Noninvasive Low-Grade Papillary Urothelial Carcinoma with Degenerative Nuclear Atypia: A Grading Pitfall

2021 ◽  
Author(s):  
Andres Matoso ◽  
Vamsi Parimi ◽  
Jonathan I. Epstein
Keyword(s):  
Urothelial Carcinoma ◽  
Low Grade ◽  
Nuclear Atypia ◽  
Papillary Urothelial Carcinoma

Umbrella Cells Mimicking Focal High-Grade Urothelial Carcinoma in Low-Grade Papillary Urothelial Carcinoma

2019 ◽  
Vol 152 (Supplement_1) ◽  
pp. S121-S121
Author(s):  
Muhammad Masood Hassan ◽  
Tammey Naab ◽  
Ali Afsari
Keyword(s):  
Urothelial Carcinoma ◽  
Proliferation Index ◽  
Low Grade ◽  
High Grade ◽  
Ki 67 ◽  
Prostate Hyperplasia ◽  
History Of ◽  
Papillary Urothelial Carcinoma ◽  
Artery Disease ◽  
Umbrella Cells

Abstract Objectives Low-grade papillary urothelial carcinoma (LGUC) has overall a preserved orderly appearance, minimal variability in architecture, and lack of significant cytologic atypia and mitotic activity without pleomorphism. A total of 53.8% of LGUC cases recur with 18.3% progression to high-grade UC. Even focal HGUC in LGUC can be a harbinger of progression. Accurate pathological interpretation is paramount in predicting recurrence and determining treatment. Methods A 63-year-old male with a past medical history of coronary artery disease, benign prostate hyperplasia, and obesity was referred to urology with a chief complaint of chronic hematuria. Cystoscopy with transurethral resection of bladder tumor was performed, which revealed mainly LGUC with focal high-grade-appearing UC. Results Histologic sections revealed papillary architecture with fused fronds, low-grade nuclear atypia, and scattered mitoses comprising 95% of the tissue submitted. No muscular wall invasion by carcinoma was seen. However, in one section, collections of large cells with well-defined cytoplasmic borders, multinucleation, and rare nuclear grooves were identified. The morphology raised the suspicion of a focal HGUC. Diffuse expression of CK20 and low Ki-67 proliferation index (1%) favored umbrella cells. Conclusion Our case reinforces the fact that sectioning can reveal foci, suspicious for HGUC, especially in urothelium. However, proper interpretation of morphology combined with the help of immunohistochemistry aids in accurate diagnosis, which is critical in determining proper clinical management of the patient.

scholarly journals Non-invasive papillary urothelial carcinoma, low-grade of the renal pelvis mimicking a xanthogranulomatous pyelonephritis in a male patient: A case report and review of literature

2020 ◽  
Vol 34 ◽  
pp. 205873842092572
Author(s):  
Xi Xie ◽  
Ning Wang ◽  
Yuyong Wang ◽  
Huadong He ◽  
Fanlei Kong ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Back Pain ◽  
Urothelial Carcinoma ◽  
Male Patient ◽  
Renal Pelvis ◽  
Xanthogranulomatous Pyelonephritis ◽  
Low Grade ◽  
Histopathologic Examination ◽  
Non Invasive ◽  
Papillary Urothelial Carcinoma

We report on a 31-year-old male patient with non-invasive papillary urothelial carcinoma, low grade of the renal pelvis disguised as xanthogranulomatous pyelonephritis. The only symptom of the patient was lower back pain. The initial renal-enhanced computed tomography, magnetic resonance imaging and contrast-enhanced ultrasonography showed that the right kidney had a benign lesion and this inflammatory lesion might be xanthogranulomatous pyelonephritis. A percutaneous renal biopsy was performed and histopathologic examination revealed a xanthogranulomatous pyelonephritis. Initially, we diagnosed it as xanthogranulomatous pyelonephritis and treated it with antibiotics. One and a half years later, the patient suffered from back pain again. The lesion increased significantly and a right renal pelvic lesion with retroperitoneal lymphadenopathy was considered a malignant lesion on computed tomography scan. Therefore, radical resection of right renal pelvis carcinoma was performed under retroperitoneal laparoscopy. Intraoperative frozen section was reported as right renal urothelial carcinoma with no metastasis in renal hilar lymph node. Postoperative histopathologic examination revealed non-invasive papillary urothelial carcinoma, low grade of renal pelvis.

scholarly journals Spectrum of histomorphological diagnosis in cystoscopic bladder biopsies

