Nested Variant of Urothelial Carcinoma

2007 ◽  
Vol 131 (11) ◽  
pp. 1725-1727 ◽  
Author(s):  
Deepti Dhall ◽  
Hikmat Al-Ahmadie ◽  
Semra Olgac
Keyword(s):  
Urothelial Carcinoma ◽  
Correct Diagnosis ◽  
Muscularis Propria ◽  
Urothelial Cells ◽  
Significant Delay ◽  
Benign Lesions ◽  
Nephrogenic Adenoma ◽  
Large Numbers ◽  
Nested Variant ◽  
Cystitis Cystica

Abstract Nested variant of urothelial carcinoma is a rare neoplasm that is histologically characterized by large numbers of small, closely packed, haphazardly arranged, poorly defined, confluent irregular nests of bland-appearing urothelial cells infiltrating the lamina propria and the muscularis propria. Due to the cells' deceptively bland appearance, the tumors are sometimes misdiagnosed as benign lesions, leading in some cases to a significant delay in establishing the correct diagnosis and thus contributing to this neoplasm's advanced stage. Nested variant of urothelial carcinoma must be differentiated from the benign proliferative lesions of urothelium, such as von Brunn nests, cystitis cystica, cystitis glandularis, nephrogenic adenoma, inverted papilloma, and paraganglioma.

scholarly journals Nested Variant of Urothelial Carcinoma

2014 ◽  
Vol 2014 ◽  
pp. 1-24 ◽  
Author(s):  
Anthony Kodzo-Grey Venyo
Keyword(s):  
Urothelial Carcinoma ◽  
Benign Lesion ◽  
Treatment Options ◽  
Correct Diagnosis ◽  
Muscularis Propria ◽  
Proliferation Index ◽  
Advanced Stage ◽  
Biological Behaviour ◽  
Nested Variant ◽  
Characteristic Features

Background. Nested variant of urothelial carcinoma was added to the WHO’s classification in 2004.Aims. To review the literature on nested variant of urothelial carcinoma.Results. About 200 cases of the tumour have been reported so far and it has the ensuing morphological features: large numbers of small confluent irregular nests of bland-appearing, closely packed, haphazardly arranged, and poorly defined urothelial cells infiltrating the lamina propria and the muscularis propria. The tumour has a bland histomorphologic appearance, has an aggressive biological behaviour, and has at times been misdiagnosed as a benign lesion which had led to a significant delay in the establishment of the correct diagnosis and contributing to the advanced stage of the disease. Immunohistochemically, the tumour shares some characteristic features with high-risk conventional urothelial carcinomas such as high proliferation index and loss of p27 expression. However, p53, bcl-2, or EGF-r immunoreactivity is not frequently seen. The tumour must be differentiated from a number of proliferative lesions of the urothelium.Conclusions. Correct and early diagnosis of this tumour is essential to provide early curative treatment to avoid diagnosis at an advanced stage. A multicentre trial is required to identify treatment options that would improve the outcome of this tumour.

scholarly journals Recurrent transitional cell carcinoma of the bladder: A mixed nested variant case report and literature review

2012 ◽  
Vol 6 (2) ◽  
Author(s):  
Ettore De Berardinis ◽  
Gian Maria Busetto ◽  
Riccardo Giovannone ◽  
Gabriele Antonini ◽  
Mariarosaria Di Placido, ◽  
...  
Keyword(s):  
Cell Carcinoma ◽  
Cell Cancer ◽  
Transitional Cell ◽  
Urothelial Cell Carcinoma ◽  
Benign Lesions ◽  
Transitional Cell Cancer ◽  
Nested Variant ◽  
Carcinoma Of The Bladder ◽  
Cystitis Cystica ◽  
Nephrogenic Metaplasia

Nested variant of urothelial cell carcinoma (NVUC) is a rare histological entity, with about 80 reported cases. It has a deceptively benign appearance with an aspect characterized by confluent small nest or urothelial’s cell tubules. This tumour often resembles inverted papilloma, von Brunn’s nests (VBNs), cystitis cystica, nephrogenic metaplasia and sometimes usual transitional cell cancer. It is very important to be able to distinguish between benign lesions and nested variant bladder cancer because, in spite of its bland morphology, there is evidence that it behaves aggressively.

