Handling and pathology reporting of specimens with carcinoma of the urinary bladder, ureter, and renal pelvis. A joint proposal of the European Society of Uropathology and the Uropathology Working Group

Unit of Anatomic Pathology, Faculty of Medicine, Avda. Menendez-Pidal S/N, 14004 Cordoba, Spain.
Archiv für Pathologische Anatomie und Physiologie und für Klinische Medicin (Impact Factor: 2.65). 09/2004; 445(2):103-10. DOI: 10.1007/s00428-004-1039-8
Source: PubMed


Pathologists play a pivotal role in the diagnosis and in the report of the pathological features related to prognosis. To meet these endpoints, the following issues must be addressed: adequate information about the patient history, proper handling of the specimens, identification of the reliable histopathological techniques necessary to reach the more detailed diagnostic information and evaluation of the prognostic variables, and standardized pathological reporting. In this review we discuss a proposal for standardization of sampling and reporting of the urothelial tissues achieved within uropathology. The urologists have a great role in assisting pathologists in the proper examination by providing them with clinical information.

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    • "After each of two passes, two smears were stained for Giemsa and two for Papanicolaou. After FNAs and CBs were performed, the surgical specimen was processed according to the guidelines of the Uropathology Working Group (European Society of Pathology) [9] and the European Working Group of Uropathology of the European Association of Urology. "
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    ABSTRACT: PURPOSE: Non-diagnostic results still hinder the routine use of core biopsy (CB) and fine needle aspiration (FNA) in the diagnostic process of renal tumours. Furthermore, substantial interobserver variability has been reported. We assessed the added value of combining the results of CB and FNA by five pathologists in the ex vivo diagnosis of renal mass. METHODS: Two ex vivo core biopsies were taken followed by two FNA passes from extirpated tumours. All samples were evaluated by five blinded pathologists. A consensus diagnosis of the surgical specimen was the index for comparison. For each pathologist, the number of non-diagnostic (non-conclusive or undetermined biology and failed biopsies), correct and incorrect scored cases of each technique was assessed. When a non-diagnostic CB or FNA had a correct diagnostic counterpart, this was considered as of added value. RESULTS: Of the 57 assessed tumours, 53 were malignant. CB was non-diagnostic in 4-10 cases (7-17.5%). FNA established the correct diagnosis in 1-7 of these cases. FNA was non-diagnostic in 2-6 cases (3.5-10.5%), and the counterpart CB established the correct diagnosis in 1-6 of these cases. For the 5 pathologists, accuracy of CB and FNA varied between 82.5-93% and 89.5-96.5%, respectively. Combination of both types of biopsy resulted in 55-57 correct results (accuracy 96.5-100%), i.e., an increase in accuracy of 3.5-14%. CONCLUSION: Combining the result of CB and FNA in renal mass biopsy leads to a higher diagnostic accuracy. Recommendations on which technique used should be adapted to local expertise and logistic possibilities.
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    ABSTRACT: This chapter reviews the clinical, macroscopic, and microscopic features, as well as the differential diagnosis of the most common lesions and tumors seen in a routine surgical pathology. It begins with common congenital anomalies. Benign lesions and mimics of cancer follow including entities such as fibroepithelial polyp, endometriosis, urethral inflammatory polyp, caruncle, urethral diverticulum, ectopic prostatic tissue, and idiopathic retroperitoneal fibrosis. This is followed by a review of neoplasms of the renal pelvis and ureter including benign urothelial neoplasms, flat urothelial lesions with atypia, urothelial carcinoma, squamous cell carcinoma, and adenocarcinoma. A review of common neoplasms of the urethra also includes benign epithelial tumors of the urethra, carcinoma of the urethra, squamous cell carcinoma of the urethra, and adenocarcinoma of the urethra. Applicable ancillary testing modalities including immunohistochemistry and other molecular findings are discussed.
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    ABSTRACT: Bladder cancer, one of the most frequently diagnosed cancers, is a significant source of morbidity and mortality throughout the world. According to the American Cancer Society (2005), approximately 63,210 new cases will be diagnosed in the United States and bladder cancer will account for nearly 13,180 deaths. The current standard for detection of bladder cancer relies on cystoscopy, an invasive procedure, and cytology. Cytology has a high specificity, but lacks sensitivity in detection of low-grade tumors, as well as requires a trained pathologist for review. Because current diagnostic tools are less than optimal and because bladder cancer has a high rate of recurrence and long term monitoring is a necessity, a better diagnostic tool is needed. There is now a great interest in researching urine markers for bladder cancer. Our lab previously identified six nuclear structural proteins (BLCA 1-6) that are specifically expressed in bladder cancer tissue. The nuclear matrix is the support scaffold of the cell nucleus. This structure has a variety of functions, many of which have implications in cancer progression.The purpose of this dissertation is to examine changes in nuclear structural proteins. The hypothesis we propose is that changes in structural elements of the nucleus are involved in the progression of bladder cancer and can be developed into markers of this disease. Specifically this study had three goals. 1) to determine if BLCA-1 could be developed into a biomarker of bladder cancer, 2) to clone the gene encoding BLCA-1, and 3) to examine functional aspects of BLCA-4. A urine-based immunoassay was developed that can detect BLCA-1 in patients with bladder cancer with a specificity of 87% and sensitivity of 80%. Furthermore, this protein can be detected in serum of individuals with bladder cancer and may associate with the stage of disease. We also demonstrated that BLCA-4 can confer a growth advantage to cells over-expressing this protein. Over-expression of BLCA-4 led to many gene expression changes. BLCA-4 may play a role in bladder cancer pathobiology by altering genes that enhance proliferation and invasion, maintain blood flow for tumor cell survival, or enhance angiogenesis. Finally, we have been successful in cloning part of the cDNA that encodes for BLCA-1 and it appears to have a close homology to a novel metastasis related gene.In summary, this project has demonstrated that bladder cancer specific nuclear matrix proteins can be developed into markers of the disease and may play a functional role in bladder cancer pathobiology.
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