1
|
Su W, Sui W, Cheng X, Zong Y, Qin Y, Cui F. Morphology, immunohistochemistry characteristics, and clinical presentation of microcystic urothelial carcinoma: a series of 10 cases. Diagn Pathol 2023; 18:94. [PMID: 37598154 PMCID: PMC10439560 DOI: 10.1186/s13000-023-01381-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Accepted: 08/10/2023] [Indexed: 08/21/2023] Open
Abstract
BACKGROUND Microcystic urothelial carcinoma (MUC) is a rare variant of urothelial carcinoma with histological appearances similar to begin lesions. Thus far, approximately 50 cases have been reported. Here, we investigated the clinicopathological features of MUC. METHODS Clinical data and paraffin-embedded tissue blocks were collected. Immunohistochemical staining and polymerase chain reaction-Sanger sequencing were performed to detect the phenotype and TERT mutation status of MUC, respectively. RESULTS The mean patient age was 58.8 ± 14.5 years, with a male predominance (8:2). The pathological stage was T1 in one case, T2 in three cases, T3 in four cases, and T4 in two cases. Tumor metastases or death occurred in all five patients who were followed up within 1-3 years. Histological analyses revealed microcystic, tubular, cribriform, and occasionally cord-like structures, which generally lacked interstitial reactions. The lumens were empty, contained eosinophilic secretion, or were filled with mucin. The microcysts/tubules/cribriform patterns were lined by flat, cuboid, signet ring, or columnar types of epithelia. The cuboid, signet ring, and columnar types represented "glandular metaplasia" or glandular differentiation of urothelial carcinoma. Immunohistochemistry analyses revealed distinct co-expression patterns involving the luminal markers FOXA1 and GATA3, as well as the basal markers CK5/6 and CD44. All 10 cases exhibited a luminal phenotype according to the GATA3+/CK14- criterion, whereas nine cases exhibited a luminal phenotype according to the FOXA1+/CK14- criterion. The telomerase reverse transcriptase-C228T mutation was detected in seven cases. CONCLUSIONS MUC is a rare variant with a deceptively benign form of urothelial carcinoma, which is generally identified as a late-stage tumor with a poor prognosis. It exhibits distinct co-expression of luminal and basal markers, along with the TERT-C228T mutation.
Collapse
Affiliation(s)
- Wenjing Su
- Department of Pathology, Shandong Provincial Hospital affiliated to Shandong First Medical University, Jinan, 250021, Shandong, P.R. China
| | - Wenwen Sui
- Department of Pathology, Dongying District People's Hospital, Dongying, 257000, Shandong, P.R. China
| | - Xiankui Cheng
- Department of Pathology, Shandong Provincial Hospital affiliated to Shandong First Medical University, Jinan, 250021, Shandong, P.R. China
| | - Yuanyuan Zong
- Department of Pathology, Shandong Provincial Hospital affiliated to Shandong First Medical University, Jinan, 250021, Shandong, P.R. China
| | - Yejun Qin
- Department of Pathology, Shandong Provincial Hospital affiliated to Shandong First Medical University, Jinan, 250021, Shandong, P.R. China
| | - Fengyun Cui
- Department of Pathology, Shandong Provincial Hospital affiliated to Shandong First Medical University, Jinan, 250021, Shandong, P.R. China.
| |
Collapse
|
2
|
Netto GJ, Amin MB, Berney DM, Compérat EM, Gill AJ, Hartmann A, Menon S, Raspollini MR, Rubin MA, Srigley JR, Hoon Tan P, Tickoo SK, Tsuzuki T, Turajlic S, Cree I, Moch H. The 2022 World Health Organization Classification of Tumors of the Urinary System and Male Genital Organs-Part B: Prostate and Urinary Tract Tumors. Eur Urol 2022; 82:469-482. [PMID: 35965208 DOI: 10.1016/j.eururo.2022.07.002] [Citation(s) in RCA: 98] [Impact Index Per Article: 49.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2022] [Accepted: 07/03/2022] [Indexed: 12/14/2022]
Abstract
The 2022 World Health Organization (WHO) classification of the urinary and male genital tumors was recently published by the International Agency for Research on Cancer. This fifth edition of the WHO "Blue Book" offers a comprehensive update on the terminology, epidemiology, pathogenesis, histopathology, diagnostic molecular pathology, and prognostic and predictive progress in genitourinary tumors. In this review, the editors of the fifth series volume on urologic and male genital neoplasms present a summary of the salient changes introduced to the classification of tumors of the prostate and the urinary tract.
