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Lassiter S, Smith ML, Siegert J, Nguyen T. Inflammatory Myofibroblastic Tumor of the urinary bladder: A case report. Urol Case Rep 2024; 54:102726. [PMID: 38799732 PMCID: PMC11126942 DOI: 10.1016/j.eucr.2024.102726] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Revised: 03/17/2024] [Accepted: 03/23/2024] [Indexed: 05/29/2024] Open
Abstract
Inflammatory Myofibroblastic Tumors represent a rare subset of spindle cell tumors that can occur in the genitourinary tract, most commonly within the bladder. These tumors are proposed to fall in a spectrum of benign inflammatory pseudotumors to true sarcomas. This, along with their rarity makes diagnosis and treatment challenging to clinicians. We present a 51-year-old female diagnosed with IMT of the bladder following a presentation for hematuria. Treatment consisted of transurethral resection of the tumor. This case, and the accompanying review of the literature highlight the need for further research due to lack of clarity for diagnosis and treatment.
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Li J, Wilkerson ML, Deng FM, Liu H. The Application and Pitfalls of Immunohistochemical Markers in Challenging Diagnosis of Genitourinary Pathology. Arch Pathol Lab Med 2024; 148:13-32. [PMID: 37074862 DOI: 10.5858/arpa.2022-0493-ra] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/26/2023] [Indexed: 04/20/2023]
Abstract
CONTEXT.— The morphologic features of different entities in genitourinary pathology overlap, presenting a diagnostic challenge, especially when diagnostic materials are limited. Immunohistochemical markers are valuable when morphologic features alone are insufficient for definitive diagnosis. The World Health Organization classification of urinary and male genital tumors has been updated for 2022. An updated review of immunohistochemical markers for newly classified genitourinary neoplasms and their differential diagnosis is needed. OBJECTIVE.— To review immunohistochemical markers used in the diagnosis of genitourinary lesions in the kidney, bladder, prostate, and testis. We particularly emphasized difficult differential diagnosis and pitfalls in immunohistochemistry application and interpretation. New markers and new entities in the 2022 World Health Organization classifications of genitourinary tumors are reviewed. Recommended staining panels for commonly encountered difficult differential diagnoses and potential pitfalls are discussed. DATA SOURCES.— Review of current literature and our own experience. CONCLUSIONS.— Immunohistochemistry is a valuable tool in the diagnosis of problematic lesions of the genitourinary tract. However, the immunostains must be carefully interpreted in the context of morphologic findings with a thorough knowledge of pitfalls and limitations.
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Affiliation(s)
- Jianhong Li
- From the Department of Pathology, Geisinger Medical Center, Danville, Pennsylvania (Li, Wilkerson, Liu)
| | - Myra L Wilkerson
- From the Department of Pathology, Geisinger Medical Center, Danville, Pennsylvania (Li, Wilkerson, Liu)
| | - Fang-Ming Deng
- the Department of Pathology, New York University Grossman School of Medicine, New York City (Deng)
| | - Haiyan Liu
- From the Department of Pathology, Geisinger Medical Center, Danville, Pennsylvania (Li, Wilkerson, Liu)
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3
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Sun L, Zhao Z, Zhu Y. USP6-associated neoplasm as a tentative subset of postoperative spindle cell nodule. Histopathology 2023; 82:587-595. [PMID: 36404122 DOI: 10.1111/his.14841] [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: 08/12/2022] [Revised: 10/29/2022] [Accepted: 11/14/2022] [Indexed: 11/22/2022]
Abstract
AIM Postoperative spindle cell nodule (PSCN) is a pseudosarcomatous proliferative lesion of unclear molecular genetic origins. METHODS AND RESULTS We examined seven patients with PSCN, using routine haematoxylin-eosin (H&E) slide preparations and a series of immunostains. The latter targeted keratin, vimentin, α-smooth muscle actin (SMA), anaplastic lymphoma kinase (ALK [D5F3]), and other proteins. Ubiquitin-specific peptidase 6 (USP6) and anaplastic lymphoma kinase (ALK) gene rearrangements were also analysed by fluorescence in situ hybridization (FISH). There were histories of prior surgical intervention (n = 6) or trauma (n = 1) in all seven patients. All lesions were highly cellular and mitotically active spindle cell proliferations, with no cytologic atypia, nuclear pleomorphism, or aberrant mitoses. Immunohistochemical (IHC) staining disclosed focal, weak keratin positivity in two lesions, whereas vimentin (diffuse, strongly positive) and SMA (tram-track pattern) were present in each instance, and ALK (D5F3) was entirely negative. FISH analysis confirmed USP6 gene rearrangements in all seven cases, showing no ALK gene rearrangements. RNA sequencing results showed an MYH9::USP6 gene fusion in only one lesion (No. 6). CONCLUSION A subset of PSCN is marked by USP6 gene rearrangements, a genetic feature of nodular fasciitis (NF). Given its similarity to NF, a designation as USP6-associated neoplasm (UAN) seems reasonable, signifying a transient clonal neoplastic lesion.
