High-grade urothelial carcinoma of the renal pelvis: Clinicopathologic study of 108 cases with emphasis on unusual morphologic variants

Department of Pathology, Ohio State University Medical Center, The Ohio State University, University Hospital, Columbus, OH 43210, USA.
Modern Pathology (Impact Factor: 6.19). 05/2006; 19(4):494-503. DOI: 10.1038/modpathol.3800559
Source: PubMed


A clinicopathologic study of 108 cases of high-grade urothelial carcinomas of the renal pelvis is presented. Of the 108 tumors, 44 (40%) showed unusual morphologic features, including micropapillary areas (four cases), lymphoepithelioma-like carcinoma (two cases), sarcomatoid carcinoma (eight cases, including pseudoangiosarcomatous type), squamous differentiation and squamous cell carcinoma (15 cases), clear cells (two cases), glandular differentiation (two cases), rhabdoid, signet-ring or plasmacytoid cells (four cases), pseudosarcomatous stromal changes (four cases) and intratubular extension into the renal pelvis (three cases). Pathological staging was available in 62 patients; of these, 46 cases (74%) were in high stage (pT2-pT4) and 16 (26%) were in low stage (pTis, pTa, pT1). Clinical follow-up ranging from 1 to 256 months (median: 50 months) was available in 42 patients; of these, 26 (61%) died of tumor with a median survival of 31 months. The patients who did not die of their tumors showed only minimal or focal infiltration of the renal parenchyma by urothelial carcinoma, whereas those who died of their tumors showed massive infiltration of the kidney by the tumor. High-grade urothelial carcinomas of the renal pelvis can show a broad spectrum of histologic features similar to those seen in the urinary bladder. Our results support the finding that, unlike urothelial carcinomas of the bladder, the majority of primary urothelial carcinomas of the renal pelvis are of high histologic grade and present in advanced stages. Our study further highlights the fact that, in the renal pelvis, urothelial carcinomas show a tendency to frequently display unusual morphologic features and metaplastic phenomena. The importance of recognizing these morphologic variants of urothelial carcinoma in the renal pelvis is to avoid confusion with other conditions. The possibility of a high-grade urothelial carcinoma should always be considered in the evaluation of a tumor displaying unusual morphologic features in the renal pelvis, and attention to proper sampling as well as the use of immunohistochemical stains will be of importance to arrive at the correct diagnosis.

