Article

Noninvasive urothelial carcinoma of the bladder with glandular differentiation: Report of 24 cases

Department of Pathology, The Johns Hopkins Hospital, Baltimore, MD 21231, USA.
The American journal of surgical pathology (Impact Factor: 4.59). 06/2009; 33(8):1241-8. DOI: 10.1097/PAS.0b013e3181a1ff41
Source: PubMed

ABSTRACT Noninvasive urothelial carcinoma (UC) with glandular differentiation in the absence of infiltrating carcinoma is a rare entity that has not been well characterized. We retrieved 24 cases of noninvasive UC of the bladder with glandular differentiation on biopsy (n=20) or transurethral resection (n=4) without an associated invasive component. The cases were identified from the consult files of one of the authors between 1992 and 2008. Mean patient age at diagnosis was 70 years (range: 48 to 87 y) and 75% were male. Half of the cases were pure noninvasive UC with glandular differentiation; half were associated with either carcinoma in situ or high-grade noninvasive papillary carcinoma. The glandular component consisted of 1 or more patterns: papillary (46% of cases), glandular (42%), cribriform (33%), and flat (25%). Mitoses, apoptosis, and necrosis were identified in 83%, 67%, and 17% of the biopsies, respectively. One case was a recent diagnosis, and 5 patients either refused treatment or were lost to follow-up. Of the 18 patients with available follow-up information, 9 (50%) did not develop invasive carcinoma; the remaining 9 (50%) eventually developed an invasive bladder tumor. Of these, 2 were small cell carcinoma, 3 were poorly-differentiated UC (2 of these developed widespread metastases), and 4 were UC, not otherwise specified. In both instances of eventual small cell carcinoma, and in 2 of the 3 cases of poorly-differentiated UC, the initial biopsy consisted of pure noninvasive UC with glandular differentiation without carcinoma in situ or noninvasive papillary carcinoma. Of note, none of the patients in the study developed invasive adenocarcinoma.

1 Follower
 · 
66 Views
 · 
0 Downloads
  • Source
    • "After a median follow-up of 22 months, none developed recurrence or progression. The largest series of noninvasive UC with glandular differentiation was reported by Miller and Epstein.12 In that series, 7 patients were treated with BCG and follow-up was available in 6. "
    [Show abstract] [Hide abstract]
    ABSTRACT: Urothelial carcinomas have an established propensity for divergent differentiation. Most of these variant tumors are muscle invasive but not all. The response of non muscle invasive variant tumors to intravesical immunotherapy with BCG is not established in the literature, and is reported here. Between June 1995 and December 2007, 760 patients (mean age of 67.5 years) underwent transurethral resection of first time bladder tumors in our institution. Histologically variant tumors were found in 79 patients (10.4%). Of these 57 patients (72%) of them had muscle-invasive disease or extensive non-muscle invasive tumors and remaining 22 patients (28%) were treated with BCG immunotherapy. These included 7 patients with squamous differentiation, 4 with glandular, 6 with nested, 4 with micropapillary and 1 patient with sarcomatoid variant. The response of these patients to immunotherapy was compared with that of 144 patients having high-grade conventional urothelial carcinomas. Median follow-up was 46 months. The 2 and 5-year progression (muscle-invasion) free survival rates were 92% and 84.24% for patients with conventional carcinoma compared to 81.06% and 63.16% for patients with variant disease (P=0.02). The 2 and 5-year disease specific survival rates were 97% and 91.43% for patients with conventional carcinoma compared to 94.74 % and 82% for patients with variant disease (P=0.33). 5 patients (22.7%) of variant group and 13 patients (9.03%) of conventional group underwent cystectomy during follow-up (P=0.068). Patients with non-muscle invasive variants of bladder cancers can be managed with intravesical immunotherapy if tumor is not bulky (>4 cm). Although progression to muscle invasive disease is more common than in conventional group and occurs in about 40% of the patients, life expectancy is similar to patients with conventional high-grade urothelial carcinomas provided that follow-up is meticulous.
    Rare tumors 04/2011; 3(2):e22. DOI:10.4081/rt.2011.e22
  • [Show abstract] [Hide abstract]
    ABSTRACT: For complex problems of data-based fuzzy modelling the computing time plays an important role. Thus, reduction of the problem size by restricting the search to promising possibilities is justified. This paper presents a new method for extracting unidimensional fuzzy sets from measured data for a subsequent rule generation process. This method is motivated by four main points: 1) the projection of multidimensional data to unidimensional fuzzy sets considers the dependence between the input variables and the output variable without anticipating the rule generation process; 2) the user is not required to predefine the number of fuzzy sets and the number is changeable in a flexible manner for each variable without new computations; 3) the sum of membership values of one variable is one; and 4) the computing time does not increase more than linearly with the number of input variables
    Fuzzy Systems Proceedings, 1998. IEEE World Congress on Computational Intelligence., The 1998 IEEE International Conference on; 06/1998
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Bladder cancer is a common form of neoplasia which most often presents histologically as urothelial (transitional cell) carcinoma. In this article we review recent publications dealing with the less common variants of urothelial carcinoma such as tumours that show unusual forms of differentiation or the well know squamous, glandular, or sarcomatoid differentiation. Urothelial tumours may also show several distinct growth variants characterized by a nested, micropapillary, lymphoepithelioma-like, or plasmacytoid and giant cell growth pattern.The clinical course of bladder cancer varies depending on the histological type of neoplasia, grade and stage of the tumour. High-grade muscle-invasive urothelial cancers and tumours showing variant microscopic morphology have in general high mortality and poor prognosis.
    Srpski arhiv za celokupno lekarstvo 09/2011; 139(9-10):693-9. DOI:10.2298/SARH1110693D · 0.17 Impact Factor
Show more