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Affiliation(s)
- Lili Sun
- Department of Pathology, Cancer Hospital of Dalian University of Technology, Cancer Hospital of China Medical University, Liaoning Cancer Hospital and Institute, Shenyang, China
| | - Zehua Zhao
- Department of Pathology, Cancer Hospital of Dalian University of Technology, Cancer Hospital of China Medical University, Liaoning Cancer Hospital and Institute, Shenyang, China
| | - Yanmei Zhu
- Department of Pathology, Cancer Hospital of Dalian University of Technology, Cancer Hospital of China Medical University, Liaoning Cancer Hospital and Institute, Shenyang, China
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4
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Mimickers of Urothelial Carcinoma and the Approach to Differential Diagnosis. Clin Pract 2021; 11:110-123. [PMID: 33668963 PMCID: PMC7931042 DOI: 10.3390/clinpract11010017] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Revised: 02/09/2021] [Accepted: 02/18/2021] [Indexed: 01/03/2023] Open
Abstract
A broad spectrum of lesions, including hyperplastic, metaplastic, inflammatory, infectious, and reactive, may mimic cancer all along the urinary tract. This narrative collects most of them from a clinical and pathologic perspective, offering urologists and general pathologists their most salient definitory features. Together with classical, well-known, entities such as urothelial papillomas (conventional (UP) and inverted (IUP)), nephrogenic adenoma (NA), polypoid cystitis (PC), fibroepithelial polyp (FP), prostatic-type polyp (PP), verumontanum cyst (VC), xanthogranulomatous inflammation (XI), reactive changes secondary to BCG instillations (BCGitis), schistosomiasis (SC), keratinizing desquamative squamous metaplasia (KSM), post-radiation changes (PRC), vaginal-type metaplasia (VM), endocervicosis (EC)/endometriosis (EM) (müllerianosis), malakoplakia (MK), florid von Brunn nest proliferation (VB), cystitis/ureteritis cystica (CC), and glandularis (CG), among others, still other cellular proliferations with concerning histological features and poorly understood etiopathogenesis like IgG4-related disease (IGG4), PEComa (PEC), and pseudosarcomatous myofibroblastic proliferations (post-operative spindle cell nodule (POS), inflammatory myofibroblastic tumor (IMT)), are reviewed. Some of these diagnoses are problematic for urologists, other for pathologists, and still others for both. Interestingly, the right identification of their definitory features will allow their correct diagnoses, thus, avoiding overtreatment. The literature selected for this review also focuses on the immunohistochemical and/or molecular data useful to delineate prognosis.