Collapse
Affiliation(s)
- George J Netto
- Heersink School of Medicine, The University of Alabama at Birmingham, Birmingham, AL, USA.
| | - Mahul B Amin
- Department of Pathology and Laboratory Medicine, University of Tennessee Health Science Center, Memphis, TN, USA; Department of Urology, USC Keck School of Medicine, Los Angeles, CA, USA
| | - Daniel M Berney
- Barts Cancer Institute, Queen Mary University of London, London, UK; Department of Cellular Pathology, Barts Health NHS Trust, London, UK
| | - Eva M Compérat
- Department of Pathology, Medical University of Vienna, General Hospital of Vienna, Vienna, Austria
| | - Anthony J Gill
- Sydney Medical School, University of Sydney, Sydney, Australia; NSW Health Pathology, Department of Anatomical Pathology, Royal North Shore Hospital St Leonards, Sydney, Australia; Pathology Group, Kolling Institute of Medical Research, Royal North Shore Hospital St Leonards, Sydney, Australia
| | - Arndt Hartmann
- Institute of Pathology, University Hospital Erlangen, Friedrich-Alexander-University Erlangen-Nürnberg, Erlangen, Germany
| | - Santosh Menon
- Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | - Maria R Raspollini
- Histopathology and Molecular Diagnostics, University Hospital Careggi, Florence, Italy
| | - Mark A Rubin
- Department for BioMedical Research (DBMR), Bern Center for Precision Medicine (BCPM), University of Bern and Inselspital, Bern, Switzerland
| | - John R Srigley
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada
| | - Puay Hoon Tan
- Division of Pathology, Singapore General Hospital, Singapore
| | - Satish K Tickoo
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Toyonori Tsuzuki
- Department of Surgical Pathology, AichiMedicalUniversity Hospital, Nagakut, Japan
| | - Samra Turajlic
- The Francis Crick Institute and The Royal Marsden NHS Foundation Trust, London, UK
| | - Ian Cree
- International Agency for Research on Cancer (IARC), World Health Organization, Lyon, France
| | - Holger Moch
- Department of Pathology and Molecular Pathology, University Hospital Zurich, Zurich, Switzerland
| |
Collapse
|
3
|
Are We Ready to Implement Molecular Subtyping of Bladder Cancer in Clinical Practice? Part 2: Subtypes and Divergent Differentiation. Int J Mol Sci 2022; 23:ijms23147844. [PMID: 35887192 PMCID: PMC9317362 DOI: 10.3390/ijms23147844] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Revised: 07/09/2022] [Accepted: 07/12/2022] [Indexed: 11/16/2022] Open
Abstract
Following several attempts to achieve a molecular stratification of bladder cancer (BC) over the last decade, a "consensus" classification has been recently developed to provide a common base for the molecular classification of bladder cancer (BC), encompassing a six-cluster scheme with distinct prognostic and predictive characteristics. In order to implement molecular subtyping (MS) as a risk stratification tool in routine practice, immunohistochemistry (IHC) has been explored as a readily accessible, relatively inexpensive, standardized surrogate method, achieving promising results in different clinical settings. The second part of this review deals with the pathological and clinical features of the molecular clusters, both in conventional and divergent urothelial carcinoma, with a focus on the role of IHC-based subtyping.