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    • "The incidence of UTUC is approximately 2 cases per 100,000 person-years, which has increased slightly over the past 3 decades [1]. Pure UC accounts for most of the UTUCs; however, UTUC with concomitant variant histology (CVH) owing to aberrant histological differentiation is a phenomenon that is well recognized by pathologists [2] [3] [4] and is similar to UC of the bladder [5]. Because of the rarity of UTUC, few studies have examined the influence of CVH on the prognosis of patients with UTUC treated with radical nephroureterectomy (RNU); the studies that have attempted 1078-1439/r 2015 Elsevier Inc. "
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    ABSTRACT: To evaluate the prognostic effect of concomitant variant histology (CVH) on survival outcomes in patients with upper urinary tract urothelial carcinoma (UTUC) after radical nephroureterectomy. Data on 417 patients with UTUC treated with radical nephroureterectomy without preoperative adjuvant therapy were retrospectively reviewed with a focus on CVH. Clinicopathological features and prognostic factors were compared between patients with pure UTUC and patients with UTUC with CVH. The primary end points were cancer-specific survival (CSS), disease recurrence-free survival (DFS), and overall survival (OS). UTUC with CVH was present in 90 (21.6%) of 417 patients. At a median follow-up of 26 months, 153 (36.7%) had died of UTUC, 161 (38.6%) had experienced a relapse, and 176 (42.2%) had died of other causes. UTUC with CVH was significantly associated with advanced tumor stage, high tumor grade, tumor diameter, lymphovascular invasion, lymph node metastasis, positive surgical margins, and tumor architecture compared with pure UTUC (all P<0.01). The estimated 5-year CSS, DFS, and OS rates were 64.9%, 61.1%, and 62.1%, respectively, in the pure UTUC group, compared with 36.3%, 34.3%, and 26.5%, respectively, in the UTUC with CVH group (P<0.001). Multivariate analysis demonstrated that CVH was an independent predictor of CSS (hazard ratio [HR] = 1.594; 95% CI: 1.125-2.259; P = 0.009), DFS (HR = 1.549; 95% CI: 1.077-2.152; P = 0.017), and OS (HR = 1.685; 95% CI: 1.212-2.343; P = 0.002). Approximately one-fifth of the specimens of patients with UTUC were observed to exhibit CVH. CVH was an independent prognostic factor for CSS, DFS, and OS in patients with UTUC on both univariate and multivariate analyses. Genitourinary pathologists should look for potential CVH components in UTUC specimens and report this in routine pathological practice. The presence of CVH should identify patients as candidates for consultation regarding early adjuvant therapy and intensive surveillance protocols. Copyright © 2015 Elsevier Inc. All rights reserved.
    Urologic Oncology 03/2015; 33(5). DOI:10.1016/j.urolonc.2015.02.010 · 2.77 Impact Factor
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    • "However, it was not associated with worse survival at a median follow-up of 11.4 years in their study. Xylinas et al. [9] reported that histological variants were associated with significantly higher risk of recurrence and worse cancer-specific mortality in univariate analysis. However, it was not an independent predictor of cancer-specific mortality in multivariate analysis when adjusted with age, gender, pathologic stage, pathologic grade, nodal metastasis, the presence of concomitant carcinoma in situ, lymphovascular invasion, and positive surgical margin. "
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    ABSTRACT: Purpose To investigate the prognostic significance of squamous and/or glandular differentiation in urothelial carcinoma (UC). Materials and Methods Among 800 consecutive patients who underwent radical cystectomy or nephroureterectomy at our institution from January 1990 to December 2010, 696 patients were included for the analysis. Clinicopathologic variables were compared according to the presence of squamous and/or glandular differentiation and the tumor location. Results A total of 51 (7.3%) patients had squamous and/or glandular differentiation. Patients with squamous and/or glandular differentiation had higher pathological T stage (p<0.001) and grade (p<0.001) than those with pure form of UC. After the median follow-up of 55.2 months, 84 (24.6%) and 82 (23.1%) died of upper urinary tract UC and UC of bladder, respectively. Patients with squamous and/or glandular differentiation in upper urinary tract UC showed poorer cancer-specific survival (CSS) (p<0.001) and overall survival (OS) (p<0.001) than those with pure form in upper urinary tract UC (p<0.001), but not in UC of bladder (p = 0.178 for CSS and p = 0.172 for OS). On multivariate Cox regression analysis, squamous and/or glandular differentiation was an independent predictor of CSS (hazard ratio [HR] 1.76; 95% confidence interval [CI] 1.08–2.85, p = 0.023), but it was not associated with OS (HR 1.52; 95% CI 1.00–2.32, p = 0.051). Conclusions The presence of variant histology could be associated with poorer survival outcome in patients with UC. Squamous and/or glandular differentiation is associated with features of biologically aggressive disease and an independent predictor of CSS.
    PLoS ONE 09/2014; 9(9):e107027. DOI:10.1371/journal.pone.0107027 · 3.23 Impact Factor
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    • "As in this case, a shorter right renal vein compared with the left may have promoted intraluminal tumor extension to the IVC. Large infiltrative urothelial carcinoma with both pelvic and parenchymal involvement may simulate other entities such as lymphoma, metastasis, xanthogranulomatous pyelonephritis, or RCC with invasion to the renal pelvis [5]. Intrarenal urothelial carcinoma is a close radiologic mimic of other infiltrative renal masses, especially centrally located RCC [9]. "
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    ABSTRACT: A 61-year-old man presented with a right renal mass with a vena caval thrombus on computed tomography that was consistent with renal cell carcinoma. The results of routine laboratory examinations and urinalysis were within normal limits. Preoperative planning was critical owing to the presence of the vena caval thrombus. A radical nephrectomy, vena caval thrombectomy, and regional lymphadenectomy were done. The pathologic report was consistent with a high-grade, invasive urothelial carcinoma, with sarcomatoid differentiation involving the renal vein and inferior vena cava (Stage IV, T4N0M0). Thus, this was a rare case of upper tract urothelial carcinoma. Adjuvant chemotherapy with the methotrexate, vinblastine, doxorubicin, cisplatinum regimen is scheduled. To our knowledge, this is the first report in Korea of upper tract urothelial carcinoma of the sarcomatoid type with a vena caval thrombus.
    Korean journal of urology 09/2014; 55(9):624-7. DOI:10.4111/kju.2014.55.9.624
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