2017 ◽  
Vol 7 (1) ◽  
pp. 1062-1065
Author(s):  
R Thapa ◽  
M Lakhey ◽  
AD Bhatta
Keyword(s):  
Urinary Bladder ◽  
Urothelial Carcinoma ◽  
Clinical Symptoms ◽  
Transitional Cell ◽  
Research Centre ◽  
Low Grade ◽  
Bladder Tumors ◽  
Primary Tumors ◽  
Neoplastic Lesions ◽  
Papillary Urothelial Carcinoma

Background:  Urinary bladder lesions are the main source of significant clinical symptoms which are more disabling than lethal. Bladder tumors constitute one of the most common urological pathology. Urothelial carcinoma accounts for 90% of all primary tumors of the bladder. This study aimed to determine the frequency of different types of lesions of the urinary bladder and to determine the grade and stage of urothelial tumors.Materials and Methods: This is a 2 years cross sectional study of cystoscopic biopsies carried out in the Department of Pathology, Medicare National Hospital and Research Centre, Kathmandu, Nepal.Results:  Out of 87 cases, 58 (66.67%) cases were neoplastic lesions and 29(33.33%) cases were non- neoplastic lesions. Majority of neoplastic lesions 96.55% were urothelial (transitional cell) tumors comprising predominantly of low grade papillary urothelial carcinoma 50.91%. Muscle invasion was seen only in high grade papillary urothelial carcinomas.Conclusion: Among bladder tumors low grade papillary urothelial carcinoma is the most common. 

scholarly journals HER2 / neu Overexpression in Urothelial Carcinoma and Its Association with Tumour Grading - A Cross Sectional Study from a Tertiary Care Hospital in Kerala

2021 ◽  
Vol 8 (9) ◽  
pp. 497-501
Author(s):  
Sebina Asmi A.T ◽  
Suma Madathiveetil
Keyword(s):  
Urothelial Carcinoma ◽  
Growth Factor Receptor ◽  
Cross Sectional Study ◽  
Low Grade ◽  
High Grade ◽  
Sectional Study ◽  
Tumour Grade ◽  
Cross Sectional ◽  
Epidermal Growth ◽  
Papillary Urothelial Carcinoma

BACKGROUND Human epidermal growth factor receptor-2 HER2 / neu, is a trans membrane tyrosine kinase receptor of epidermal growth factor receptor (EGFR) family and is involved in the pathogenesis of urinary bladder cancer. In this study we attempted to evaluate the HER2 / neu expression in urothelial carcinoma of bladder and its association with tumour grading. METHODS This was a cross sectional study with a sample size of 75. Routine 4 micrometre thick sections of formalin fixed paraffin embedded tissue blocks stained with haematoxylin & eosin were reviewed. Tumour grade was determined by using the World Health Organization (WHO) / International Society of Urological Pathologist criteria (ISUP). Immunohistochemistry was done by using HER2 / neu monoclonal antibody and its expression were observed. The membrane staining intensity and pattern were studied and scored. RESULTS In our study 75 cases of urothelial carcinoma were studied, of which 49 cases were papillary urothelial carcinoma low grade, 26 cases were papillary urothelial carcinoma high grade. Among these, 19 cases were infiltrating urothelial carcinoma. HER2 / neu positivity were observed in 27 (36 %) cases and overexpression in 8 (10 %) cases. Low grade urothelial carcinoma showed HER2 / neu positivity in 11 (22 %) cases and overexpression in 1 (2 %) case. High grade urothelial carcinoma showed HER2 / neu positivity in 16 (64 %) cases, among which 7 (28 %) cases showed overexpression. HER2 / neu positivity was seen in 13 (68 %) cases of infiltrating urothelial carcinoma with 4 (21 %) cases showing overexpression. A statistically significant difference in HER2 / neu expression was noted in high grade and invasive urothelial carcinoma compared to low grade and non-invasive urothelial carcinoma. CONCLUSIONS Urothelial carcinomas show overexpression of HER2 / neu and this over expression increases with increasing grade of tumour and muscle invasiveness. KEYWORDS Urothelial Carcinoma, HER2 / neu, Overexpression, Tumour Grade, Trastuzumab

Utility of GATA-3 and Cytokeratin 5/6 Immunostains in Separating Condyloma Acuminatum Arising in the Urinary Tract From Non-Invasive Papillary Urothelial Carcinoma

2021 ◽  
pp. 106689692110522
Author(s):  
Diego Montoya-Cerrillo ◽  
Laurence M. Briski ◽  
Merce Jorda ◽  
Oleksandr N. Kryvenko
Keyword(s):  
Urinary Tract ◽  
Urothelial Carcinoma ◽  
Condylomata Acuminata ◽  
Condyloma Acuminatum ◽  
Low Risk ◽  
Low Grade ◽  
High Grade ◽  
Non Invasive ◽  
Urothelial Carcinomas ◽  
Papillary Urothelial Carcinoma

Background Condyloma acuminatum is a squamous epithelial lesion which uncommonly involves the urinary tract. In this location, non-invasive papillary urothelial carcinoma constitutes one of the main differential diagnoses with significant prognostic and therapeutic implications. To date, no ancillary immunohistochemical stain has been described to differentiate these two entities. We assess the utility of cytokeratin 5/6 (CK5/6) and GATA-3 immunohistochemistry in distinguishing condyloma acuminatum from non-invasive papillary urothelial carcinoma. Design We reviewed 9 condylomata acuminata involving the urinary tract, 12 low-grade and 8 high-grade non-invasive papillary urothelial carcinomas. CK5/6 immunostaining was performed in all cases. GATA-3 immunostaining and low-risk human papilloma virus (HPV) chromogenic in situ hybridization was performed in all condyloma cases and 2 urothelial carcinomas with squamous differentiation. Results 8/9 condylomata acuminata were positive for low-risk HPV. All condylomata acuminata exhibited strong full-thickness cytoplasmic staining for CK5/6. In 10 of 12 low-grade non-invasive papillary urothelial carcinomas, CK5/6 expression was continuous and limited to the basal cell layer, while it was patchy and limited to the basal cell layer in all 8 high-grade non-invasive papillary urothelial carcinomas. Two low-grade non-invasive papillary urothelial carcinomas showed focal full-thickness CK5/6 expression in the areas of squamous differentiation. These 2 cases were negative for low-risk HPV. GATA-3 immunostaining was positive in all condylomata acuminata. Conclusions CK5/6 immunostaining is a useful and simple tool that can help separate low-grade and high-grade non-invasive papillary urothelial carcinomas from condyloma acuminatum involving the urothelium-lined organs. GATA-3 has no discriminatory role between condyloma acuminatum and papillary urothelial carcinomas.

Comparative Evaluation of ProEx C and ImmunoCyt/uCyt Assays in Atypical Urine Cytology

2014 ◽  
Vol 138 (9) ◽  
pp. 1215-1222 ◽  
Author(s):  
Maria E. Vergara-Lluri ◽  
Eugenia Hu ◽  
Jian-Yu Rao ◽  
Mary Levin ◽  
Sophia K. Apple ◽  
...  
Keyword(s):  
Urothelial Carcinoma ◽  
Topoisomerase Ii ◽  
High Sensitivity ◽  
Urine Cytology ◽  
Urothelial Cell ◽  
Low Grade ◽  
Nuclear Staining ◽  
High Grade ◽  
Surgical Biopsy ◽  
Papillary Urothelial Carcinoma

Context.—Detection of urothelial carcinoma by urine cytology can be challenging. Recently, ProEx C has been studied as a marker to improve detection of urothelial carcinoma. ProEx C is an assay targeting expression of topoisomerase II-α and the minichromosome maintenance protein-2 and is used to assist in diagnoses of gynecologic specimens. Objective.—To evaluate the utility of ProEx C and uCyt in atypical urine cytology. Design.—Sixty-eight specimens with a diagnosis of atypical urine cytology, concurrent uCyt testing, and surgical biopsy follow-up were included. Slides were restained with ProEx C. ProEx C was recorded as positive when nuclear staining was seen in at least one morphologically atypical urothelial cell. The uCyt was scored as positive if at least one morphologically atypical urothelial cell showed positive fluorescence staining. Thirteen cases (19%) had benign histologic diagnoses, 18 (26%) had low-grade papillary urothelial carcinoma, and 37 (54%) had high-grade urothelial carcinoma. Results.—The overall sensitivity was 85% for ProEx C, 85% for uCyt, and 93% for the combination of the 2 assays. The overall specificity was 69% for ProEx C, 31% for uCyt, and 23% for the combination of the 2 tests. In predicting high-grade urothelial carcinoma, sensitivity was 92% for ProEx C, 86% for uCyt, and 92% for both tests. In predicting low-grade papillary urothelial carcinoma, sensitivity was best with the combination of the 2 tests at 94%. Conclusion.—ProEx C has superior specificity to uCyt. The combination of the 2 tests yielded high sensitivity not only for high-grade urothelial carcinoma but also for low-grade papillary urothelial carcinoma.

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