Clinicopathologic analysis of patients undergoing repeat transurethral resection of bladder tumour following an initial diagnosis of urothelial carcinoma with lamina propria invasion and variant/divergent histology

2021 ◽  
pp. jclinpath-2021-207756
Author(s):  
Patrick Mullane ◽  
Shreyas Joshi ◽  
Mehmet Bilen ◽  
Adeboye O Osunkoya
Keyword(s):  
Urothelial Carcinoma ◽  
Lamina Propria ◽  
Critical Role ◽  
Bladder Tumour ◽  
Significant Risk ◽  
Muscularis Propria ◽  
Giant Cells ◽  
Senior Author ◽  
Repeat Biopsy ◽  
Male Predominance

AimsA subset of patients with urothelial carcinoma (UCa) and lamina propria (LP) invasion in bladder biopsies/transurethral resections (TURs) are at significant risk for recurrence and have increased rates of progression to UCa with muscularis propria (MP) invasion. The clinicopathologic features of this patient population has not been well characterised in the Pathology literature.MethodsWe performed a search through our urologic pathology files and expert consult cases of the senior author for bladder biopsies/TURs of UCa with LP invasion and variant/divergent histology from 2014 to 2020. Patients with a prior diagnosis of UCa with MP invasion or upper tract UCa were excluded. Clinicopathologic data were obtained.ResultsNinety-five patients with at least one biopsy/TUR of UCa with LP invasion and variant/divergent histology were identified. Mean patient age was 72 years (range: 46–92 years) with a male predominance 2.3:1. Initial variant/divergent histologies identified were: glandular (35.8%), squamous (23.2%), micropapillary (20%), clear cell/lipid rich (12.6%), diffuse/signet ring/plasmacytoid (10.5%), nested (9.5%), sarcomatoid (6.3%), poorly differentiated/anaplastic (4.2%), small cell (2.1%), lymphoepithelioma-like (2.1%), osteoclast-like giant cells (1.1%) and tumour giant cells (1.1%). Two or more variant histologies were identified in 18.9% of these cases. The rate of micropapillary UCa was significantly higher in multifocal tumours compared with unifocal tumours (37% vs 7.1%).ConclusionsIn our cohort of patients undergoing early repeat biopsy/TUR, 75% of patients had persistent UCa. Additionally, almost 25% of patients had a prior diagnosis of UCa without a variant/divergent histology identified. Our findings highlight the critical role of repeat biopsy/TUR especially in a subset of patients who have variant/divergent histology, even in the absence of MP invasion.

scholarly journals Recurrence and upstaging rates of T1 high-grade urothelial carcinoma of the bladder on repeat resection in a Canadian, resource-limited, healthcare system

2018 ◽  
Vol 12 (8) ◽  
Author(s):  
Adam Kinnaird ◽  
Peter Dromparis ◽  
Howard Evans
Keyword(s):  
Urothelial Carcinoma ◽  
Healthcare System ◽  
Bladder Tumour ◽  
Muscularis Propria ◽  
High Grade ◽  
Recurrence Rates ◽  
Repeat Resection ◽  
Resource Limited ◽  
Carcinoma Of The Bladder ◽  
Muscle Invasive

Introduction: Non-muscle-invasive bladder cancer is the most expensive malignancy to treat. Current Canadian guidelines recommend repeat transurethral resection of bladder tumour (TURBT) within six weeks after initial resection of T1 high-grade (T1HG) urothelial carcinoma, prior to initiation of intravesical bacillus Calmette- Guerin treatment. This is a burden on operating room usage and adds further cost and risk of complications. Internationally, major cancer centres report significant rates of recurrence and upstaging on repeat resection, however, minimal Canadian data is available. We aimed to determine the rate of recurrence and upstaging in a resource-limited, Canadian healthcare system.Methods: A retrospective review of patients receiving TURBT between November 2009 and November 2014 was performed. Patients were included if they had all three of the following: a pathological diagnosis of T1HG, adequate muscularis propria present in the specimen, and a repeat resection.Results: We reviewed 3166 patients who underwent TURBT and found 173 to meet our inclusion criteria. The overall recurrence and upstaging rates were 57.2% and 9.2%, respectively. Tumour recurrence and upstaging occurred more often in patients who had repeat resection after 12‒24 weeks compared to those patients whose repeat resection occurred within 12 weeks.Conclusions: Although recurrence rates are similar, we have found upstaging rates to be three- to four-fold lower than those previously reported. Despite this, one in 10 patients will be upstaged, justifying use of this resource within our healthcare system. Finally, timely repeat resection, within 12 weeks appears to be associated with preventing disease progression.