scholarly journals Microcystic Variant of Urothelial Carcinoma

2013 ◽  
Vol 2013 ◽  
pp. 1-7 ◽  
Author(s):  
Anthony Kodzo-Grey Venyo
Keyword(s):  
Urothelial Carcinoma ◽  
Neuroendocrine Differentiation ◽  
Muscularis Propria ◽  
Biological Behaviour ◽  
Squamous Cells ◽  
High Stage ◽  
Microscopic Features ◽  
Microcystic Variant ◽  
The Moment ◽  
Cystitis Cystica

Background. Microcystic variant of urothelial carcinoma is one of the new variants of urothelial carcinoma that was added to the WHO classification in 2004.Aims.To review the literature on microcystic variant of urothelial carcinoma.Methods.Various internet search engines were used to identify reported cases of the tumour.Results. Microscopic features of the tumour include: (i) Conspicuous intracellular and intercellular lumina/microcysts encompassed by malignant urothelial or squamous cells. (ii) The lumina are usually empty; may contain granular eosinophilic debris, mucin, or necrotic cells. (iii) The cysts may be variable in size; round, or oval, up to 2 mm; lined by urothelium which are either flattened cells or low columnar cells however, they do not contain colonic epithelium or goblet cells; are infiltrative; invade the muscularis propria; mimic cystitis cystica and cystitis glandularis; occasionally exhibit neuroendocrine differentiation. (iv) Elongated and irregular branching spaces are usually seen. About 17 cases of the tumour have been reported with only 2 patients who have survived. The tumour tends to be of high-grade and high-stage. There is no consensus opinion on the best option of treatment of the tumour.Conclusions. It would prove difficult at the moment to be dogmatic regarding its prognosis but it is a highly aggressive tumour. New cases of the tumour should be reported in order to document its biological behaviour.

scholarly journals Case Report: Large nested variant urothelial carcinoma –invasive malignancy masquerading as low grade disease

F1000Research ◽  
2014 ◽  
Vol 3 ◽  
pp. 314
Author(s):  
Andrew Keller ◽  
Ai Jye Lim ◽  
Ahmad Ali
Keyword(s):  
Case Report ◽  
Urothelial Carcinoma ◽  
Urothelial Cancer ◽  
Muscularis Propria ◽  
Low Grade ◽  
Clinical Recurrence ◽  
Non Invasive ◽  
Operative Specimen ◽  
Cytological Features ◽  
Nested Variant

IntroductionThe large nested variant of urothelial carcinoma (LNVUC) is a newly described and rare subtype of urothelial carcinoma. It is characterised by bland cytological features and a large nested architecture similar in appearance to low grade urothelial carcinoma with an inverted growth pattern. To date only 23 cases in a single series have been described.Case ReportWe describe the case of a 59 year old male with LNVUC whose tumour was initially misdiagnosed as a non-invasive low grade urothelial carcinoma. At a subsequent re-resection, his tumour was correctly re-classified as LNVUC with extensive invasion of the muscularis propria. Radical cystectomy and formation of an ileal conduit was performed. His operative specimen revealed invasion of prostatic stroma and perivesical fat, with all surgical margins clear. He is currently free from clinical recurrence 12 months after his cystectomy.ConclusionLNVUC is a newly described and rare urothelial carcinoma subtype. It characteristically possesses bland cytological features and may mimic low grade urothelial cancer. Despite its bland appearance it behaves aggressively with invasion, metastasis and death being common.

The nested variant of urothelial carcinoma: an aggressive tumor closely simulating benign lesions

2006 ◽  
Vol 12 (2) ◽  
pp. 105-107 ◽  
Author(s):  
Emine Dundar ◽  
Mustafa Fuat Acikalin ◽  
Cavit Can
Keyword(s):  
Urothelial Carcinoma ◽  
Benign Lesions ◽  
Nested Variant ◽  
Aggressive Tumor

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

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 Interobserver reproducibility of The Paris System for Reporting Urinary Cytology

CytoJournal ◽  
2017 ◽  
Vol 14 ◽  
pp. 17 ◽  
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.

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.

Sign in / Sign up

Export Citation Format

Share Document