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5
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Wang W, Zhang M, Lu JR, Li QY. Inflammatory Myofibroblastic Tumor of Urinary Bladder. Chin Med J (Engl) 2019; 131:2259-2261. [PMID: 30203811 PMCID: PMC6144846 DOI: 10.4103/0366-6999.240816] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Affiliation(s)
- Wei Wang
- Department of Urology, The Yantai Affiliated Hospital of Binzhou Medical University, Yantai, Shandong 264100, China
| | - Min Zhang
- Department of Urology, The Yantai Affiliated Hospital of Binzhou Medical University, Yantai, Shandong 264100, China
| | - Jing-Ru Lu
- Department of Nephrology and Central Laboratory, The Affiliated Hospital of Qingdao University, Qingdao, Shandong 266000, China
| | - Qing-Yuan Li
- Department of Urology, The Yantai Affiliated Hospital of Binzhou Medical University, Yantai, Shandong 264100, China
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6
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Iatrogenic Disease of the Genitourinary Tract. Adv Anat Pathol 2019; 26:171-185. [PMID: 30720471 DOI: 10.1097/pap.0000000000000226] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Iatrogenic disease is defined as illness caused by diagnostic procedures or treatment given by health care professionals. More recently described treatment complications involving the genitourinary tract include newly recognized variants of renal carcinoma in the setting of dialysis/end-stage renal disease, treatment effect in genitourinary carcinomas, and medical renal disease caused by drug therapies, including immunotherapy. The objective of this review is to cover iatrogenic inflammatory diseases, pseudotumors and tumors of the kidney, bladder, prostate, testis and paratestis of most interest to surgical pathologists. For this reason, disease caused by the following will not be covered: iatrogenic glomerulonephritis, self-inflicted injury including the introduction of foreign bodies, surgical error, drugs of abuse and herbal medications, and iatrogenic disease in the transplant setting including ischemia/reperfusion injury. Emphasis is placed upon commonly encountered diseases in order to ensure that the review is of utility to practicing pathologists. The clinical context, pathophysiology and histopathology of each disease entity are covered.
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7
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Jebastin JAS, Smith SC, Perry KD, Gupta NS, Alanee S, Carskadon S, Chitale DA, Palanisamy N, Williamson SR. Pseudosarcomatous myofibroblastic proliferations of the genitourinary tract are genetically different from nodular fasciitis and lack USP6, ROS1 and ETV6 gene rearrangements. Histopathology 2018; 73:321-326. [PMID: 29617048 DOI: 10.1111/his.13526] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2018] [Accepted: 03/29/2018] [Indexed: 01/14/2023]
Abstract
AIMS Pseudosarcomatous myofibroblastic proliferations of the genitourinary tract have a debatable relationship with inflammatory myofibroblastic tumour (generally lacking ALK rearrangement); however, they share several overlapping features with nodular fasciitis of soft tissue. As rearrangement of the USP6 gene has been recently recognised as a recurrent alteration in soft tissue nodular fasciitis, and several other alternative gene fusions have been recently recognised in inflammatory myofibroblastic tumour, the aim of this study was to investigate whether USP6, ROS1 or ETV6 rearrangements were present in these lesions (12 cases). METHODS AND RESULTS Fluorescence in-situ hybridisation analysis was performed by the use of bacterial artificial chromosome-derived break-apart probes against USP6, ROS1, and ETV6. Two cases with adequate genetic material from recent paraffin tissue blocks were also tested by use of a solid tumour gene fusion detection assay via next-generation sequencing, targeting >50 known genes involved in recurrent fusions. None of the genitourinary pseudosarcomatous myofibroblastic proliferations was found to harbour USP6 (0/12), ROS1 (0/8) or ETV6 (0/7) rearrangements, and no gene fusions were detected in two cases studied by sequencing. CONCLUSIONS Despite overlap in histological and immunohistochemical features between pseudosarcomatous myofibroblastic proliferation and nodular fasciitis, these tumours lack the recently recognised USP6 rearrangements that occur in nodular fasciitis, as well as alternative fusions found in ALK-negative inflammatory myofibroblastic tumours. At present, this diagnosis remains based primarily on clinical, histological and immunohistochemical features.
