Aims Pathologic stage T1 (pT1) bladder cancers are a clinically heterogeneous group. However, current staging guidelines for superficially invasive cancers do not acknowledge the variability in type and extent of lamina propria invasion in papillary urothelial carcinomas (PUC), and historically proposed substaging systems showed either high inter-observer variation or limited value in predicting patient outcomes. Herein we reappraise pT1 PUC substaging, aiming to identify a novel scheme which is reproducible and prognostically meaningful. Methods and results Stage pT1 PUC diagnosed during years 1999–2015 were retrospectively reviewed and characterized as focal invasion confined to papillary stalk, focal invasion of tumor base, or extensive invasion of tumor base. Cases with concurrent flat carcinoma in-situ, angiolymphatic invasion, absent muscularis propria, or clinically advanced disease were excluded. We calculated cumulative incidence of recurrence, progression, and death by tumor subtype and evaluated differential risks using log-rank tests and Kaplan-Meier curves stratified by type and extent of invasion. Among 62 patients satisfying inclusion criteria, 22 of 29 patients with base extensive invasion progressed while 4 of 13 with base focal and 0 of 20 with stalk only invasion progressed. There was strong evidence that base extensive patients had higher risk of progression and death due to bladder cancer than base focal or stalk only counterparts (P<0.0001). However, tumor subtype was not significantly associated with risk of recurrence (P=0.21). Conclusions We propose an innovative substaging approach for reporting site and extent of lamina propria invasion in patients with pT1 PUC allowing patient stratification for risk of progression.

Morphologic features of GI tract lymphangiomas can be reliably distinguished from lymphangiectasia by clinical and pathologic characteristics.

SMAD4 immunohistochemstry is a helpful ancillary diagnostic test in cases of suspected juvenile polyposis syndrome involving the stomach.

Giant cell tumors of bone (GCTs) are generally benign, locally aggressive neoplasms that rarely metastasize. The beta subunit of human chorionic gonadotropin (beta-hCG) is expressed in syncytiotrophoblasts and several nongynecologic neoplasms but has not been described in GCT. At our institution, we observed cases of elevated beta-hCG in patients with GCT leading to diagnostic difficulty and in one case, concern for metastatic choriocarcinoma. This study aims to determine the frequency of beta-hCG expression in GCT and any relationship to clinical aggressiveness. We evaluated tissue expression of beta-hCG by immunohistochemistry with 58% of cases staining for beta-hCG. Additionally, 2 of 11 patients with available serum and/or urine beta-hCG measurements demonstrated elevated beta-hCG due to tumor. It is important to be aware of beta-hCG expression by GCT and the potential for elevated urine and serum beta-hCG levels in patients with GCT so as to avoid misdiagnosis of pregnancy or gestational trophoblastic disease.

This triad of IHC stains can improve the precision of pathologic diagnosis of histologically atypical urothelial lesions of flat bladder mucosa. We recommend that pathologists apply this set of IHC stains to such lesions they find problematic based on H&E stains.