Skip to main content
SpringerLink
Log in

Urothelial Carcinoma with Variant Histology: Sarcomatoid, Plasmacytoid, and Micropapillary

  • Chapter
  • First Online:
Book cover Rare Genitourinary Tumors

  • 534 Accesses

Abstract

Approximately 80 % of bladder cancer is diagnosed as “conventional” urothelial carcinoma (UC) with 10–25 % nonurothelial and “variants” of urothelial carcinoma (UC). For the current discussion, variant histology will refer to any bladder malignancy other than pure UC. Furthermore, we have limited our review to the specific histologic variants sarcomatoid, plasmacytoid, and micropapillary bladder cancer. Before we discuss each of these variants in detail, we should mention that each of these histologic descriptions is based on morphologic features from H&E pathologic sections with little insight into their biology. Moreover, mixed histologies are often present (including so-called urothelial and nonurothelial carcinomas), for which the term variant histology is generally used. Figure 6.1 describes the histological classification of tumors arising from the urinary tract and was adapted from the 2004 World Health Organization classification of tumors.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 89.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 119.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 169.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Wasco MJ, Daignault S, Zhang Y, et al. Urothelial carcinoma with divergent histologic differentiation (mixed histologic features) predicts the presence of locally advanced bladder cancer when detected at transurethral resection. Urology. 2007;70(1):69–74.

    Article  PubMed  Google Scholar 

  2. Kantor AF, Hartge P, Hoover RN, Fraumeni Jr JF. Epidemiological characteristics of squamous cell carcinoma and adenocarcinoma of the bladder. Cancer Res. 1988;48(13):3853–5.

    CAS  PubMed  Google Scholar 

  3. Abd El-Latif A, Watts KE, Elson P, Fergany A, Hansel DE. The sensitivity of initial transurethral resection or biopsy of bladder tumor(s) for detecting bladder cancer variants on radical cystectomy. J Urol. 2013;189(4):1263–7.

    Article  PubMed  Google Scholar 

  4. Hansel DE, Amin MB, Comperat E, et al. A contemporary update on pathology standards for bladder cancer: transurethral resection and radical cystectomy specimens. Eur Urol. 2013;63(2):321–32.

    Article  PubMed  Google Scholar 

  5. Kamat AM, Gee JR, Dinney CP, et al. The case for early cystectomy in the treatment of nonmuscle invasive micropapillary bladder carcinoma. J Urol. 2006;175(3 Pt 1):881–5.

    Article  PubMed  Google Scholar 

  6. Ghoneim IA, Miocinovic R, Stephenson AJ, et al. Neoadjuvant systemic therapy or early cystectomy? Single-center analysis of outcomes after therapy for patients with clinically localized micropapillary urothelial carcinoma of the bladder. Urology. 2011;77(4):867–70.

    Article  PubMed  Google Scholar 

  7. Comperat E, Roupret M, Yaxley J, et al. Micropapillary urothelial carcinoma of the urinary bladder: a clinicopathological analysis of 72 cases. Pathology. 2010;42(7):650–4.

    Article  PubMed  Google Scholar 

  8. Vourganti S, Harbin A, Singer EA, Shuch B, Metwalli AR, Agarwal PK. Low grade micropapillary urothelial carcinoma, does it exist? – analysis of management and outcomes from the Surveillance, Epidemiology and End Results (SEER) database. J Cancer. 2013;4(4):336–42.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  9. Amin A, Epstein JI. Noninvasive micropapillary urothelial carcinoma: a clinicopathologic study of 18 cases. Hum Pathol. 2012;43(12):2124–8.

    Article  PubMed  Google Scholar 

  10. Wright JL, Black PC, Brown GA, et al. Differences in survival among patients with sarcomatoid carcinoma, carcinosarcoma and urothelial carcinoma of the bladder. J Urol. 2007;178(6):2302–6; discussion 2307.

    Article  PubMed  Google Scholar 

  11. Shapur NK, Katz R, Pode D, et al. Is radical cystectomy mandatory in every patient with variant histology of bladder cancer. Rare Tumors. 2011;3(2):e22.