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Affiliation(s)
- Judith A S Jebastin
- Department of Pathology and Laboratory Medicine and Henry Ford Cancer Institute, Henry Ford Health System, Detroit, MI, USA
| | - Steven C Smith
- Department of Pathology, Virginia Commonwealth University, Richmond, VA, USA
| | - Kyle D Perry
- Department of Pathology and Laboratory Medicine and Henry Ford Cancer Institute, Henry Ford Health System, Detroit, MI, USA
| | - Nilesh S Gupta
- Department of Pathology and Laboratory Medicine and Henry Ford Cancer Institute, Henry Ford Health System, Detroit, MI, USA
| | - Shaheen Alanee
- Vattikutti Urology Institute, Henry Ford Health System, Detroit, MI, USA
| | - Shannon Carskadon
- Vattikutti Urology Institute, Henry Ford Health System, Detroit, MI, USA
| | - Dhananjay A Chitale
- Department of Pathology and Laboratory Medicine and Henry Ford Cancer Institute, Henry Ford Health System, Detroit, MI, USA
- Department of Pathology, Wayne State University School of Medicine, Detroit, MI, USA
| | - Nallasivam Palanisamy
- Vattikutti Urology Institute, Henry Ford Health System, Detroit, MI, USA
- Michigan Center for Translational Pathology, University of Michigan, Ann Arbor, MI, USA
| | - Sean R Williamson
- Department of Pathology and Laboratory Medicine and Henry Ford Cancer Institute, Henry Ford Health System, Detroit, MI, USA
- Department of Pathology, Wayne State University School of Medicine, Detroit, MI, USA
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8
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Filotico M, D'Amuri A. Polypoid Carcinoma of the Oropharynx with Stromal Ossifying Myofibroblastic Proliferation: A Case Report and Literature Review. Case Rep Pathol 2016; 2016:2540407. [PMID: 28050299 PMCID: PMC5165139 DOI: 10.1155/2016/2540407] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2016] [Accepted: 11/15/2016] [Indexed: 11/17/2022] Open
Abstract
A 76-year-old man reported a worsening difficulty in swallowing, leading to the inability to eat. Physical examination and CT scan revealed a polypoid mass on the posterior oropharynx and obstructing the oropharyngeal space. Histologically, the surface was ulcerated. In the underlying necrotic rim, there was active granulation tissue, and a proliferation of voluminous, globoid elements with hyperchromatic and irregular nucleus, sometimes arranged in a alveolar aggregate. The core of the lesion contained spindle-like myoid elements in interwoven bundles, with trabeculae of osteoid matrix maturing into calcified bone. Immunohistochemistry documented positivity for cytokeratins, epithelial membrane antigen, and P63 in the globoid elements beneath the necrotic rim; strong and diffuse expression of vimentin, smooth muscle actin, and CD99 and BCL2 in the spindle elements; and complete negativity for cytokeratin 5/6, high molecular weight cytokeratin (clone 34βE12), S100, muscle-specific actin, desmin, CD117, and anaplastic lymphoma kinase. The lesion was morphologically and immunophenotypically classified as a polypoid oropharyngeal carcinoma with ossifying myofibroblastic stromal proliferation.
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Affiliation(s)
- Marcello Filotico
- Department of Anatomic Pathology, Fondazione Card. Panico Azienda Ospedaliera, Tricase, Italy
| | - Alessandro D'Amuri
- Department of Anatomic Pathology, Fondazione Card. Panico Azienda Ospedaliera, Tricase, Italy
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9
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Patne SCU, Katiyar R, Chaudhary D, Trivedi S. Dysuria and fever in a young woman diagnosed as having inflammatory myofibroblastic tumour of the urinary bladder. BMJ Case Rep 2016; 2016:bcr-2015-214059. [PMID: 26880824 DOI: 10.1136/bcr-2015-214059] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
A 38-year-old woman presented with dysuria and fever. Her medical and family histories were unremarkable. CT scan of the abdomen revealed a polypoid mass of 4×2.6×2.2 cm. Her cystoscopy showed a 4×2 cm solid broad-based growth at trigone of the urinary bladder. She underwent transurethral resection of the urinary bladder tumour (TURBT). Histopathology revealed a poorly circumscribed proliferation of spindle cells arranged in a haphazard and fascicular manner along with many traversing blood vessels in a myxoid and hyalinised stroma. Immunohistochemistry was positive for anaplastic lymphoma kinase-1, smooth muscle actin, CD10, cytokeratin and desmin; and negative for CD34 and S-100 protein. Ki-67 proliferative index in the tumour was <1%. The patient was diagnosed as having inflammatory myofibroblastic tumour of the urinary bladder. After TURBT, her fever and urinary symptoms resolved. Her 1-month postoperative period was uneventful. She has been advised regular follow-up.
