain
| | - Mahul Amin
- Department of Pathology and Laboratory Medicine, University of Tennessee Health Science Center, Memphis, TN, USA.,Department of Urology, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Fadi Brimo
- McGill University Health Center, Glen Site, Office E4-4188, 1001 Decarie Blvd, Montréal, QC, H4A 3J1, Canada
| | - David Grignon
- Department of Pathology and Laboratory Medicine, Indiana University School of Medicine, IUH Pathology Laboratory, Indianapolis, IN, USA
| | - Donna Hansel
- Departments of Pathology and Urology, University of California, San Diego, CA, USA
| | - Ondra Hes
- Charles University and University Hospital Plzen, Pilsen, Czech Republic
| | - Bernard Malavaud
- Department of Urology, Institut Universitaire du Cancer de Toulouse, Toulouse, France
| | - Victor Reuter
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Theo van der Kwast
- Laboratory Medicine Program, University Health Network, University of Toronto, Toronto, ON, Canada
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36
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Wang G, McKenney JK. Urinary Bladder Pathology: World Health Organization Classification and American Joint Committee on Cancer Staging Update. Arch Pathol Lab Med 2018; 143:571-577. [DOI: 10.5858/arpa.2017-0539-ra] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Context.—
Since the publication of the previous World Health Organization (WHO) Classification of Tumours on the Pathology and Genetics of Tumours of the Urinary System and Male Genital Organs in 2004, significant new knowledge has been generated regarding the pathology and genetics of bladder neoplasia. Publication of the 2016 WHO “Blue Book” has codified that new data into updated recommendations for classification and prognostication. Similarly, the recent release of the 8th edition of the American Joint Committee on Cancer (AJCC) Cancer Staging Manual, which was implemented in January 2018, has also addressed staging criteria for bladder cancer in several unique settings to clarify their application.
Objective.—
To highlight subtle changes within the recent WHO and AJCC publications that may affect daily surgical pathology practice.
Data Sources.—
Peer-reviewed published literature, the 2016 WHO Classification of Tumours of the Urinary System and Male Genital Organs, and the 8th edition of the AJCC Cancer Staging Manual were reviewed.
Conclusions.—
Selected changes and/or clarifications are discussed and include classification of flat and papillary urothelial neoplasia, select variant patterns of invasive urothelial carcinoma, staging of invasive carcinoma in bladder diverticula, and staging of carcinomas involving the prostate gland.
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Affiliation(s)
- Gang Wang
- From the Department of Pathology, University of Texas MD Anderson Cancer Center, Houston (Dr Wang); and the Robert J. Tomsich Pathology and Laboratory Medicine Institute, Department of Anatomic Pathology, Cleveland Clinic, Cleveland, Ohio (Dr McKenney)
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37
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Abstract
Morphological variants of urothelial cancer have been recently described. The timely identification and recognition of these histological variants should avoid their misinterpretation as benign lesions. We emphasize the peculiar features of these variants because some may require different/specific therapeutic approaches.
