Vulvar Paget disease secondary to high-grade urothelial carcinoma with underlying massive vascular embolization and cervical involvement: case report of unusual presentation

Abstract Background Vulvar extramammary Paget disease is a rare chronic condition, that presents with non-specific symptoms such as pruritus and eczematous lesions. Because most of these lesions are noninvasive, the distinction between primary and secondary Paget disease is crucial to management. Case presentation We report an unusual case of vulvar Paget disease associated with massive dermal vascular embolization, cervicovaginal involvement and metastasis to inguinal and retroperitoneal lymph nodes. The intraepithelial vulvar lesion had a classical appearance and was accompanied by extensive component of dermal lymphovascular tumor emboli, similar to those observed in inflammatory breast carcinoma. Immunohistochemical analysis revealed that the lesion was secondary to high-grade urothelial cell carcinoma. The patient had a history of superficial low-grade papillary urothelial carcinoma of the bladder, which had appeared 2 years before the onset of vulvar symptoms. Conclusions Eczematoid vulvar lesions merit careful clinical examination and biopsy, including vulva mapping and immunohistochemistry. The information obtained may help to define and classify a particular presentation of Paget disease. Noninvasive primary lesions do not require the same aggressive approaches required for the treatment of invasive and secondary disease.

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

American Journal of Clinical Pathology ◽

10.1093/ajcp/aqz122.011 ◽

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.

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A Contemporary Clinicopathologic Analysis of Primary Urothelial Carcinoma of the Urethra Without Concurrent Renal Pelvic, Ureteral, or Bladder Carcinoma

International Journal of Surgical Pathology ◽

10.1177/10668969211032481 ◽

2021 ◽

pp. 106689692110324

Author(s):

Fengming Chen ◽

Shreyas Joshi ◽

Bradley C. Carthon ◽

Adeboye O. Osunkoya

Keyword(s):

Urothelial Carcinoma ◽

Renal Pelvis ◽

Previous History ◽

Low Grade ◽

High Grade ◽

Divergent Differentiation ◽

History Of ◽

Variant Histology

Primary urothelial carcinoma (UCa) of the urethra is relatively uncommon, and the underlying pathogenesis has not been well characterized, especially in the absence of concurrent UCa at other sites. A search for cases of primary UCa of the urethra was conducted. Patients with concurrent UCa of the renal pelvis, ureter, or bladder at the time of diagnosis of the primary tumor were excluded. Clinicopathologic and follow-up data were obtained. A total of 35 cases from 30 patients (27 male and 3 female) were included in the study. The mean patient age at the initial diagnosis was 71 years (range: 41-90 years). Cases were composed of high-grade UCa (26 of 35 = 74%), low-grade UCa (4 of 35 = 11%), and UCa in situ (5 of 35 = 14%). Invasion was present in 14 of 26 (54%) cases of high-grade UCa. Interestingly, 23 of 30 (77%) patients had a previous history of UCa including 7 (30%) cases with divergent differentiation or variant histology. Follow-up data were available in 23 patients with a mean duration of 26.7 months (range: 0.6-87 months). Eleven patients (31%) died of metastatic UCa. This is one of the largest studies to date of primary UCa of the urethra without concurrent UCa of the renal pelvis, ureter, or bladder. Previous history of UCa of the bladder, especially with divergent differentiation or variant histology is conceivably a key risk factor for developing subsequent primary UCa of the urethra. These findings are important for the development of surveillance protocols and therapeutic strategies.

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A Rare Presentation of Cardiac Tamponade from Metastatic Urothelial Carcinoma of the Bladder

Case Reports in Cardiology ◽

10.1155/2018/6750264 ◽

2018 ◽

Vol 2018 ◽

pp. 1-4 ◽

Cited By ~ 1

Author(s):

Sowmya Palam ◽

Ridhima Kapoor ◽

Jacquelyn Kulinski

Keyword(s):