    Article  PubMed  PubMed Central  Google Scholar 

  12. Jozwicki W, Domaniewski J, Skok Z, Wolski Z, Domanowska E, Jozwicka G. Usefulness of histologic homogeneity estimation of muscle-invasive urinary bladder cancer in an individual prognosis: a mapping study. Urology. 2005;66(5):1122–6.

    Article  PubMed  Google Scholar 

  13. Monn MF, Kaimakliotis HZ, Pedrosa JA, et al. Contemporary bladder cancer: variant histology may be a significant driver of disease. Urol Oncol. 2015;33(1):18 e15–20.

    Article  PubMed  Google Scholar 

  14. Turker P, Bostrom PJ, Wroclawski ML, et al. Upstaging of urothelial cancer at the time of radical cystectomy: factors associated with upstaging and its effect on outcome. BJU Int. 2012;110(6):804–11.

    Article  PubMed  Google Scholar 

  15. Kassouf W, Agarwal PK, Grossman HB, et al. Outcome of patients with bladder cancer with pN+ disease after preoperative chemotherapy and radical cystectomy. Urology. 2009;73(1):147–52.

    Article  PubMed  Google Scholar 

  16. Domanowska E, Jozwicki W, Domaniewski J, et al. Muscle-invasive urothelial cell carcinoma of the human bladder: multidirectional differentiation and ability to metastasize. Hum Pathol. 2007;38(5):741–6.

    Article  PubMed  Google Scholar 

  17. Rogers CG, Palapattu GS, Shariat SF, et al. Clinical outcomes following radical cystectomy for primary nontransitional cell carcinoma of the bladder compared to transitional cell carcinoma of the bladder. J Urol. 2006;175(6):2048–53; discussion 2053.

    Article  PubMed  Google Scholar 

  18. Scosyrev E, Ely BW, Messing EM, et al. Do mixed histological features affect survival benefit from neoadjuvant platinum-based combination chemotherapy in patients with locally advanced bladder cancer? A secondary analysis of Southwest Oncology Group-Directed Intergroup Study (S8710). BJU Int. 2011;108(5):693–9.

    Article  CAS  PubMed  Google Scholar 

  19. Weizer AZ, Wasco MJ, Wang R, Daignault S, Lee CT, Shah RB. Multiple adverse histological features increase the odds of under staging T1 bladder cancer. J Urol. 2009;182(1):59–65; discussion 65.

    Article  PubMed  Google Scholar 

  20. El-Sebaie M, Zaghloul MS, Howard G, Mokhtar A. Squamous cell carcinoma of the bilharzial and non-bilharzial urinary bladder: a review of etiological features, natural history, and management. Int J Clin Oncol. 2005;10(1):20–5.

    Article  PubMed  Google Scholar 

  21. Kamat AM, Dinney CP, Gee JR, et al. Micropapillary bladder cancer: a review of the University of Texas M. D. Anderson Cancer Center experience with 100 consecutive patients. Cancer. 2007;110(1):62–7.

    Article  PubMed  Google Scholar 

  22. Zhai QJ, Black J, Ayala AG, Ro JY. Histologic variants of infiltrating urothelial carcinoma. Arch Pathol Lab Med. 2007;131(8):1244–56.

    PubMed  Google Scholar 

  23. Sung MT, Wang M, MacLennan GT, et al. Histogenesis of sarcomatoid urothelial carcinoma of the urinary bladder: evidence for a common clonal origin with divergent differentiation. J Pathol. 2007;211(4):420–30.

    Article  PubMed  Google Scholar 

  24. Lopez-Beltran A, Pacelli A, Rothenberg HJ, et al. Carcinosarcoma and sarcomatoid carcinoma of the bladder: clinicopathological study of 41 cases. J Urol. 1998;159(5):1497–503.