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Affiliation(s)
- Antonio Lopez-Beltran
- Anatomical Pathology Unit, Department of Surgery and Pathology, Faculty of Medicine, University of Cordoba, Cordoba, Spain
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38
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Latest Novelties on the World Health Organization Morphological Classifications of Genitourinary Cancers. ACTA ACUST UNITED AC 2017. [DOI: 10.1016/j.eursup.2017.09.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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Hong M, Kim JW, Shin MK, Kim BC. Poorly Differentiated Clusters in Colorectal Adenocarcinomas Share Biological Similarities with Micropapillary Patterns as well as Tumor Buds. J Korean Med Sci 2017; 32:1595-1602. [PMID: 28875602 PMCID: PMC5592172 DOI: 10.3346/jkms.2017.32.10.1595] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2017] [Accepted: 06/24/2017] [Indexed: 01/06/2023] Open
Abstract
In colorectal carcinoma, poorly differentiated clusters (PDCs) are a poor prognostic indicator and show morphological continuity and behavioral similarities to micropapillary patterns (MPPs) as well as tumor buds (TBs). Epithelial-mesenchymal transition (EMT) and inhibition of cancer-stromal interactions may contribute to the development of PDCs. To clarify the biological nature of PDCs, we examined immunohistochemical stainings for β-catenin, Ki-67, E-cadherin, epithelial cell adhesion molecule (EpCAM), MUC1, and epithelial membrane antigen (EMA), which are associated with EMT and cancer-stromal interactions. The expression frequencies and patterns of PDCs, TBs, and differentiated neoplastic glands from the tumor center (TC) were compared. In the study group (117 cases), the nuclear β-catenin staining index was higher in PDCs (37.3%) and TBs (43.3%) than in neoplastic glands from TC (8.9%, P < 0.001). The mean Ki-67 labeling index in TC was 71.5%, whereas it was decreased in PDCs (31.2%) and TBs (10.2%, P < 0.001). E-cadherin and EpCAM displayed a tendency to be found along the cell membrane in TC samples (91.5% and 92.3%, respectively), whereas they showed loss of membranous staining in PDC (44.4% and 36.8%, respectively) and TB samples (60.7% and 68.4%, respectively). An inside-out pattern for MUC1 and EMA was frequently observed in PDC (48.7% and 45.3%, respectively) and TB samples (46.2% and 45.3%, respectively), but not in TC samples. Our data demonstrate that there is a pathogenetic overlap among PDCs, TBs, and MPPs and suggest that they might represent sequential growth patterns that branch from common biological processes such as dedifferentiation and alteration in cancer-stromal interactions.
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Affiliation(s)
- Mineui Hong
- Department of Pathology, Hallym University Kangnam Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Korea
| | - Jeong Won Kim
- Department of Pathology, Hallym University Kangnam Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Korea.
| | - Mi Kyung Shin
- Department of Pathology, Hallym University Kangnam Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Korea
| | - Byung Chun Kim
- Department of Surgery, Hallym University Kangnam Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Korea
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41
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Characteristics and clinical significance of histological variants of bladder cancer. Nat Rev Urol 2017; 14:651-668. [DOI: 10.1038/nrurol.2017.125] [Citation(s) in RCA: 115] [Impact Index Per Article: 16.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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Warrick JI, Kaag M, Raman JD, Chan W, Tran T, Kunchala S, Shuman L, DeGraff D, Chen G. FOXA1 and CK14 as markers of luminal and basal subtypes in histologic variants of bladder cancer and their associated conventional urothelial carcinoma. Virchows Arch 2017; 471:337-345. [DOI: 10.1007/s00428-017-2190-3] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2017] [Revised: 06/04/2017] [Accepted: 06/28/2017] [Indexed: 11/28/2022]
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Solomon JP, Lowenthal BM, Kader AK, Parsons JK, Flaig TW, Siefker-Radtke AO, Dyrskjøt L, Hansel DE. Challenges in the Diagnosis of Urothelial Carcinoma Variants: Can Emerging Molecular Data Complement Pathology Review? Urology 2017; 102:7-16. [DOI: 10.1016/j.urology.2016.10.014] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2016] [Revised: 09/12/2016] [Accepted: 10/07/2016] [Indexed: 11/17/2022]
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Shah TS, Kaag M, Raman JD, Chan W, Tran T, Kunchala S, Shuman L, DeGraff DJ, Chen G, Warrick JI. Clinical significance of prominent retraction clefts in invasive urothelial carcinoma. Hum Pathol 2017; 61:90-96. [DOI: 10.1016/j.humpath.2016.10.021] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2016] [Revised: 10/15/2016] [Accepted: 10/19/2016] [Indexed: 10/20/2022]