Urothelial Carcinoma ◽

Cardiac Tamponade ◽

English Literature ◽

Pericardial Fluid ◽

High Grade ◽

Rare Presentation ◽

Pericardial Window ◽

Cardiac Metastases ◽

History Of ◽

Carcinoma Of The Bladder

A 62-year-old man presented with 2 weeks of progressive dyspnea and chest pain. He was previously diagnosed with high-grade invasive urothelial carcinoma (UC) of the bladder and underwent neoadjuvant chemotherapy followed by radical cystectomy 10 months earlier, resulting in pathologic complete remission. Clinical evaluation and echocardiographic imaging was consistent with a diagnosis of cardiac tamponade. Due to a history of malignancy, the patient was referred for a surgical pericardial window, to include biopsy of the pericardium. Pericardial fluid and pericardial biopsy specimens were consistent with metastatic UC. Cardiac tamponade due to metastatic UC is a rare presentation, and, to our knowledge, there have been only 5 cases reported in the English literature. We report a rare case of cardiac tamponade due to isolated pericardial metastases from high grade UC of the bladder and discuss the symptoms, treatment, and prognosis of this pathologic condition. We also present a brief review of previously published literature. Through this discussion, we would like to emphasize the (1) consideration of cardiac metastases in the differential diagnosis for patients with a history of UC presenting with cardiac or pulmonary symptoms and (2) improved diagnostics with pericardial biopsy and pericardiocentesis over pericardiocentesis alone.

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Incidentally Discovered Osseous Metaplasia Within High-grade Urothelial Carcinoma of the Bladder

Urology ◽

10.1016/j.urology.2011.06.043 ◽

2012 ◽

Vol 79 (4) ◽

pp. e59-e60 ◽

Cited By ~ 3

Author(s):

Anne G. Dudley ◽

Jeffrey J. Tomaszewski ◽

Amber H. Hughes ◽

Benjamin J. Davies

Keyword(s):

Urothelial Carcinoma ◽

Osseous Metaplasia ◽

High Grade ◽

Carcinoma Of The Bladder

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Expression of Semaphorin 3A in Malignant and Normal Bladder Tissue: Immunohistochemistry Staining and Morphometric Evaluation

Biology ◽

10.3390/biology10020109 ◽

2021 ◽

Vol 10 (2) ◽

pp. 109

Author(s):

Ilan Bejar ◽

Jacob Rubinstein ◽

Jacob Bejar ◽

Edmond Sabo ◽

Hilla K Sheffer ◽

...

Keyword(s):

Urothelial Carcinoma ◽

Carcinoma In Situ ◽

Urothelial Cancer ◽

Basal Layer ◽

Low Grade ◽

High Grade ◽

Bladder Tissue ◽

Normal Bladder ◽

Normal Bladder Tissue

Introduction: Our previous studies showed elevated levels of Semaphorin3a (Sema3A) in the urine of patients with urothelial cancer compared to healthy patients. The aim of this study was to analyze the extent of Sema3A expression in normal and malignant urothelial tissue using immune-staining microscopic and morphometric analysis. Materials and Methods: Fifty-seven paraffin-embedded bladder samples were retrieved from our pathology archive and analyzed: 14 samples of normal urothelium, 21 samples containing low-grade urothelial carcinoma, 13 samples of patients with high-grade urothelial carcinoma, 7 samples containing muscle invasive urothelial carcinoma, and 2 samples with pure urothelial carcinoma in situ. All samples were immunostained with anti Sema3A antibodies. The area of tissue stained with Sema3A and its intensity were analyzed using computerized morphometry and compared between the samples’ groups. Results: In normal bladder tissue, very light Sema3A staining was demonstrated on the mucosal basal layer and completely disappeared on the apical layer. In low-grade tumor samples, cells in the basal layer of the mucosa were also lightly stained with Sema3A, but Seama3A expression intensified upon moving apically, reaching its highest level on apical cells exfoliating to the urine. In high grade urothelial tumors, Seama3A staining was intense in the entire thickness of the mucosa. In samples containing carcinoma in situ, staining intensity was high and homogenous in all the neoplastic cells. Conclusions: Sema3A may be serve as a potential non-invasive marker of urothelial cancer.

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High-grade urothelial carcinoma of the bladder with rhabdoid features: cytological and histological report of two cases

Cytopathology ◽

10.1111/cyt.12139 ◽

2014 ◽

Vol 26 (1) ◽

pp. 54-56 ◽

Cited By ~ 5

Author(s):

A. Kagotani ◽

M. Ishida ◽

K. Yoshida ◽

M. Iwai ◽

H. Okabe

Keyword(s):

Urothelial Carcinoma ◽

High Grade ◽

Carcinoma Of The Bladder ◽

Rhabdoid Features

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1780 FEMALE GENDER IS ASSOCIATED WITH HIGHER RISK OF DISEASE RECURRENCE IN PATIENTS WITH PRIMARY T1 HIGH GRADE UROTHELIAL CARCINOMA OF THE BLADDER

The Journal of Urology ◽

10.1016/j.juro.2013.02.2870 ◽

2013 ◽

Vol 189 (4S) ◽

Author(s):

Luis A Kluth ◽

Harun Fajkovic ◽

Evanguelos Xylinas ◽

Joseph J Crivelli ◽

Niccolo Passoni ◽

...