    Article  CAS  PubMed  Google Scholar 

  25. Wang J, Wang FW, Lagrange CA, Hemstreet Iii GP, Kessinger A. Clinical features of sarcomatoid carcinoma (carcinosarcoma) of the urinary bladder: analysis of 221 cases. Sarcoma. 2010;2010:454792, 7.

    Google Scholar 

  26. Black PC, Brown GA, Dinney CP. The impact of variant histology on the outcome of bladder cancer treated with curative intent. Urol Oncol. 2009;27(1):3–7.

    Article  PubMed  Google Scholar 

  27. Froehner M, Gaertner HJ, Manseck A, Wirth MP. Durable complete remission of metastatic sarcomatoid carcinoma of the bladder with cisplatin and gemcitabine in an 80-year-old man. Urology. 2001;58(5):799.

    Article  CAS  PubMed  Google Scholar 

  28. Keck B, Wach S, Stoehr R, et al. Plasmacytoid variant of bladder cancer defines patients with poor prognosis if treated with cystectomy and adjuvant cisplatin-based chemotherapy. BMC Cancer. 2013;13:71.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  29. Keck B, Stoehr R, Wach S, et al. The plasmacytoid carcinoma of the bladder – rare variant of aggressive urothelial carcinoma. Int J Cancer. 2011;129(2):346–54.

    Article  CAS  PubMed  Google Scholar 

  30. Shiota M, Song Y, Yokomizo A, et al. Foxo3a suppression of urothelial cancer invasiveness through Twist1, Y-box-binding protein 1, and E-cadherin regulation. Clin Cancer Res. 2010;16(23):5654–63.

    Article  CAS  PubMed  Google Scholar 

  31. Topalak O, Saygili U, Soyturk M, et al. Serum, pleural effusion, and ascites CA-125 levels in ovarian cancer and nonovarian benign and malignant diseases: a comparative study. Gynecol Oncol. 2002;85(1):108–13.

    Article  PubMed  Google Scholar 

  32. Dayyani F, Czerniak BA, Sircar K, et al. Plasmacytoid urothelial carcinoma, a chemosensitive cancer with poor prognosis, and peritoneal carcinomatosis. J Urol. 2013;189(5):1656–61.

    Article  PubMed  Google Scholar 

  33. Hayashi T, Tanigawa G, Fujita K, et al. Two cases of plasmacytoid variant of urothelial carcinoma of urinary bladder: systemic chemotherapy might be of benefit. Int J Clin Oncol. 2011;16(6):759–62.

    Article  PubMed  Google Scholar 

  34. Holmang S, Thomsen J, Johansson SL. Micropapillary carcinoma of the renal pelvis and ureter. J Urol. 2006;175(2):463–6; discussion 466–7.

    Article  PubMed  Google Scholar 

  35. Johansson SL, Borghede G, Holmang S. Micropapillary bladder carcinoma: a clinicopathological study of 20 cases. J Urol. 1999;161(6):1798–802.

    Article  CAS  PubMed  Google Scholar 

  36. Alvarado-Cabrero I, Sierra-Santiesteban FI, Mantilla-Morales A, Hernandez-Hernandez DM. Micropapillary carcinoma of the urothelial tract. A clinicopathologic study of 38 cases. Ann Diagn Pathol. 2005;9(1):1–5.

    Article  PubMed  Google Scholar 

  37. Baschinsky DY, Chen JH, Vadmal MS, Lucas JG, Bahnson RR, Niemann TH. Carcinosarcoma of the urinary bladder – an aggressive tumor with diverse histogenesis. A clinicopathologic study of 4 cases and review of the literature. Arch Pathol Lab Med. 2000;124(8):1172–8.

    CAS  PubMed  Google Scholar 

  38. Sangoi AR, Beck AH, Amin MB, et al. Interobserver reproducibility in the diagnosis of invasive micropapillary carcinoma of the urinary tract among urologic pathologists. Am J Surg Pathol. 2010;34(9):1367–76.

    Article  PubMed  Google Scholar 

  39. Samaratunga H, Khoo K. Micropapillary variant of urothelial carcinoma of the urinary bladder; a clinicopathological and immunohistochemical study. Histopathology. 2004;45(1):55–64.