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von Rundstedt FC, Mata DA, Kryvenko ON, Shah AA, Jhun I, Lerner SP. Utility of Clinical Risk Stratification in the Selection of Muscle-Invasive Bladder Cancer Patients for Neoadjuvant Chemotherapy: A Retrospective Cohort Study. Bladder Cancer 2017; 3:35-44. [PMID: 28149933 PMCID: PMC5271426 DOI: 10.3233/blc-160062] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Introduction: Level I evidence supports the use of cisplatin-based neoadjuvant chemotherapy (NAC) for muscle-invasive bladder cancer prior to radical cystectomy (RC). On average, 30–40% of patients achieve a complete pathologic response (i.e., stage pT0) after receiving NAC. Some centers risk-stratify patients, suggesting that there may be a higher-risk population that would derive the most benefit from NAC. Recently, a risk-stratification model developed at M.D. Anderson Cancer Center (MDACC) specified criteria for clinical staging and patient selection for NAC. We applied this model to our own RC patient cohort and evaluated our own experience with clinical risk stratification and the effect of NAC on post treatment risk categories. Methods: We retrospectively reviewed the charts of consecutive patients who underwent RC at two institutions between 2004 and 2014 and noted whether or not they received NAC. We determined the clinical stage by reviewing the exam under anesthesia, transurethral resection biopsy (TURBT) pathology, and preoperative imaging. Patients with cT2-T4a node-negative disease were included. Those with sarcomatoid features or adenocarcinoma were excluded. Patients were classified as high risk if they had tumor-associated hydronephrosis, clinical stage≥T3b-T4a disease, variant histology (i.e., micropapillary or small cell), or lymphovascular invasion (LVI), as specified by the MDACC model. Variables were examined for associations with cancer-specific survival (CSS), overall survival (OS), and risk-category reclassification. Results: We identified 166 patients with a median follow-up time of 22.2 months. In all, 117 patients (70.5%) did not receive NAC, 68 (58.1%) of whom we classified as high risk. Among patients not receiving NAC, CSS and OS were significantly decreased in high-risk patients (log-rank test p = 0.01 for both comparisons). The estimated age-adjusted hazard ratios of high-risk classification for cancer-specific and overall death were 3.2 (95% CI: 1.2 to 8.6) and 2.2 (95% CI: 1.1 to 4.4), respectively. On post-RC final pathology, 23 (46.9%) low-risk patients were up-classified to high risk and 17 (25.0%) high-risk patients were down-classified. Complete pathologic responses (pT0) were achieved in 7 (6.0%) patients and partial responses (pT1, pTa, pTis) were achieved in 28 (23.9%) patients. Of the 49 patients who did receive NAC, 43 (87.8%) received cisplatin-based and six (12.2%) received carboplatin-based regimens. Applying the MDACC model, we categorized 41 (83.7%) patients as high risk prior to NAC treatment. On final pathology, 3 (37.5%) low-risk patients were up-classified and 17 (41.5%) high-risk patients were down-classified. Complete pathologic responses (pT0) were seen in 13 (26.5%) patients and partial responses were seen in 10 (20.4%) patients. Although the utilization of NAC was not statistically significantly associated with CSS or OS (log-rank test p > 0.05 for both comparisons), it was associated with a 1.2 times increased odds (95% CI: 0.4 to 2.1) of post-RC reclassification from high to low risk on age-adjusted logistic regression. Conclusions: We found similar results using the clinical risk-stratification model in our cohort and showed that the high-risk category was associated with lower CSS and OS. NAC was associated with a higher probability of risk reclassification from high to low risk.
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Affiliation(s)
- Friedrich-Carl von Rundstedt
- Scott Department of Urology, Baylor College of Medicine, Houston, TX, USA; Department of Urology, Jena University Hospital, Friedrich-Schiller University, Jena, Germany
| | - Douglas A Mata
- Department of Pathology, Brigham and Women's Hospital , Harvard Medical School, Boston, MA, USA
| | - Oleksandr N Kryvenko
- Departments of Pathology and Urology, Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine , FL, USA
| | - Anup A Shah
- Department of Urology, University of Pittsburgh Medical Center , PA, USA
| | - Iny Jhun
- Department of Pathology, Brigham and Women's Hospital , Harvard Medical School, Boston, MA, USA
| | - Seth P Lerner
- Scott Department of Urology, Baylor College of Medicine , Houston, TX, USA
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Reversed polarity of the glandular epithelial cells in micropapillary carcinoma of the large intestine and the EMA/MUC1 immunostain. Pathology 2016; 46:527-32. [PMID: 25158820 DOI: 10.1097/pat.0000000000000144] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Micropapillary carcinoma of the colon and rectum is associated with an adverse prognosis. This tumour type displays reverse polarity of the tumour cells and is stated to be characterised by an inside-out epithelial membrane antigen (EMA)/MUC1 staining. Nine cases of primary colorectal carcinoma and one omental metastasis were studied by means of immunohistochemistry, using antibodies to detect EMA, MUC1, MUC2, MUC3, MUC5AC, MUC6, CD10, CA125, carcinoembryonic antigen (CEA). The inside-out pattern staining with EMA/MUC1 ranged from diffuse circumferential through focal and partial to negative, but in some cases CEA, MUC3 and CD10 also showed this pattern staining, sometimes more clearly than did EMA or MUC1. The reverse polarity of colorectal micropapillary carcinomas is sometimes better visualised by immunostains other than EMA/MUC1.
