Micropapillary Pattern in Urothelial Carcinoma: A Clinicopathological Analysis

Abstract

Objectives: Our aim was to review our pathological archive to find out the actual incidence of micropapillary pattern (MPP) in our urothelial carcinoma patient population and determine its correlation with clinical outcome. Patients and Methods: 14 out of 170 cases with complete clinical follow-up were clinicopathologically analyzed. The extent of MPP was determined as tumor percentage. Results: 12 further cases with MPP were defined in the review. The percentage of patients with positive MPP increased in parallel to the tumor stage. There was no considerable difference between MPP-positive and MPP-negative groups according to the progression rates in non-muscle-invasive and muscle-invasive groups. Progression-free survival was much shorter in MPP cases, but again without statistical significance. Also, there was no significant relation between percentage of MPP and progression-free survival. Conclusions: Awareness of pathologists about MPP and its highly possible relation with aggressive behavior must be raised, as it may be more common than reported. A multicentric review of a large number of cases with MPP is needed for a better definition of its biological behavior. Focal MPP cases may have a better prognosis but this needs to be confirmed.

Rare Malign Tumors of Bladder: Review of the Literature

“…Tüm ürotelyal karsinomların %0,6'sını oluşturmaktadır. 26 Erken metastaz potansiyeli ve kötü prognozu nedeni ile ürotelyal karsinomdan patolojik ayrımının yapıl-ması önemlidir. Erkeklerde daha sık görülmekte-dir.…”

Interobserver Reproducibility in the Diagnosis of Invasive Micropapillary Carcinoma of the Urinary Tract Among Urologic Pathologists

“…23 Prognostically, IMPC is recognized as an aggressive variant of urothelial carcinoma that is commonly associated with extensive lymphovascular invasion. 3,4,6,10,[12][13][14][15][16][17][18]22,23,24,34,35,37,38 In the largest reported series to date, IMPC had 5-year and 10-year KaplanMeier overall survival rates of 54% and 27%, respectively. 18 It has also been suggested that IMPC is predictive of a poor response to standard intravesical therapy relative to usual invasive urothelial carcinoma.…”

“…Since that initial description, IMPC has become increasingly well recognized as a unique and aggressive variant within the genitourinary tract, 3,4,6,10,[12][13][14][15][16][17][18]22,23,24,34,35,37,38 and in other organs including the breast, lung, salivary gland, and colon. 7,28,29,36,40 Given the propensity for lymphovascular invasion and lymph node metastasis, frequent presentation with high-stage disease, and the reported poor response to standard intravesical therapy, some urologic oncologists have proposed early cystectomy for patients with a diagnosis of IMPC, even in the absence of muscularis propria invasion on initial biopsy or transurethral resection.…”

Das plasmazytoide und mikropapilläre Urothelkarzinom

“…Ein weiteres morphologisches Merkmal stellt die invertierte zelluläre Polarisation dar, bei welcher die apikale Membrandomäne der Tumorzellen nach außen gerichtet zum umgebenden Stroma zeigt [19]. Das MPC der Harnblase wird ebenfalls wie das PUC meist von einem konventionellen Urothelkarzinom begleitet, wobei der prozentuale Anteil der mikropapillären Morphologie am Gesamtpräparat mit dem Tumorstadium korreliert und als prognostischer Faktor diskutiert wird [10,20].…”

“…Zur Klinik des MPC existieren mehrere Fallberichte oder retrospektive Studien [20,21,22]. Das größte Fallkollektiv wird von Kamat et al [9] beschrieben.…”