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Affiliation(s)
| | - Richa Katiyar
- Department of Pathology, Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh, India
| | - Deepshikha Chaudhary
- Department of Pathology, Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh, India
| | - Sameer Trivedi
- Department of Urology, Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh, India
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10
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Lei JH, Yang L, Liu LR, Wei Q. Successful treatment and follow-up of a case of recurrent pseudosarcomatous myofibroblastic proliferation. Saudi Med J 2015; 36:363-5. [PMID: 25737182 PMCID: PMC4381024 DOI: 10.15537/smj.2015.3.10149] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
This report describes a case of recurrent pseudosarcomatous myofibroblastic proliferation (PMP) of the bladder with a satisfactory clinical course after a 3.5-year follow-up. There is a lack of reports of successful treatment experiences on recurrent PMP of the bladder in adults. For the primary lesion, a transurethral resection of the bladder tumor (TUR-BT) was performed; for the recurrent lesion, a combination regime of TUR-BT and intravesical mitomycin C proved effective treatment. The patient did not suffer local recurrence or distal metastasis during the 3.5-year follow-up. Our experience may serve as treatment reference to urologists who encounter similar cases.
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Affiliation(s)
- Jun H Lei
- Department of Urology, West China Hospital of Sichuan University, Sichuan, China. E-mail.
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11
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Wu S, Xu R, Zhao H, Zhu X, Zhang L, Zhao X. Inflammatory myofibroblastic tumor of renal pelvis presenting with iterative hematuria and abdominal pain: A case report. Oncol Lett 2015; 10:3847-3849. [PMID: 26788220 DOI: 10.3892/ol.2015.3767] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2014] [Accepted: 09/14/2015] [Indexed: 12/23/2022] Open
Abstract
Inflammatory myofibroblastic tumor (IMT) is a rare type of mesenchymal tumor, which may affect various organs. The preferential site for IMT in the genitourinary system is the urinary bladder, while the presence of IMT in the kidney, and particularly in the renal pelvis, is rare. In the present report, the case of a 43-year-old man who was admitted to the Department of Urology of The Second Xiangya Hospital of Central South University (Changsha, China) in July 2012, with complaints of iterative gross hematuria and abdominal pain unresponsive to antibiotics is described. Computed tomography and magnetic resonance imaging indicated a slightly enhanced mass in the left renal pelvis of 1.5 cm in diameter. On request of the patient, a left nephrectomy was then performed, based on a suspected diagnosis of renal pelvic carcinoma. However, analysis of the intraoperative fast-frozen section exhibited proliferation of compact spindle cells, suggesting IMT. Therefore, further ureterectomy was avoided, and the patient remained in healthy condition thereafter.