Keyword(s):

Urothelial Carcinoma ◽

Female Gender ◽

Disease Recurrence ◽

High Grade ◽

Risk Of Disease ◽

Carcinoma Of The Bladder

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Interobserver reproducibility of The Paris System for Reporting Urinary Cytology

CytoJournal ◽

10.4103/cytojournal.cytojournal_12_17 ◽

2017 ◽

Vol 14 ◽

pp. 17 ◽

Cited By ~ 25

Author(s):

Theresa Long ◽

Lester J. Layfield ◽

Magda Esebua ◽

Shellaine R. Frazier ◽

D. Tamar Giorgadze ◽

...

Keyword(s):

Urothelial Carcinoma ◽

Urinary Cytology ◽

Low Grade ◽

High Grade ◽

Urothelial Cells ◽

Urothelial Carcinomas ◽

Absolute Agreement ◽

Potential Impact ◽

Urine Specimens

Background: The Paris System for Reporting Urinary Cytology represents a significant improvement in classification of urinary specimens. The system acknowledges the difficulty in cytologically diagnosing low-grade urothelial carcinomas and has developed categories to deal with this issue. The system uses six categories: unsatisfactory, negative for high-grade urothelial carcinoma (NHGUC), atypical urothelial cells, suspicious for high-grade urothelial carcinoma, high-grade urothelial carcinoma, other malignancies and a seventh subcategory (low-grade urothelial neoplasm). Methods: Three hundred and fifty-seven urine specimens were independently reviewed by four cytopathologists unaware of the previous diagnoses. Each cytopathologist rendered a diagnosis according to the Paris System categories. Agreement was assessed using absolute agreement and weighted chance-corrected agreement (kappa). Disagreements were classified as low impact and high impact based on the potential impact of a misclassification on clinical management. Results: The average absolute agreement was 65% with an average expected agreement of 44%. The average chance-corrected agreement (kappa) was 0.32. Nine hundred and ninety-nine of 1902 comparisons between rater pairs were in agreement, but 12% of comparisons differed by two or more categories for the category NHGUC. Approximately 15% of the disagreements were classified as high clinical impact. Conclusions: Our findings indicated that the scheme recommended by the Paris System shows adequate precision for the category NHGUC, but the other categories demonstrated unacceptable interobserver variability. This low level of diagnostic precision may negatively impact the applicability of the Paris System for widespread clinical application.

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Urothelial carcinoma and its association with age and gender.

The Professional Medical Journal ◽

10.29309/tpmj/2019.26.10.3704 ◽

2019 ◽

Vol 26 (10) ◽

pp. 1719-1723

Author(s):

Rukhsana Parveen Samo ◽

Asim Mehmood ◽

Sana Kashif

Keyword(s):

Urothelial Carcinoma ◽

Male Gender ◽

Health Science ◽

P Value ◽

Low Grade ◽

High Grade ◽

Histological Grading ◽

Age And Gender ◽

Significant Difference ◽

And Gender

Objectives: To determine the urothelial carcinoma and its association with age and gender. Study Design: Retrospective study. Setting: Pathology department of Liaquat university of Medical and Health Science. Period: One year from January 2016 to December 2016. Material and Methods: Four micrometer thick paraffin-embedded and formalin-fixed sections were prepared from transurethral resection6of bladder6tumor (TURBT) samples of urothelial carcinoma patients and were examined. Histological grading was categorized as low and high grades. All the data was collected by self-made proforma. Data was analyzed by SPSS version 20. Results: Total 83 cases were enrolled in current study; their mean age was 49.19+12.33 years. Males were found in the majority 51(61.4%) and females were 32(38.6%). Most common age group was 46-60 years 36(43.4%). According to the histological grading high grade was most common as 65.10%, and low grade urothelial carcinoma was 34.90%. There was no significant difference according to age of histological grading. Male gender was most common, while progression of disease was higher among females in contrast to males as high grade carcinoma was significantly higher among females, p-value 0.014. Conclusion: It was concluded that male gender is the contributing factor of urothelial carcinoma, but disease progression significantly high among females. No significant association has been found according to age.

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

Canadian Urological Association Journal ◽

10.5489/cuaj.5039 ◽

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.

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