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Human epidermal growth factor receptor 2 expression in micropapillary urothelial carcinoma of the bladder: an analysis of 27 cases. Hum Pathol 2016; 57:160-164. [DOI: 10.1016/j.humpath.2016.07.014] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2016] [Revised: 07/04/2016] [Accepted: 07/15/2016] [Indexed: 01/29/2023]
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Sui W, Matulay JT, James MB, Onyeji IC, Theofanides MC, RoyChoudhury A, DeCastro GJ, Wenske S. Micropapillary Bladder Cancer: Insights from the National Cancer Database. Bladder Cancer 2016; 2:415-423. [PMID: 28035322 PMCID: PMC5181670 DOI: 10.3233/blc-160066] [Citation(s) in RCA: 44] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022]
Abstract
Introduction: Micropapillary bladder cancer (MPBC) is a variant histology of urothelial carcinoma (UC) that is associated with poor outcomes however given its rarity, little is known outside of institutional reports. We sought to use a population-level cancer database to assess survival outcomes in patients treated with surgery, radiation therapy and/or chemotherapy. Materials and Methods: The National Cancer Database (NCDB) was queried for all cases of MPBC and UC using International Classification of Disease-O-3 morphologic codes between 2004–2014. Primary outcome was survival outcomes stratified by treatment modality. Treatments included radical cystectomy (RC) with or without neoadjuvant chemotherapy (NAC) or adjuvant chemotherapy (AC). Results: Overall 869 patients with MPBC and 389,603 patients with UC met the inclusion criteria. Median age of the MPBC cohort was 69.9 years (58.9–80.9) with the majority of the cohort presenting with high-grade (89.3%) and muscle invasive or locally advanced disease (47.6%). For cT1 MPBC, outcomes of RC and BPS were not statistically different. For≥cT2 disease, NAC showed a survival benefit compared with RC alone for UC but not for MPBC. On multivariable analysis, MPBC histology independently predicted worse increased risk of death. On subanalysis of the MPBC RC patients, NAC did not improve survival outcomes compared with RC alone. Conclusions: Neoadjuvant chemotherapy utilization and early cystectomy did not show a survival benefit in patients with MPBC. This histology independently predicts decreased survival and prognosis is poor regardless of treatment modality. Further research should focus on developing better treatment options for this rare disease.
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Affiliation(s)
- Wilson Sui
- Department of Urology, Columbia University Medical Center , New York, NY, USA
| | - Justin T Matulay
- Department of Urology, Columbia University Medical Center , New York, NY, USA
| | - Maxwell B James
- Department of Urology, Columbia University Medical Center , New York, NY, USA
| | - Ifeanyi C Onyeji
- Department of Urology, Columbia University Medical Center , New York, NY, USA
| | | | - Arindam RoyChoudhury
- Department of Biostatistics, Mailman School of Public Health, Columbia University , New York, NY, USA
| | - G Joel DeCastro
- Department of Urology, Columbia University Medical Center , New York, NY, USA
| | - Sven Wenske
- Department of Urology, Columbia University Medical Center , New York, NY, USA
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Abstract
Bladder cancer is the fourth most common cancer in men, and is associated with significant morbidity and mortality. Pathologic evaluation of urothelial cancers relies predominantly on histomorphologic features but can be aided in a small subset of cases by immunohistochemical analyses. Distinction of papillary versus flat lesions, low-grade versus high-grade cytology, and histologic variants and the presence or absence of invasive tumor is important for proper clinical management. Advances in the molecular alterations associated with the various subtypes of urothelial carcinoma have been made but such studies are ongoing.
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