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Clinicopathologic analysis of upper urinary tract carcinoma with variant histology

  • Inês Rolim
  • Vanessa Henriques
  • Nídia Rolim
  • Ana Blanca
  • Rita Canas Marques
  • Metka Volavšek
  • Inês Carvalho
  • Rodolfo Montironi
  • Alessia Cimadamore
  • Maria R. Raspollini
  • Liang Cheng
  • Antonio Lopez-BeltranEmail author
Original Article
  • 52 Downloads

Abstract

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.

Keywords

Renal pelvis Ureter Urothelial carcinoma Variant histology Micropapillary Nested Plasmacytoid Sarcomatoid Squamous Glandular Divergent MMR 

Notes

Authors’ Contribution

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.

Funding information

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.

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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2020

Authors and Affiliations

  1. 1.Serviço de Anatomia PatológicaInstituto Português de Oncologia de Lisboa Francisco Gentil E.P.ELisbonPortugal
  2. 2.Anatomic Pathology ServiceChampalimaud Clinical CenterLisbonPortugal
  3. 3.Serviço de UrologiaHospital de Egas MonizLisbonPortugal
  4. 4.Maimonides Biomedical Research Institute of CordobaCordobaSpain
  5. 5.Institute of Pathology, Faculty of MedicineUniversity of LjubljanaLjubljanaSlovenia
  6. 6.Institute of Pathological Anatomy and HistopathologyAnconaItaly
  7. 7.Histopathology and Molecular DiagnosticsCareggi University HospitalFlorenceItaly
  8. 8.Departments of Pathology and Laboratory Medicine and UrologyIndiana UniversityIndianapolisUSA
  9. 9.Department of Surgery and Pathology, Faculty of MedicineCordoba UniversityCordobaSpain
  10. 10.Champalimaud Clinical CenterLisbonPortugal

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