Micropapillary urothelial carcinoma of the urinary bladder: a clinicopathological analysis of 72 cases

Compérat, Éva; Rouprêt, Morgan; Yaxley, John; Reynolds, Jamie; Varinot, Justine; Ouzaïd, I.; Cussenot, Olivier; Samaratunga, Hemamali

doi:10.3109/00313025.2010.522173

Cited by 121 publications

(91 citation statements)

References 12 publications

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“…The micropapillary variant of urothelial carcinoma has been well documented in the literature [82][83][84][85][86][87][88][89]. Morphologically, it is defined as small nests and aggregates of tumour cells within lacunae.…”

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confidence: 99%

The 2016 WHO Classification of Tumours of the Urinary System and Male Genital Organs—Part B: Prostate and Bladder Tumours

et al. 2016

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It has been 12 yr since the publication of the last World Health Organization (WHO) classification of tumours of the prostate and bladder. During this time, significant new knowledge has been generated about the pathology and genetics of these tumours. Intraductal carcinoma of the prostate is a newly recognized entity in the 2016 WHO classification. In most cases, it represents intraductal spread of aggressive prostatic carcinoma and should be separated from high-grade prostatic intraepithelial neoplasia. New acinar adenocarcinoma variants are microcystic adenocarcinoma and pleomorphic giant cell adenocarcinoma. Modifications to the Gleason grading system are incorporated into the 2016 WHO section on grading of prostate cancer, and it is recommended that the percentage of pattern 4 should be reported for Gleason score 7. The new WHO classification further recommends the recently developed prostate cancer grade grouping with five grade groups. For bladder cancer, the 2016 WHO classification continues to recommend the 1997 International Society of Urological Pathology grading classification. Newly described or better defined noninvasive urothelial lesions include urothelial dysplasia and urothelial proliferation of uncertain malignant potential, which is frequently identified in patients with a prior history of urothelial carcinoma. Invasive urothelial carcinoma with divergent differentiation refers to tumours with some percentage of "usual type" urothelial carcinoma combined with other morphologies. Pathologists should mention the percentage of divergent histologies in the pathology report. PATIENT SUMMARY Intraductal carcinoma of the prostate is a newly recognized entity in the 2016 World Health Organization classification. Better defined noninvasive urothelial lesions include urothelial dysplasia and urothelial proliferation of uncertain malignant potential. v a i l a b l e a t w w w . s c i e n c e d i r e c t . c o m j AbstractIt has been 12 yr since the publication of the last World Health Organization (WHO) classification of tumours of the prostate and bladder. During this time, significant new knowledge has been generated about the pathology and genetics of these tumours.

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Section: 3mentioning

confidence: 99%

The 2016 WHO Classification of Tumours of the Urinary System and Male Genital Organs—Part B: Prostate and Bladder Tumours

et al. 2016

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“…[1][2][3] Several studies demonstrated that micropapillary urothelial carcinoma is diagnosed at a more advanced stage, and is associated with adverse outcome relative to typical urothelial carcinoma. [4][5][6][7][8] However, a recent study found that, although patients with micropapillary urothelial carcinoma presented at higher stage than patients with typical urothelial carcinoma, the outcomes following radical cystectomy were no different when matched for stage and other clinicopathologic variables. 9 In addition to unique histologic features, studies have shown that micropapillary urothelial carcinoma exhibits amplification of the human epidermal growth factor receptor (ERBB2 or HER2) in over 40% of cases.…”

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Outcome of patients with micropapillary urothelial carcinoma following radical cystectomy: ERBB2 (HER2) amplification identifies patients with poor outcome

et al. 2014

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Micropapillary urothelial carcinoma exhibits amplification of the human epidermal growth factor receptor, ERBB2(HER2), and overexpression of the ERBB2 protein product. The clinical significance of this has yet to be established. The objective of this study was to examine ERBB2 amplification and protein expression in micropapillary urothelial carcinoma and stage-matched typical urothelial carcinoma treated by radical cystectomy to assess the frequency of amplification and protein expression, and to determine the association with cancer-specific survival. Pathologic material and data from patients undergoing cystectomy at Mayo Clinic between 1980 and 2008 were reviewed. ERBB2 amplification by fluorescence in situ hybridization (FISH) and protein expression by immunohistochemistry were assessed. Univariate and multivariate Cox proportional hazards regression models were used to evaluate for associations of ERBB2 amplification and protein expression with survival. ERBB2 amplification was identified in 9 (15%) of 61 micropapillary carcinomas compared with 9 (9%) of 100 urothelial carcinomas. In patients with micropapillary carcinoma, ERBB2 amplification was associated with a nearly threefold increased risk of cancer death. ERBB2 amplification (hazard ratio 4.3; P ¼ 0.0008) remained associated with an increased risk of death from bladder cancer among patients with micropapillary urothelial carcinoma on multivariate analysis. The association of cancer-specific survival and ERBB2 amplification was not seen in patients with urothelial carcinoma. ERBB2 immunohistochemistry correlated with ERBB2 amplification but there was no association of ERBB2 protein expression and survival. ERBB2 amplification is more frequent in micropapillary urothelial carcinoma than typical urothelial carcinoma, and patients with micropapillary carcinoma who have ERBB2 amplification have worse cancer-specific survival than those who do not. Identification of ERBB2 amplification in micropapillary carcinoma could provide important prognostic information and possibly provide a role for ERBB2 targeted therapy.