Collapse
|
4
|
Johnson SM, Khararjian A, Legesse TB, Khani F, Robinson BD, Epstein JI, Wobker SE. Nested Variant of Urothelial Carcinoma Is a Luminal Bladder Tumor With Distinct Coexpression of the Basal Marker Cytokeratin 5/6. Am J Clin Pathol 2021; 155:588-596. [PMID: 33118597 DOI: 10.1093/ajcp/aqaa160] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Abstract
OBJECTIVES The nested variant of urothelial carcinoma (NVUC) is a rare bladder tumor that may possess a luminal molecular phenotype. We sought to determine whether a small immunohistochemical (IHC) panel using common surrogates for molecular phenotypes would reliably classify a cohort of pure NVUC cases. METHODS IHC staining with a panel composed of markers for basal subtypes (CK5/6, CK14) and luminal subtypes (FOXA1, GATA3) was performed on pure small NVUC cases (n = 23) and 5 large NVUC cases (n = 5). Scoring of IHC stains was performed semiquantitatively. Individual cases were analyzed using previously reported IHC-based surrogates for molecular subtype. RESULTS The phenotype of NVUC was classified as luminal from 60.1% (FOXA1+/CK5/6-) to 100% (GATA3+/CK14-) of cases using composite phenotypes. No cases possessed a basal or squamous cell carcinoma-like phenotype. The majority of small NVUC cases (69.5%) showed subset CK5/6 expression distinctly localized to the basal layers of tumor cell nests. Intratumoral heterogeneity was also noted in CK5/6 (21.7% of small NVUC cases) but no other markers. CONCLUSIONS NVUC appears to express markers of both basal and luminal bladder tumors. Definitive gene expression profiling may be valuable to further characterize this unique histologic variant.
Collapse
Affiliation(s)
- Steven M Johnson
- Department of Pathology and Laboratory Medicine, University of North Carolina School of Medicine, Chapel Hill
| | - Armen Khararjian
- Department of Pathology, Johns Hopkins Medical Institutions, Baltimore, MD
| | - Teklu B Legesse
- Department of Pathology, Johns Hopkins Medical Institutions, Baltimore, MD
| | - Francesca Khani
- Department of Pathology and Urology, Weill Cornell Medicine, New York, NY
| | - Brian D Robinson
- Department of Pathology and Urology, Weill Cornell Medicine, New York, NY
| | - Jonathan I Epstein
- Department of Pathology, Johns Hopkins Medical Institutions, Baltimore, MD
- Department of Urology and Oncology, Johns Hopkins Medical Institutions, Baltimore, MD
| | - Sara E Wobker
- Department of Pathology and Laboratory Medicine, University of North Carolina School of Medicine, Chapel Hill
- Lineberger Comprehensive Cancer Center, University of North Carolina School of Medicine, Chapel Hill
| |
Collapse
|
5
|
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]
|
6
|
Han L, Gallan AJ, Steinberg GD, Sweis RF, Paner GP. Morphological correlation of urinary bladder cancer molecular subtypes in radical cystectomies. Hum Pathol 2020; 106:54-61. [PMID: 32987034 PMCID: PMC7746505 DOI: 10.1016/j.humpath.2020.09.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2020] [Revised: 09/16/2020] [Accepted: 09/21/2020] [Indexed: 12/30/2022]
Abstract
Several molecular subtypes of bladder cancer were identified with differing clinical behavior and responses to platinum-based chemotherapy. But so far, their urothelial histomorphologic features, besides association with some variant histologies, have remained fully undefined. We sought to characterize the histological features of genomically classified bladder cancers more extensively to tumor in radical cystectomy (RC) specimens. Forty-eight bladder cancers submitted to The Cancer Genome Atlas (TCGA) were classified using the BASE47 genomic classifier into luminal subtype (LS) (14 cases), basal subtype (BS) (18 cases), and claudin-low subtype (CLS) (16 cases), and TCGA samples and the corresponding RC specimens were histologically assessed. Marked pleomorphism was more extensive in CLS tumors (87.5% had >15% extent) than in LS tumors (21.4%) (p = 0.0006), whereas the extent in BS tumors was in between LS and CLS tumors. Pleomorphism in distant carcinoma in situ appeared to correlate with that in the main tumor. Ki-67 proliferation was higher in CLS tumors (mean = 61%) than in LS tumors (mean = 29%) or BS (mean = 30%) (p < 0.001). Squamous differentiation was more extensive in BS and CLS tumors (38.2% of BS and CLS tumors versus 7.1% of LS tumors had >30% squamous, p = 0.040). Sarcomatoid change was present in BS and CLS tumors only. The micropapillary variant was identified in LS (3/14) and BS (4/18) tumors only. Histologic features associated with aggressiveness (eg, marked pleomorphism, high proliferation, and sarcomatoid change) are enriched in CLS tumors, correlating with its known poorer outcome that may provide hints in their microscopic distinction. Features more associated with BS than with LS tumors (eg, squamous, marked pleomorphism, and sarcomatoid change) are also identified or enhanced in CLS tumors, supporting the genomic findings suggesting CLS tumor as a hyperbasal form of BS tumor.
Collapse
Affiliation(s)
- Lisa Han
- Department of Pathology, University of Chicago, Chicago, IL, USA
| | - Alexander J Gallan
- Department of Pathology, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Gary D Steinberg
- Department of Urology, New York University Langone Health, New York, NY, USA
| | - Randy F Sweis
- Department of Medicine (Hematology-Oncology), University of Chicago, Chicago, IL, USA.
| | - Gladell P Paner
- Department of Pathology, University of Chicago, Chicago, IL, USA; Department of Surgery (Urology), University of Chicago, Chicago, IL, USA.
| |
Collapse
|
7
|
Weyerer V, Weisser R, Moskalev EA, Haller F, Stoehr R, Eckstein M, Zinnall U, Gaisa NT, Compérat E, Perren A, Keck B, Allory Y, Kristiansen G, Wullich B, Agaimy A, Hartmann A, Bertz S. Distinct genetic alterations and luminal molecular subtype in nested variant of urothelial carcinoma. Histopathology 2019; 75:865-875. [DOI: 10.1111/his.13958] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2019] [Accepted: 07/23/2019] [Indexed: 12/15/2022]
Affiliation(s)
- Veronika Weyerer
- Institute of Pathology University Hospital Erlangen Friedrich‐Alexander‐Universität Erlangen‐Nürnberg Erlangen Germany
| | - Rebecca Weisser
- Institute of Pathology University Hospital Erlangen Friedrich‐Alexander‐Universität Erlangen‐Nürnberg Erlangen Germany
| | - Evgeny A Moskalev
- Institute of Pathology University Hospital Erlangen Friedrich‐Alexander‐Universität Erlangen‐Nürnberg Erlangen Germany
| | - Florian Haller
- Institute of Pathology University Hospital Erlangen Friedrich‐Alexander‐Universität Erlangen‐Nürnberg Erlangen Germany
| | - Robert Stoehr
- Institute of Pathology University Hospital Erlangen Friedrich‐Alexander‐Universität Erlangen‐Nürnberg Erlangen Germany
| | - Markus Eckstein
- Institute of Pathology University Hospital Erlangen Friedrich‐Alexander‐Universität Erlangen‐Nürnberg Erlangen Germany
| | - Ulrike Zinnall
- Institute of Pathology University Hospital Erlangen Friedrich‐Alexander‐Universität Erlangen‐Nürnberg Erlangen Germany
- Institute of Medical Systems Biology Max Delbrück Center for Molecular Medicine in the Helmholtz Association Berlin Germany
| | - Nadine T Gaisa
- Department of Pathology RWTH Aachen University Aachen Germany
| | - Eva Compérat
- Department of Pathology Pitié‐Salpétrière Hospital UPMC Paris France
| | - Aurel Perren
- Institute of Pathology University of Bern Bern Switzerland
| | - Bastian Keck
- Department of Urology and Pediatric Urology University Hospital Erlangen Friedrich‐Alexander‐Universität Erlangen‐Nürnberg Erlangen Germany
- Private Practice for Urology Erlangen Germany
| | - Yves Allory
- Service de Pathologie CHU Henri Mondor Créteil France
| | | | - Bernd Wullich
- Department of Urology and Pediatric Urology University Hospital Erlangen Friedrich‐Alexander‐Universität Erlangen‐Nürnberg Erlangen Germany
| | - Abbas Agaimy
- Institute of Pathology University Hospital Erlangen Friedrich‐Alexander‐Universität Erlangen‐Nürnberg Erlangen Germany
| | - Arndt Hartmann
- Institute of Pathology University Hospital Erlangen Friedrich‐Alexander‐Universität Erlangen‐Nürnberg Erlangen Germany
| | - Simone Bertz
- Institute of Pathology University Hospital Erlangen Friedrich‐Alexander‐Universität Erlangen‐Nürnberg Erlangen Germany
| |
Collapse
|
8
|
Arias-Stella JA, Shah AB, Gupta NS, Williamson SR. CK20 and p53 Immunohistochemical Staining Patterns in Urinary Bladder Specimens With Equivocal Atypia. Arch Pathol Lab Med 2017; 142:64-69. [DOI: 10.5858/arpa.2016-0411-oa] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Context.—
Urinary bladder flat carcinoma in situ (CIS) is a worrisome lesion, requiring aggressive surveillance and treatment. Cytokeratin 20 (CK20) and p53 are common immunohistochemical antibodies used to supplement CIS diagnosis in biopsy samples. However, existing data come primarily from unequivocally benign and malignant specimens.
