Abstract
Conventional urothelial carcinoma is the most common histological type of urinary bladder carcinoma. The latest edition of the WHO classification of tumours of the urothelial tract lays special emphasis on the ability of urothelial tumours to exhibit divergent differentiation with multiple histologic variants and a diverse genomic landscape. The presence of a micropapillary component (MPC) in urothelial carcinoma is associated with high-grade disease and poor response to intravesical chemotherapy. The present study aims to enumerate the clinicohistological features of urothelial carcinomas with micropapillary differentiation. Slides from 144 radical cystectomy specimens received over 6 years were reviewed independently by two pathologists. A predominant histological pattern along with co-existing pathology was noted. Of these, five cases were pure micropapillary carcinomas, four had conventional urothelial carcinoma with a MPC, one had a microscopic tumour at the mucosal surface, and two cases showed micropapillary histology in the lymph node metastasis, following transurethral resection of bladder tumour and Bacillus Calmette-Guerin therapy. The tumours with pure micropapillary carcinoma presented with a higher pathological stage and poor overall survival. Organ and lymph node metastasis was noted in five and eight cases, respectively, of which six showed a micropapillary pattern in the lymph nodes. Micropapillary urothelial carcinoma is a rare and aggressive variant of urothelial carcinoma with unique histologic features. This variant is often missed and underreported in biopsy and surgical resection specimens. Since the presence of MPC confers a poorer prognosis, the identification and reporting of this entity are important.
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The datasets generated during and/or analysed during the current study are available from the corresponding author on reasonable request.
References
Sung H, Ferlay J, Siegel RL, Laversanne M, Soerjomataram I, Jemal A, Bray F (2021) Global Cancer Statistics 2020: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin 71(3):209–249
Humphrey PA, Moch H, Cubilla AL, Ulbright TM, Reuter VE (2016) The 2016 WHO classification of tumours of the urinary system and male genital organs-part B: prostate and bladder tumours. Eur Urol 70(1):106–119
Hsu J, Ro J (2019) Micropapillary carcinoma of the bladder: recent advances. Annals Urologic Oncol 7:1–10
Amin MB, Ro JY, el-Sharkawy T, Lee KM, Troncoso P, Silva EG, Ordóñez NG, Ayala AG (1994) Micropapillary variant of transitional cell carcinoma of the urinary bladder Histologic pattern resembling ovarian papillary serous carcinoma. Am J Surg Pathol 18(12):1224–32
Samaratunga H, Khoo K (2004) Micropapillary variant of urothelial carcinoma of the urinary bladder; a clinicopathological and immunohistochemical study. Histopathology 45(1):55–64
Kamat AM, Dinney CP, Gee JR, Grossman HB, Siefker-Radtke AO, Tamboli P, Detry MA, Robinson TL, Pisters LL (2007) Micropapillary bladder cancer: a review of the University of Texas M. D. Anderson Cancer Center experience with 100 consecutive patients. Cancer 110(1):62–7
Meeks JJ, Taylor JM, Matsushita K, Herr HW, Donat SM, Bochner BH, Dalbagni G (2013) Pathological response to neoadjuvant chemotherapy for muscle-invasive micropapillary bladder cancer. BJU Int 111(8):E325-30
Sui W, Matulay JT, James MB, Onyeji IC, Theofanides MC, RoyChoudhury A, DeCastro GJ, Wenske S (2016) Micropapillary bladder cancer: insights from the National Cancer Database. Bladder Cancer 2(4):415–423
Cheng YT, Luo HL, Sung MT, Chiang PH (2010) Micropapillary variant of urothelial carcinoma: a report of 4 cases and literature review. Chang Gung Med J 33(4):461–5
Perepletchikov AM, Parwani AV (2009) Micropapillary urothelial carcinoma: clinico-pathologic review. Pathol Res Pract 205(12):807–10
Lopez-Beltran A, Montironi R, Blanca A, Cheng L (2010) Invasive micropapillary urothelial carcinoma of the bladder. Hum Pathol 41(8):1159–64
Kwon GY, Ro JY (2011) Micropapillary variant of urothelial carcinoma. Adv Urol 2011:217153
Compérat E, Roupret M, Yaxley J, Reynolds J, Varinot J, Ouzaïd I, Cussenot O, Samaratunga H (2010) Micropapillary urothelial carcinoma of the urinary bladder: a clinicopathological analysis of 72 cases. Pathology 42(7):650–4
Monn M, Cheng L (2016) Evolving concepts of micropapillary variant urothelial carcinoma. Transl Cancer Res 5(S7):S1539–S1542
Hui Y, Lombardo KA, Quddus MR, Matoso A (2018) Cell polarity reversal distinguishes true micropapillary growth from retraction artifact in invasive urothelial carcinoma. Appl Immunohistochem Mol Morphol 26(1):e1–e6
Sangoi AR, Higgins JP, Rouse RV, Schneider AG, McKenney JK (2009) Immunohistochemical comparison of MUC1, CA125, and Her2Neu in invasive micropapillary carcinoma of the urinary tract and typical invasive urothelial carcinoma with retraction artifact. Mod Pathol 22(5):660–7
Chatterjee D, Das A, Radotra BD (2015) Invasive micropapillary carcinoma of urinary bladder: a clinicopathological study. Indian J Pathol Microbiol 58(1):2–6
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Pallavi Prasad: conceptualisation, methodology, software, reviewing, and editing. Harshita Baranwal: Data curation and writing—original draft preparation. Vinita Agrawal: supervision, reviewing, and editing.
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Prasad, P., Baranwal, H. & Agrawal, V. Invasive Micropapillary Urothelial Carcinoma: an Uncommon and Underreported Variant in Cystectomy Specimens. Indian J Surg Oncol 14, 222–227 (2023). https://doi.org/10.1007/s13193-022-01692-7
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DOI: https://doi.org/10.1007/s13193-022-01692-7