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Affiliation(s)
- Shuiqing Wu
- Department of Urology, The Second Xiangya Hospital of Central South University, Changsha, Hunan 410011, P.R. China
| | - Ran Xu
- Department of Urology, The Second Xiangya Hospital of Central South University, Changsha, Hunan 410011, P.R. China
| | - Huasheng Zhao
- Department of Urology, The Second Xiangya Hospital of Central South University, Changsha, Hunan 410011, P.R. China
| | - Xuan Zhu
- Department of Urology, The Second Xiangya Hospital of Central South University, Changsha, Hunan 410011, P.R. China
| | - Lei Zhang
- Department of Urology, The Second Xiangya Hospital of Central South University, Changsha, Hunan 410011, P.R. China
| | - Xiaokun Zhao
- Department of Urology, The Second Xiangya Hospital of Central South University, Changsha, Hunan 410011, P.R. China
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12
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Fuller TW, Dangle P, Reese JN, Ristau BT, Lyon TD, Jaffe R, Stephany HA. Inflammatory myofibroblastic tumor of the bladder masquerading as eosinophilic cystitis: case report and review of the literature. Urology 2015; 85:921-3. [PMID: 25817116 DOI: 10.1016/j.urology.2015.01.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2014] [Revised: 12/20/2014] [Accepted: 01/05/2015] [Indexed: 11/17/2022]
Abstract
A 9-year-old boy presented with gross hematuria of 2 days duration. Cystoscopic evaluation revealed an anterior bladder mass. Pathology was consistent with eosinophilic cystitis, and a steroid regimen was initiated accordingly, but no improvement ensued. Concern for alternate malignant pathology led to open resection and the ultimate diagnosis of inflammatory myofibroblastic tumor of the bladder. Inflammatory myofibroblastic tumor is a rare tumor of the bladder in children and to our knowledge has not previously been associated with a misleading eosinophil-rich mucosal inflammatory response.
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Affiliation(s)
- Thomas W Fuller
- Department of Urology, University of Pittsburgh Medical Center, Pittsburgh, PA.
| | - Pankaj Dangle
- Department of Urology, University of Pittsburgh Medical Center, Pittsburgh, PA
| | - Jeremy N Reese
- Department of Urology, University of Pittsburgh Medical Center, Pittsburgh, PA
| | - Benjamin T Ristau
- Department of Urology, University of Pittsburgh Medical Center, Pittsburgh, PA
| | - Timothy D Lyon
- Department of Urology, University of Pittsburgh Medical Center, Pittsburgh, PA
| | - Ronald Jaffe
- Department of Urology, University of Pittsburgh Medical Center, Pittsburgh, PA
| | - Heidi A Stephany
- Department of Urology, University of Pittsburgh Medical Center, Pittsburgh, PA
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13
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Wu S, Xu R, Wan Q, Zhu X, Zhang L, Jiang H, Zhao X. Assessment of the potential diagnostic role of anaplastic lymphoma kinase for inflammatory myofibroblastic tumours: a meta-analysis. PLoS One 2015; 10:e0125087. [PMID: 25910080 PMCID: PMC4409171 DOI: 10.1371/journal.pone.0125087] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2014] [Accepted: 03/20/2015] [Indexed: 12/15/2022] Open
Abstract
Objective To assess the value of anaplastic lymphoma kinase for the diagnosis of inflammatory myofibroblastic tumours using a comprehensive meta-analysis. Methods We searched the related literature using electronic databases and manual searches. Approximately 454 cases from several countries were included in this analysis. The quality of studies included was assessed by QUADAS (quality assessment of studies of diagnostic accuracy). The diagnostic odds ratio (DOR), positive likelihood ratio (PLR), negative likelihood ratio (NLR), sensitivity and specificity were calculated to assess the role of anaplastic lymphoma kinase in the diagnosis of inflammatory myofibroblastic tumours. The overall test performance was summarised by an SROC (summary receiver operating characteristic curve). The heterogeneity and publication bias were analysed using Meta-regression and Deeks' test. All data were analysed by Stata 12.0 software. Results Eight studies were included according to our inclusion criteria. The overall results for the specificity, sensitivity, PLR, NLR, DOR and area under the curve (AUC) were 0.99 (95% CI 0.82-1.00), 0.67 (95% CI 0.46-0.83), 0.67 (95% CI 0.46-0.83), 60.6 (95% CI 3.3-1112.4), 0.33 (95% CI 0.19-0.60), 181 (95% CI 9-3684) and 0.95 (95% CI 0.93-0.97), respectively, while the specificity, sensitivity, PLR, NLR, DOR and AUC for bladder IMTs were 0.99 (95% CI 0.67-1.00), 0.86 (95% CI 0.58-0.96), 95.6 (95% CI 2.0-4616.2), 0.14 (95% CI 0.04-0.50), 671 (95% CI 16-28913) and 0.99 (95% CI 0.97-0.99), respectively. Conclusion The present meta-analysis indicated that anaplastic lymphoma kinase plays a significant role in the differential diagnosis of inflammatory myofibroblastic tumours, particularly for inflammatory myofibroblastic tumours of the urinary bladder.