Objective.—
To correlate these markers in specimens with borderline histology with outcomes.
Design.—
CK20 and p53 immunohistochemistry was analyzed for staining pattern, classified as CIS pattern (both stains yielding strong labeling of the area of concern), discordant (only 1 stain yielding CIS pattern), indeterminate (1 or both stains yielding partial or equivocal labeling), or benign (both stains yielding a benign pattern).
Results.—
Specimens with equivocal atypia (n = 69) from 65 patients were studied. There were 9 specimens (13%) that had a CIS staining pattern, 18 (26%) were discordant, 31 (45%) were indeterminate, and 11 (16%) were benign. Of the discordant specimens, 13 labeled for CK20 but not p53, whereas 5 showed the opposite. Most specimens (n = 47; 68%) were obtained from patients with a known history of bladder cancer, of which recurrence developed in 27, with an average interval of 37 months (range, 2–216 months). A subset (n = 22; 34%) had no prior history of bladder cancer, from which only 1 patient with CK20-positive/p53-equivocal staining later developed diagnostic carcinoma.
Conclusions.—
In our cohort of specimens with equivocal urothelial atypia, very few patients without a prior diagnosis of bladder cancer progressed to diagnostic cancer (1 of 22), suggesting that staining results should be interpreted with caution in de novo atypia. Patients with a known history of bladder cancer had a substantial rate of recurrence, independent of staining pattern.
Collapse
Affiliation(s)
- Javier A. Arias-Stella
- From the Department of Pathology and Laboratory Medicine, Henry Ford Health System and Cancer Institute, Detroit, Michigan (Drs Arias-Stella, Shah, Gupta, and Williamson); and the Department of Pathology, Wayne State University School of Medicine, Detroit (Dr Williamson). Dr Arias-Stella is now with the Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Alpa B. Shah
- From the Department of Pathology and Laboratory Medicine, Henry Ford Health System and Cancer Institute, Detroit, Michigan (Drs Arias-Stella, Shah, Gupta, and Williamson); and the Department of Pathology, Wayne State University School of Medicine, Detroit (Dr Williamson). Dr Arias-Stella is now with the Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Nilesh S. Gupta
- From the Department of Pathology and Laboratory Medicine, Henry Ford Health System and Cancer Institute, Detroit, Michigan (Drs Arias-Stella, Shah, Gupta, and Williamson); and the Department of Pathology, Wayne State University School of Medicine, Detroit (Dr Williamson). Dr Arias-Stella is now with the Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Sean R. Williamson
- From the Department of Pathology and Laboratory Medicine, Henry Ford Health System and Cancer Institute, Detroit, Michigan (Drs Arias-Stella, Shah, Gupta, and Williamson); and the Department of Pathology, Wayne State University School of Medicine, Detroit (Dr Williamson). Dr Arias-Stella is now with the Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, New York
| |
Collapse
|
9
|
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]
|
10
|
Noninvasive Papillary Basal-like Urothelial Carcinoma: A Subgroup of Urothelial Carcinomas With Immunohistochemical Features of Basal Urothelial Cells Associated With a High Rate of Recurrence and Progression. Appl Immunohistochem Mol Morphol 2017; 24:575-82. [PMID: 26574632 DOI: 10.1097/pai.0000000000000224] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND We investigated the clinical and pathologic significance of a subgroup of noninvasive papillary urothelial carcinomas (UCs) expressing reactivity to urothelial basal cell markers. DESIGN In total, 302 consecutive cases of noninvasive papillary UC were evaluated immunohistochemically with cytokeratin 5 (CK5)/CD44. Any UC that was reactive for greater than 25% thickness of the urothelium was designated as basal-like urothelial carcinoma (BUC); remaining UC cases were designated as non-BUC. The follow-up period was up to 3 years. Historical review of UC was extended for up to 3 retrospective years. RESULTS Among 302 noninvasive UC, BUC was identified in 33 of 256 (12.9%) low-grade UC and 8 of 46 (17%) high-grade UC (P=0.041). Immunoreactivity for CD44 was similar to that of CK5, but displayed weaker and more diffuse staining. CK20 was reactive in 9 cases, primarily high-grade BUC. Other basal cell markers (34bE12, p63, bcl2, and EP4) were found to be neither sensitive nor specific in detecting UC with high CK5 expression. In comparison with non-BUC, BUC was associated with increased multifocality, larger tumor size, higher recurrence rate, and more frequent upgrading and stage progression. In the follow-up period of 3 years, distant metastasis occurred in 6 cases of which 5 were in the BUC subgroup. CONCLUSIONS Our results showed that noninvasive papillary BUC represents a small subset associated with increased risk of tumor recurrence and progression. The aggressive behavior is likely associated with basal-like features of BUC, as seen in carcinomas with basal cell features in other body sites.