Study on Staging and Grading of Urinary Bladder Tumour with Histopathological Correlation

2014 ◽  
Vol 22 (Number 1) ◽  
pp. 3-9
Author(s):  
S Sultana ◽  
T Chowdhury ◽  
F Jahan ◽  
A.H.M. O Farooque
Keyword(s):  
Urinary Bladder ◽  
Urothelial Carcinoma ◽  
Bladder Tumor ◽  
Bladder Wall ◽  
Bladder Tumour ◽  
Muscularis Propria ◽  
Low Grade ◽  
Cross Sectional ◽  
Histopathological Correlation ◽  
Papillary Urothelial Carcinoma

A cross sectional observational study was done to see the staging and grading of urinary bladder tumor along with their histopathological correlation at the Department of Pathology, Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka. The study was done during the period of July 2006 to June 2007 and total 150 cases were included those were clinically suggestive and cystoscopically or sonographically suspected cases of bladder tumor. Size of bladder, length of ureters, other organs present; tumor characteristics: size (including thickness), location extent of invasion, shape (papillary, ulcerated), multifocal lesion and appearance of non-neoplastic mucosa, thickness of bladder wall away from tumor were observed. Total 145 samples were collected by TURBT and 5 were by cystectomy. Mean age of the study patients was 58.5 years and 95.33% of them were male. Histopathologically 95.33% were papillary urothelial carcinoma, 2.66% were adenocarcinoma, 1.33% was squamous cell carcinoma and 0.66% were carcinosarcoma. Among 150 cases 72 (50.34%) bladder tumour were of high grade and 71 (49.65%) were low grade. In 7 (4.66%) cases grading were not done because they were other than papillary urothelial carcinoma. Staging were done in 93 cases and in remaining 57 cases staging was not possible due to absence of muscularis propria. 32 (21.33%) cases were stage T2, 31 (20.66%) cases T1 and 4 (2.66%) were in stage Ta. Overall findings of the cross sectional Bangladeshi population was almost similar to other developing and developed countries.

scholarly journals Nested variant of urothelial carcinoma of the urinary bladder

Rare Tumors ◽  
2011 ◽  
Vol 3 (4) ◽  
pp. 132-134 ◽  
Author(s):  
Tadashi Terada
Keyword(s):  
Urothelial Carcinoma ◽  
Lamina Propria ◽  
Bladder Tumor ◽  
Clinical Course ◽  
Carcinoma Cells ◽  
Ki 67 ◽  
Atypical Cells ◽  
Nested Variant ◽  
Aggressive Clinical Course ◽  
Nephrogenic Metaplasia

The nested variant of urothelial carcinoma (NVUC) is characterized by the presence of benign-appearing urothelial carcinoma cells in the lamina propria, sparing the surface urothelial involvement. NVUC shows aggressive clinical course despite of benign-looking histology. Herein reported are two cases of NVUC. One is 80-year-old woman, and another is 78-year-old man. In both cases, atypical cells forming nests and tubules were seen in the lamina propria without surface urothelial involvement. One case resembled nephrogenic metaplasia and another proliferated Brunn's nest or inverted papilloma. Immunohistochemically, both cases showed positive p53 and high Ki67 labeling, suggesting that both cases are malignant. Immunohistochemically, one case was characterized by positive cytokeratins, EMA, p53, Ki-67 (labeling=15%), α-methylacyl CoA racemase, CA19-9, and MUC1, and another case by positive cytokeratins, EMA, p63, p53, Ki-67 (lebeling=30%), CD10, CEA, and MUC1. Cyto keratin immunoprofiles were described and other antigens’ expressions were shown. The patients are now free of tumor 6 and 15 months after the resection of the bladder tumor.

Association of current molecular subtypes in urothelial carcinoma with patterns of muscularis propria invasion

2021 ◽  
Author(s):  
Koorosh Haghayeghi ◽  
Shaolei Lu ◽  
Andres Matoso ◽  
Stephen F. Schiff ◽  
Catrina Mueller-Leonhard ◽  
...  
Keyword(s):  
Urothelial Carcinoma ◽  
Molecular Subtypes ◽  
Muscularis Propria

scholarly journals The chaperone effect in scientific publishing

2018 ◽  
Vol 115 (50) ◽  
pp. 12603-12607 ◽  
Author(s):  
Vedran Sekara ◽  
Pierre Deville ◽  
Sebastian E. Ahnert ◽  
Albert-László Barabási ◽  
Roberta Sinatra ◽  
...  
Keyword(s):  
Biological Sciences ◽  
Critical Role ◽  
Scientific Work ◽  
Senior Author ◽  
High Impact ◽  
Principal Investigators ◽  
New Principal ◽  
Average Impact ◽  
Quantitative Understanding ◽  
Shed Light

