Atypia in inverted urothelial papillomas: Pathology and prognostic significance

Broussard, Jennifer N.; Tan, Puay Hoon; Epstein, Jonathan I.

doi:10.1016/j.humpath.2004.09.010

Cited by 46 publications

(40 citation statements)

References 20 publications

(15 reference statements)

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“…IUPs should have a low Ki-67 proliferation rate (<1%) and typically negative staining for CK20. 2,25,26,28 In one study, 27.8% of IUPs showed positivity for p53, making it unreliable in distinguishing IUP from UC. 28 CK7 positivity can be seen in IUP, especially in cases with vacuolated cells.…”

Section: Distinguishing Iup From Ucmentioning

confidence: 99%

“…7,9 However, as there are no reported cases of metastases arising from an IUP, it is believed that this lesion does not have malignant potential. 2 …”

Section: Biological Behaviourmentioning

confidence: 99%

“…The cellular layers should be of normal thickness and maintain polarity. 2,8 Mitotic activity should be rare to absent. Microcyst formation and squamous metaplasia are also common 20 (Fig, 1D).…”

Section: Morphology and Variantsmentioning

confidence: 99%

“…7 Studies have recommended frequent cystoscopy with urine cytology for at least two years following diagnosis of IUP, with some suggesting indefinite annual exams thereafter. 2,3,6,11 Other authors have stated that rigorous, long-term surveillance protocols are unnecessary in cases with a solitary lesion, complete resection, and no concurrent UC findings. 4,5,7,12,22 A moderate approach in cases without a history of UC would include frequent cystoscopy for the first year, followed by further examinations based only on recurrent symptoms.…”

Section: Distinguishing Iup From Ucmentioning

confidence: 99%

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Inverted urothelial papilloma: A review of diagnostic pitfalls and clinical management

Sweeney

Rais‐Bahrami

Gordetsky

2017

CUAJ

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Inverted urothelial papilloma (IUP) is a rare, non-invasive endophytic lesion that accounts for 1-2% of urothelial tumours. On cystoscopy, IUP appears as a pedunculated/papillary mass with a smooth surface. On microscopy, IUP has an endophytic growth pattern with the bulk of the tumour covered by a superficial layer of urothelium, which can be hyperplastic or attenuated. The cytology should be bland, with uniform, spindled cells arranged in anastomosing trabeculae and cords with peripheral palisading of basaloid cells. Exophytic papillae and mitotic activity should be absent or focal. Pseudoglandular spaces and squamous metaplasia may also be present. There are distinct molecular differences between IUP and urothelial carcinoma (UC). IUP rarely has mutations of FGFR3, homozygous loss of 9p21, or gain of chromosomes 3, 7, and 17, whereas these mutations are frequently seen in UC. In addition, IUP is much less likely to have TERT mutations compared to UC. Immunohistochemistry can also be helpful in distinguishing the two entities as IUP is typically negative for CK20 and has a low Ki-67 proliferation index. Positivity for p53 may be seen in a minority of IUP. IUP can recur and be seen in association with UC.Distinguishing IUP from UC can be difficult due to the similarity between the two entities both on cystoscopy and histology, as up to 25% of UCs will also have inverted growth. Given the morphologic variants of IUP and UC, it is possible for a diagnostic error to occur, which can significantly impact patient management.

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Section: Distinguishing Iup From Ucmentioning

confidence: 99%

“…7,9 However, as there are no reported cases of metastases arising from an IUP, it is believed that this lesion does not have malignant potential. 2 …”

Section: Biological Behaviourmentioning

confidence: 99%

Section: Morphology and Variantsmentioning

confidence: 99%

Section: Distinguishing Iup From Ucmentioning

confidence: 99%

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Inverted urothelial papilloma: A review of diagnostic pitfalls and clinical management

Sweeney

Rais‐Bahrami

Gordetsky

2017

CUAJ

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“…1,14 Generally speaking, IP is a benign disorder, but in some specimens atypic features may be recognized, including the detection of prominent nuclei, atypical squamous characteristics, urothelial dysplasia and giant multinucleated cells.…”

Section: -49-13mentioning

confidence: 99%

Inverted papilloma of the ureter: study of a rare case with emphasis on clinicopathologic implications

Mertziotis¹,

Kozyrakis²,

Petrolekas³

et al. 2012

CUAJ

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A 62-year old male patient presented complaining of intermittent macroscopic hematuria. The ultrasonographic investigation revealed a hydronephrosis of remarkable degree with indiscrete renal parenchyma. The abdominal computed tomography scan identified a ureteral lesion with proximal dilatation, hydronephrosis and a functionless ipsilateral renal unit. The retrograde urography showed a 4-cm lesion with multiple filling defects and a smooth contour. The endoscopic examination showed an exophytic lesion, highly suspicious for malignancy. Urine cytology revealed atypia. Right nephroureterectomy was performed and the pathology revealed a ureteral inverted papilloma (UIP). Polymerase chain reaction examination for the presence of human papilloma virus, using GP5+/6+ consensus primers, was negative. The presence UIP should be considered in patients with urotheleal lesions in the ureter when the diagnostic workup for malignancy is inconclusive. The clinical course of the disease seems to be favorable.

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