Collapse
|
11
|
Mai KT, Truong LD, Ball CG, Williams P, Flood TA, Belanger EC. Invasive urothelial carcinoma exhibiting basal cell immunohistochemical markers: A variant of urothelial carcinoma associated with aggressive features. Pathol Res Pract 2015; 211:610-8. [PMID: 26100813 DOI: 10.1016/j.prp.2015.05.005] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2014] [Revised: 04/14/2015] [Accepted: 05/22/2015] [Indexed: 01/10/2023]
Abstract
We characterize invasive urothelial carcinoma (UC) exhibiting urothelial basal cell immunohistochemical markers. Consecutive invasive UCs were immunostained with CK20 and urothelial basal cell markers, cytokeratin 5 (CK5)/CD44. Immunostaining for CK5 and CD44 was scored as follows: positive for staining of more than 25% thickness of the epithelial nest or epithelium and low for lesser immunoreactivity. Invasive urothelial carcinoma (UC) exhibiting positive CK5/CD44 staining was designated as basal-like UC (BUC). In this study, of 251 invasive UC (pT1 in 57% and pT2-4 in 43%), BUC accounted for 40% of cases (accounting for most pT2-4 UC) and often presented as non-papillary UC without previous history of UC. In addition, BUC exhibited uniform nuclei with lesser degree of atypia than non BUC and decreased or negative cytokeratin 20 reactivity. Nested and microcystic variants of UC immunohistochemically stained as BUCs. Invasive non-BUCs were often papillary with marked cytologic atypia and pleomorphism, and accounted for most pT1 UC. The rates of perivesical invasion, lymph node and distant metastases were higher for BUC than non-BUC. All nine cases with absent/minimal residual in situ UC in 102 radical cystectomy specimens were from invasive non-BUC. BUC is distinguished from non-BUC due to this aggressive behavior, distinct immunohistochemical profile, and predominant non-papillary architecture. Our findings are consistent with recent studies identifying a subtype of muscle-invasive UC with molecular expression of basal cell and luminal cell molecular profiles. Our study further supports categorizing invasive UCs into these subtypes with different biological behaviors, possibly contributing to better therapeutic strategies.
Collapse
Affiliation(s)
- Kien T Mai
- The Ottawa Hospital, Ottawa, ON, Canada; University of Ottawa, Pathology and Laboratory Medicine, Ottawa, ON, Canada.
| | - Luan D Truong
- Department of Pathology and Genomic Medicine, The Methodist Hospital Physician Organization, Weill Cornell Medical College of Cornell University, United States
| | - Christopher G Ball
- The Ottawa Hospital, Ottawa, ON, Canada; University of Ottawa, Pathology and Laboratory Medicine, Ottawa, ON, Canada
| | - Phillip Williams
- The Ottawa Hospital, Ottawa, ON, Canada; University of Ottawa, Pathology and Laboratory Medicine, Ottawa, ON, Canada
| | - Trevor A Flood
- The Ottawa Hospital, Ottawa, ON, Canada; University of Ottawa, Pathology and Laboratory Medicine, Ottawa, ON, Canada
| | - Eric C Belanger
- The Ottawa Hospital, Ottawa, ON, Canada; University of Ottawa, Pathology and Laboratory Medicine, Ottawa, ON, Canada
| |
Collapse
|