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Affiliation(s)
- Shuiqing Wu
- Department of Urology, The Second Xiangya Hospital of Central South University, Changsha, China
| | - Ran Xu
- Department of Urology, The Second Xiangya Hospital of Central South University, Changsha, China
| | - Qi Wan
- Neural Medical Center of the First Hospital in Changsha City, Changsha, China
| | - Xuan Zhu
- Department of Urology, The Second Xiangya Hospital of Central South University, Changsha, China
| | - Lei Zhang
- Department of Urology, The Second Xiangya Hospital of Central South University, Changsha, China
| | - Hongyi Jiang
- Department of Urology, The Second Xiangya Hospital of Central South University, Changsha, China
| | - Xiaokun Zhao
- Department of Urology, The Second Xiangya Hospital of Central South University, Changsha, China
- * E-mail:
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14
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Choi E, Williamson SR, Montironi R, Zhang S, Wang M, Eble JN, Grignon DJ, Lopez-Beltran A, Idrees MT, Baldridge LA, Scarpelli M, Jones CL, Wang L, MacLennan GT, Osunkoya AO, Cheng L. Inflammatory myofibroblastic tumour of the urinary bladder: the role of immunoglobulin G4 and the comparison of two immunohistochemical antibodies and fluorescencein-situhybridization for the detection of anaplastic lymphoma kinase alterations. Histopathology 2015; 67:20-38. [DOI: 10.1111/his.12619] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2014] [Accepted: 11/15/2014] [Indexed: 12/15/2022]
Affiliation(s)
- Euna Choi
- Department of Pathology and Laboratory Medicine; Indiana University School of Medicine; Indianapolis IN USA
| | | | - Rodolfo Montironi
- Institute of Pathological Anatomy and Histopathology; School of Medicine; Polytechnic University of the Marche Region (Ancona); United Hospitals; Ancona Italy
| | - Shaobo Zhang
- Department of Pathology and Laboratory Medicine; Indiana University School of Medicine; Indianapolis IN USA
| | - Mingsheng Wang
- Department of Pathology and Laboratory Medicine; Indiana University School of Medicine; Indianapolis IN USA
| | - John N Eble
- Department of Pathology and Laboratory Medicine; Indiana University School of Medicine; Indianapolis IN USA
| | - David J Grignon
- Department of Pathology and Laboratory Medicine; Indiana University School of Medicine; Indianapolis IN USA
| | | | - Muhammad T Idrees
- Department of Pathology and Laboratory Medicine; Indiana University School of Medicine; Indianapolis IN USA
| | - Lee Ann Baldridge
- Department of Pathology and Laboratory Medicine; Indiana University School of Medicine; Indianapolis IN USA
| | - Marina Scarpelli
- Institute of Pathological Anatomy and Histopathology; School of Medicine; Polytechnic University of the Marche Region (Ancona); United Hospitals; Ancona Italy
| | - Carol L Jones
- Department of Pathology and Laboratory Medicine; Indiana University School of Medicine; Indianapolis IN USA
| | - Lisha Wang
- Department of Pathology; Fudan University Shanghai Cancer Center; Shanghai China
| | | | | | - Liang Cheng
- Department of Pathology and Laboratory Medicine; Indiana University School of Medicine; Indianapolis IN USA
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15
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Abstract
We illustrate a case of an inflammatory myofibroblastic tumor (IMT) involving the bladder in a woman with dysuria and review the literature and differential diagnosis. Inflammatory myofibroblastic tumor, also referred to as pseudosarcomatous myofibroblastic proliferation, is a rare lesion that can arise in the genitourinary system and is characterized by a fascicular arrangement of myofibroblasts with admixed inflammatory cells and slitlike vessels. Urinary bladder IMT can be a diagnostic pitfall because its histologic features (brisk mitoses, invasion into muscularis propria, and prominent nucleoli) can mimic malignancy. The differential diagnosis of urinary bladder IMT includes sarcomatoid carcinoma and leiomyosarcoma. Diagnostic features such as bland nuclear chromatin, ganglion-like cells, pale eosinophilic cytoplasm with long processes, overexpression of anaplastic lymphoma kinase (immunohistochemistry or gene rearrangement studies), and the absence of atypical mitoses help distinguish IMT from its malignant mimics. Current controversies regarding postoperative spindle cell nodule and IMT are discussed.
