Clinicopathologic analysis of upper urinary tract carcinoma with variant histology
- 52 Downloads
We report on the clinicopathologic features of 115 cases of high-grade urothelial carcinoma of the upper urinary tract with variant histology present in 39 (34%). Variant histology was typically seen in high pathological stage (pT2-pT4) (82%, 32 cases) patients with lower survival rate (70%, 27 cases, median survival 31 months) and consisted in urothelial with one (23%), two (3%), and three or more variants (3%); 4% of cases presented with pure variant histology. Squamous divergent differentiation was the most common variant (7%) followed by sarcomatoid (6%) and glandular (4%), followed by 3% each of micropapillary, diffuse-plasmacytoid, inverted growth, clear cell glycogenic, or lipid-rich. The pseudo-angiosarcomatous variant is seen in 2%, and 1% each of nested, giant-cell, lymphoepithelioma-like, small-cell, trophoblastic, rhabdoid, microcystic, lymphoid-rich stroma, or myxoid stroma/chordoid completed the study series. Loss of mismatch repair protein expression was identified in one case of upper urinary tract carcinoma with inverted growth variant (3.6%). Variant histology was associated to pathological stage (p = 0.007) and survival status (p = 0.039). The univariate survival analysis identified variant histology as a feature of lower recurrence-free survival (p = 0.046). Our findings suggest that variant histology is a feature of aggressiveness in urothelial carcinoma of the upper urinary tract worth it to be reported.
KeywordsRenal pelvis Ureter Urothelial carcinoma Variant histology Micropapillary Nested Plasmacytoid Sarcomatoid Squamous Glandular Divergent MMR
IR, VH, and ALB drafted the article. ALB, IR, NR, RM, MV, RCM, MRR, and LC formulated and designed the study. IC and IR conducted the immunohistochemical analysis of MMR proteins. RCM, MRR, AC, and VH made the literature search. AB completed the statistical analysis. All the authors critically read, edited, and approved the final manuscript.
This study was supported in part by the Grant PI17/01981 [FIS (Ministry of Health), Madrid, Spain].
Compliance with ethical standards
Conflict of interest
The authors declare that they have no conflict of interest.
- 2.Bianconi M, Cimadamore A, Faloppi L, Scartozzi M, Santoni M, Lopez-Beltran A, Cheng L, Scarpelli M, Montironi R (2019) Contemporary best practice in the management of urothelial carcinomas of the renal pelvis and ureter. Ther Adv Urol 8:1756287218815372. https://doi.org/10.1177/1756287218815372 CrossRefGoogle Scholar
- 3.Mbeutcha A, Rouprêt M, Kamat AM, Karakiewicz PI, Lawrentschuk N, Novara G, Raman JD, Seitz C, Xylinas E, Shariat SF (2017) Prognostic factors and predictive tools for upper tract urothelial carcinoma: a systematic review. World J Urol 35:337–353. https://doi.org/10.1007/s00345-016-1826-2 CrossRefPubMedGoogle Scholar
- 5.Moch H, Humphrey PA, Ulbright TM, Reuter VE (2016) WHO classification of tumours of the urinary system and male genital organs, 4th edn. IARC, LyonGoogle Scholar
- 9.Rink M, Robinson BD, Green DA, Cha EK, Hansen J, Comploj E, Margulis V, Raman JD, Ng CK, Remzi M, Bensalah K, Kabbani W, Haitel A, Rioux-Leclercq N, Guo CC, Chun FK, Kikuchi E, Kassouf W, Sircar K, Sun M, Sonpavde G, Lotan Y, Pycha A, Karakiewicz PI, Scherr DS, Shariat SF (2012) Impact of histological variants on clinical outcomes of patients with upper urinary tract urothelial carcinoma. J Urol 188:398–404. https://doi.org/10.1016/j.juro.2012.04.009 CrossRefPubMedGoogle Scholar
- 13.Sakano S, Matsuyama H, Kamiryo Y, Hayashida S, Yamamoto N, Kaneda Y, Nasu T, Baba Y, Shimabukuro T, Suga A, Yamamoto M, Aoki A, Takai K, Yoshihiro S, Oba K, Yamaguchi Uro-Oncology Group (2015) Impact of variant histology on disease aggressiveness and outcome after nephroureterectomy in Japanese patients with upper tract urothelial carcinoma. Int J Clin Oncol 20:362–368. https://doi.org/10.1007/s10147-014-0721-3 CrossRefPubMedGoogle Scholar
- 16.Tang Q, Xiong G, Li X, Fang D, Xi C, Zhang L, Yang K, Yao L, Zhang C, Yu W, He Q, Gong K, He Z, Zhou L (2016) The prognostic impact of squamous and glandular differentiation for upper tract urothelial carcinoma patients after radical nephroureterectomy. World J Urol 34:871–877. https://doi.org/10.1007/s00345-015-1715-0 CrossRefPubMedGoogle Scholar
- 22.Cimadamore A, Scarpelli M, Santoni M, Cheng L, Lopez-Beltran A, Montironi R (2018) Upper urinary tract urothelial carcinoma and its variants: transition from morphology to personalized molecular characterization in diagnosis, prognosis, and therapy. Exp Rev Mol Diagn 18:1021–1028. https://doi.org/10.1080/14737159.2018.1549490 CrossRefGoogle Scholar
- 23.Soria F, Shariat SF, Lerner SP, Fritsche HM, Rink M, Kassouf W, Spiess PE, Lotan Y, Ye D, Fernández MI, Kikuchi E, Chade DC, Babjuk M, Grollman AP, Thalmann GN (2017) Epidemiology, diagnosis, preoperative evaluation and prognostic assessment of upper-tract urothelial carcinoma (UTUC). World J Urol 35:379–387. https://doi.org/10.1007/s00345-016-1928-x CrossRefPubMedGoogle Scholar
- 24.Elawdy M, Taha DE, Elbaset MA, Abouelkheir RT, Osman Y (2016) Histopathologic characteristics of upper tract urothelial carcinoma with emphasis on their impact in cancer survival: a single institute experience in 305 patients with long-term follow-up. Clin Genitourin Cancer. https://doi.org/10.1016/j.clgc.2016.04.017 CrossRefGoogle Scholar