Experience plays a critical role in crafting high-impact scientific work. This is particularly evident in top multidisciplinary journals, where a scientist is unlikely to appear as senior author if he or she has not previously published within the same journal. Here, we develop a quantitative understanding of author order by quantifying this “chaperone effect,” capturing how scientists transition into senior status within a particular publication venue. We illustrate that the chaperone effect has a different magnitude for journals in different branches of science, being more pronounced in medical and biological sciences and weaker in natural sciences. Finally, we show that in the case of high-impact venues, the chaperone effect has significant implications, specifically resulting in a higher average impact relative to papers authored by new principal investigators (PIs). Our findings shed light on the role played by experience in publishing within specific scientific journals, on the paths toward acquiring the necessary experience and expertise, and on the skills required to publish in prestigious venues.

Pitfalls in the Use of Smoothelin to Identify Muscularis Propria Invasion by Urothelial Carcinoma

2010 ◽  
Vol 34 (3) ◽  
pp. 418-422 ◽  
Author(s):  
Hiroshi Miyamoto ◽  
Rajni B. Sharma ◽  
Peter B. Illei ◽  
Jonathan I. Epstein
Keyword(s):  
Urothelial Carcinoma ◽  
Muscularis Propria

scholarly journals NEET as an Outcome for Care Leavers in South Africa: The Case of Girls and Boys Town

2018 ◽  
Vol 8 (1) ◽  
pp. 64-72 ◽  
Author(s):  
Lisa Dickens ◽  
Peter Marx
Keyword(s):  
Emerging Adults ◽  
South African ◽  
Critical Role ◽  
Significant Risk ◽  
Significant Risk Factor ◽  
Care Leavers ◽  
Boys Town ◽  
Employment Education ◽  
Status Of Care ◽  
And Training

A well-documented outcome for emerging adults in determining their “success” is whether they are Not in Employment, Education, or Training (NEET) or engaged in Education, Employment, and Training (EET). Being NEET can create psychological, emotional, financial, and health challenges and is a significant risk factor in youth making successful transitions into adulthood. This article describes and compares the NEET and EET status of care leavers from Girls and Boys Town after 1 and 2 years and in relation to other outcomes. The results suggest that while care leavers’ NEET rates are high, they are not significantly higher than those of the South African general population as seen elsewhere in the world. Furthermore, being NEET is associated with more negative care leaving outcomes than being EET; however, this article also highlights the vulnerability of those who are EET. Relationships with family and support networks play a critical role in helping and supporting these youth.

scholarly journals Metabolic Syndrome and Risk of Upper Tract Urothelial Carcinoma: A Case-Control Study From Surveillance, Epidemiology and End Results-Medicare-Linked Database

2021 ◽  
Vol 10 ◽  
Author(s):  
Yi Lu ◽  
Wei Zhang ◽  
Shujun Fan ◽  
Zhen Liang ◽  
Zhongjia Li ◽  
...  
Keyword(s):  
Metabolic Syndrome ◽  
Urothelial Carcinoma ◽  
Tumor Size ◽  
Significant Risk ◽  
Upper Tract Urothelial Carcinoma ◽  
Central Adiposity ◽  
Upper Tract ◽  
Tumor Stages ◽  
Diagnosis Date ◽  
End Results

BackgroundMetabolic syndrome (MetS) and its components are associated with increased risks of several cancers. However, the relationship between MetS and upper tract urothelial carcinoma (UTUC) has never been investigated before.MethodsWe identified 3,785 UTUC cases aged over 65 years old within the Surveillance, Epidemiology and End Results-Medicare database between 2007 and 2016. For comparison, non-cancer controls (n = 189,953) were selected from the 5% random sample of individuals residing within regions of SEER registries and matched with cases through diagnosis date and pseudo-diagnosis date. MetS and its components were all defined by using ICD-9-CM codes. Multivariate logistic regression models were conducted to calculate odds ratios (ORs) and 95% confidence intervals (CIs). Time trends for MetS and its components were reported and we also performed dose-response effect analysis to test the concomitant effect of these components. The study was presented following the STROBE reporting checklist.ResultsUTUC risk was associated with metabolic syndrome (NCEP-III: OR: 1.669, 95% CI: 1.550–1.792; IDF: OR: 1.924, 95% CI: 1.676–2.172) and its component factors: elevated waist circumference/central adiposity (OR: 1.872, 95% CI: 1.693–2.055), impaired fasting glucose (OR: 1.306, 95% CI: 1.133–1.480), high blood pressure (OR: 1.295, 95% CI: 1.239–1.353), high triglycerides (OR: 1.280, 95% CI: 1.222–1.341), and low high-density lipoprotein cholesterol (OR: 1.354, 95% CI: 1.118–1.592). Consistent associations could also be observed in the subgroup analyses by tumor stages, grades, and tumor size. Additionally, the rates of MetS increased over time in both UTUC and control cohort (NCEP-III criterion; EAPC: +18.1%, P <0.001; EAPC: +16.1%, P <0.001, respectively). A significantly gradual increase in UTUC rates could be seen as the No. of the MetS components increase (χ² = 37.239, Ptrend = 0.000).ConclusionsAmong people aged over 65, MetS and its components were significant risk factors for UTUC with consistent associations in different tumor stages, grades, and tumor size. Even if a subject who did not meet the criteria for MetS had only one of the components, he (she) still had an elevated risk for UTUC. Strategies to control the epidemic of MetS and its components might contribute to a reduction in the UTUC burden. The findings should be considered tentative until ascertained by more researches.

scholarly journals Giant Cell Urothelial Carcinoma of Bladder

2021 ◽  
Vol 2021 ◽  
pp. 1-5
Author(s):  
Harshima Disvini Wijesinghe ◽  
Ajith Malalasekera
Keyword(s):  
Urothelial Carcinoma ◽  
Giant Cell ◽  
Early Stage ◽  
Giant Cells ◽  
World Health ◽  
World Health Organization Classification ◽  
Health Organization

Giant cell urothelial carcinoma is a rare variant of bladder cancer recognized by the current World Health Organization classification of urologic tumours. It is an aggressive tumour with a poor prognosis that usually presents at an advanced stage. It is characterized histologically by pleomorphic giant cells. We discuss a case of giant cell urothelial carcinoma presenting at an early stage in a previously well 62-year-old woman. Histology showed a tumour comprising pancytokeratin positive bizarre mononuclear and multi-nuclear giant cells admixed with areas of conventional urothelial carcinoma and carcinoma in situ. Three-month follow-up cystoscopy and magnetic resonance imaging showed no evidence of recurrence or pelvic lymphadenopathy.

scholarly journals Spontaneous secretion of interferon γ and interleukin 4 by human intraepithelial and lamina propria gut lymphocytes

Gut ◽  
1998 ◽  
Vol 42 (5) ◽  
pp. 643-649 ◽  
Author(s):  
M Carol ◽  
A Lambrechts ◽  
A Van Gossum ◽  
M Libin ◽  
M Goldman ◽  
...  
Keyword(s):  
Lamina Propria ◽  
Intestinal Mucosa ◽  
Mononuclear Cells ◽  
Critical Role ◽  
Gastrointestinal Diseases ◽  
Interferon Γ ◽  
Interleukin 4 ◽  
Peripheral Blood Mononuclear ◽  
Ifn Γ

Background—Cytokines secreted by intestinal T lymphocytes probably play a critical role in regulation of the gut associated immune responses.Aims—To quantify interferon γ (IFN-γ) and interleukin 4 (IL-4) secreting cells (SC) among human intraepithelial (IEL) and lamina propria (LPL) lymphocytes from the duodenum and right colon in non-pathological situations and in the absence of in vitro stimulation.Patients—Duodenal and right colonic biopsy specimens were obtained from patients with no inflammation of the intestinal mucosa.Methods—Intraepithelial and lamina propria cell suspensions were assayed for numbers of cells spontaneously secreting IFN-γ and IL-4 by a two site reverse enzyme linked immunospot technique (ELISPOT).Results—The relatively high proportion of duodenal lymphocytes spontaneously secreting IFN-γ (IEL 3.6%; LPL 1.9%) and IL-4 (IEL 1.3%; LPL 0.7%) contrasted with the very low numbers of spontaneously IFN-γ SC and the absence of spontaneously IL-4 SC among peripheral blood mononuclear cells. In the basal state, both IFN-γ and IL-4 were mainly produced by CD4+ cells. Within the colon, only 0.2% of IEL and LPL secreted IFN-γ in the basal state, and 0.1% secreted IL-4.Conclusions—Compared with peripheral lymphocytes substantial proportions of intestinal epithelial and lamina propria lymphocytes spontaneously secrete IFN-γ and/or IL-4. These cytokines are probably involved in the normal homoeostasis of the human intestinal mucosa. Disturbances in their secretion could play a role in the pathogenesis of gastrointestinal diseases.

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