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Affiliation(s)
- Megan Alderman
- From the Department of Pathology, University of Michigan Medical School, Ann Arbor
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Lightfoot M, Li R, Alsyouf M, Nicolay L, Chamberlin D. Transurethral needle biopsy: a novel technique for pathologic diagnosis of bladder tumors in children. J Pediatr Urol 2014; 10:1280-2. [PMID: 25082712 DOI: 10.1016/j.jpurol.2014.06.014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2014] [Accepted: 06/19/2014] [Indexed: 10/25/2022]
Abstract
Although rare, both benign and malignant bladder tumors are occasionally encountered in the pediatric population. In the present article, the technique of transurethral needle biopsy, which utilizes an 18-gauge core biopsy instrument inserted through a 9.5 French offset pediatric cystoscope to obtain diagnostic biopsies, is described. This technique has been used successfully in two patients, both of whom had an inflammatory myofibroblastic tumor on biopsy and on final pathology from partial cystectomy. This provides an alternative technique, which may be used when a pediatric resectoscope is not available or in patients with a small caliber urethra.
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Affiliation(s)
- Michelle Lightfoot
- Department of Urology, Loma Linda University Medical Center, Loma Linda, CA, 92354, United States.
| | - Roger Li
- Department of Urology, Loma Linda University Medical Center, Loma Linda, CA, 92354, United States.
| | - Muhannad Alsyouf
- Department of Urology, Loma Linda University Medical Center, Loma Linda, CA, 92354, United States.
| | - Lesli Nicolay
- Department of Urology, Loma Linda University Medical Center, Loma Linda, CA, 92354, United States.
| | - David Chamberlin
- Department of Urology, Loma Linda University Medical Center, Loma Linda, CA, 92354, United States.
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Wilkerson ML, Lin F, Liu H, Cheng L. The Application of Immunohistochemical Biomarkers in Urologic Surgical Pathology. Arch Pathol Lab Med 2014; 138:1643-65. [DOI: 10.5858/arpa.2014-0078-ra] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Context
Tumors of the genitourinary tract can be diagnostically challenging, particularly in core biopsies and cystoscopic biopsies with limited material. Immunohistochemistry is a valuable tool to use when morphology alone is insufficient for diagnosis.
Objectives
To review tumors and benign lesions of the kidney, urinary bladder, prostate gland, testis, and paratesticular structures with an emphasis on difficult differential diagnoses, as well as staining patterns in normal tissue. Recommended immunohistochemical stain panels are discussed that can assist in the diagnostic workup.
Data Sources
Review of current literature.
Conclusions
Immunohistochemistry is a valuable tool, assisting in the diagnosis of problematic tumors and benign lesions of the genitourinary tract.
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Affiliation(s)
- Myra L. Wilkerson
- From the Department of Laboratory Medicine, Geisinger Medical Center, Danville, Pennsylvania (Drs Wilkerson, Lin, and Liu)
| | - Fan Lin
- From the Department of Laboratory Medicine, Geisinger Medical Center, Danville, Pennsylvania (Drs Wilkerson, Lin, and Liu)
| | - Haiyan Liu
- From the Department of Laboratory Medicine, Geisinger Medical Center, Danville, Pennsylvania (Drs Wilkerson, Lin, and Liu)
| | - Liang Cheng
- and the Department of Laboratory Medicine, Indiana University School of Medicine, Indianapolis (Dr Cheng)
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