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“…2,3 Among transurethral resections of bladder with a micropapillary component, 79% are upstaged at subsequent cystectomy. 4 The proportion of MPUC appears to predict poor prognosis, [12][13][14] and at least predicts high pathologic stage and lymph node metastasis. 4,5 Multiple authors 4,5,12 recommend a quantitative report of MPUC whenever it is present.…”

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“…Micropapillary urothelial carcinoma occurs almost exclusively in the setting of conventional UC, 2,3 and the proportion of MPUC predicts high pathologic stage and lymph node metastasis. 4,5 The overall prognosis is poor; the 5-year and 10-year survival in the largest study were 51% and 24%, respectively. 6 Multiple investigators have examined vascular invasion in MPUC by using immunohistochemistry for factor VIII, Ulex europaeus, CD31, and CD34, 1,7-10 as summarized in Table 1.…”

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Lymphovascular Invasion in Micropapillary Urothelial Carcinoma: A Study of 22 Cases

McQuitty¹,

Ro²,

Truong³

et al. 2012

Archives of Pathology &Amp; Laboratory Medicine

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is a known aggressive variant of urothelial carcinoma. However, the reasons for its aggressiveness remain unclear.Objective.-To investigate the frequency of lymphovascular invasion in 22 cases of MPUC.Design.-Consecutive tissue sections were stained with D2-40 and CD34 to highlight lymphovascular channels associated with MPUC. Spaces containing tumor cells were scored as positive for lymphovascular invasion if the staining pattern on immunohistochemistry was distinct and circumferential.Results.-Of 22 cases, 21 (95%) had lymphovascular invasion on immunohistochemical staining, with 91% lymphatic invasion and 4% vascular invasion. Interestingly, 8 cases were originally signed out as negative for lymphovascular invasion on the basis of hematoxylineosin-stained sections; of these, 7 (88%) had focal lymphovascular invasion evident on immunohistochemical staining.Conclusions.-Our results confirm that micropapillary lacunae are not lymphovascular channels. However, nearly all MPUC tumors (95% in this series) have evidence of lymphovascular invasion by immunohistochemical analysis. Our data support the use of micropapillary features as a morphologic marker for lymphovascular invasion and MPUC as an adverse histologic type of urothelial carcinoma.(Arch Pathol Lab Med. 2012;136:635-639; doi: 10.5858/ arpa.2011-0463-OA) M icropapillary urothelial carcinoma (MPUC) is a rare, clinically aggressive histologic variant of urothelial carcinoma (UC). It was first described by Amin et al 1 in 1994 and is characterized by small, infiltrating clusters of neoplastic cells that appear to float within clear lacunar spaces and that lack a fibrovascular core (Figure 1). Micropapillary urothelial carcinoma occurs almost exclusively in the setting of conventional UC, 2,3 and the proportion of MPUC predicts high pathologic stage and lymph node metastasis. 4,5 The overall prognosis is poor; the 5-year and 10-year survival in the largest study were 51% and 24%, respectively. 6Multiple investigators have examined vascular invasion in MPUC by using immunohistochemistry for factor VIII, Ulex europaeus, CD31, and CD34, 1,7-10 as summarized in Table 1. Together, these studies demonstrate vascular invasion in 23 of 33 cases (70%). But these studies are hampered by exclusive use of vascular endothelial markers, and the rate of lymphovascular invasion in MPUC may be even higher.

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Micropapillary urothelial carcinoma of the urinary bladder: a clinicopathological analysis of 72 cases

Cited by 121 publications

References 12 publications

The 2016 WHO Classification of Tumours of the Urinary System and Male Genital Organs—Part B: Prostate and Bladder Tumours

The 2016 WHO Classification of Tumours of the Urinary System and Male Genital Organs—Part B: Prostate and Bladder Tumours

Outcome of patients with micropapillary urothelial carcinoma following radical cystectomy: ERBB2 (HER2) amplification identifies patients with poor outcome

Lymphovascular Invasion in Micropapillary Urothelial Carcinoma: A Study of 22 Cases

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