    Article  CAS  PubMed  Google Scholar 

  40. Lopez-Beltran A, Cheng L. Histologic variants of urothelial carcinoma: differential diagnosis and clinical implications. Hum Pathol. 2006;37(11):1371–88.

    Article  CAS  PubMed  Google Scholar 

  41. Wang JK, Boorjian SA, Cheville JC, et al. Outcomes following radical cystectomy for micropapillary bladder cancer versus pure urothelial carcinoma: a matched cohort analysis. World J Urol. 2012;30(6):801–6.

    Article  PubMed  Google Scholar 

  42. Fairey AS, Daneshmand S, Wang L, et al. Impact of micropapillary urothelial carcinoma variant histology on survival after radical cystectomy. Urol Oncol. 2014;32(2):110–6.

    Article  PubMed  Google Scholar 

  43. Willis DL, Flaig TW, Hansel DE, et al. Micropapillary bladder cancer: current treatment patterns and review of the literature. Urol Oncol. 2014;32(6):826–32.

    Article  PubMed  PubMed Central  Google Scholar 

  44. Meeks JJ, Taylor JM, Matsushita K, et al. Pathological response to neoadjuvant chemotherapy for muscle-invasive micropapillary bladder cancer. BJU Int. 2013;111(8):E325–30.

    Article  PubMed  Google Scholar 

  45. Willis DL, Fernandez MI, Dickstein RJ, et al. Clinical outcomes of cT1 micropapillary bladder cancer. J Urol. 2015;193(4):1129–34.

    Google Scholar 

  46. Spaliviero M, Dalbagni G, Bochner BH, et al. Clinical outcome of patients with T1 micropapillary urothelial carcinoma of the bladder. J Urol. 2014;192(3):702–7.

    Article  PubMed  PubMed Central  Google Scholar 

  47. Porten SP, Willis D, Kamat AM. Variant histology: role in management and prognosis of nonmuscle invasive bladder cancer. Curr Opin Urol. 2014;24(5):517–23.

    Article  PubMed  Google Scholar 

  48. Choi W, Porten S, Kim S, et al. Identification of distinct basal and luminal subtypes of muscle-invasive bladder cancer with different sensitivities to frontline chemotherapy. Cancer Cell. 2014;25(2):152–65.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  49. Choi W, Czerniak B, Ochoa A, et al. Intrinsic basal and luminal subtypes of muscle-invasive bladder cancer. Nat Rev Urol. 2014;11(7):400–10.

    Article  CAS  PubMed  Google Scholar 

  50. Eble JN, Sauter G, Epstein JI, Sesterhenn IA. Pathology and genetics of tumours of the urinary system and male genital organs. World Health Organization Classification of Tumours, IARC Press, Lyon, France. 2004. p. 1–354.

    Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Urology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd., Unit 1373, Houston, TX, 77030, USA

    Stephen B. Williams MD & Ashish M. Kamat MD, MBBS, FACS

Authors
  1. Stephen B. Williams MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Ashish M. Kamat MD, MBBS, FACS
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Ashish M. Kamat MD, MBBS, FACS .

Editor information

Editors and Affiliations

  1. Department of Oncology, Mayo Clinic, Division of Medical Oncology, Rochester, Minnesota, USA

    Lance Pagliaro

Rights and permissions

Reprints and permissions

Copyright information

© 2016 Springer International Publishing Switzerland

About this chapter

Cite this chapter

Williams, S.B., Kamat, A.M. (2016). Urothelial Carcinoma with Variant Histology: Sarcomatoid, Plasmacytoid, and Micropapillary. In: Pagliaro, L. (eds) Rare Genitourinary Tumors. Springer, Cham. https://doi.org/10.1007/978-3-319-30046-7_6

Download citation

  • DOI: https://doi.org/10.1007/978-3-319-30046-7_6

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-30044-3

  • Online ISBN: 978-3-319-30046-7

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation