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Patterns of invasion and histological growth as prognostic indicators in urothelial carcinoma of the upper urinary tract

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Abstract

The biological significance of squamous and glandular differentiation and different patterns of invasion in upper urinary tract urothelial carcinoma is unclear. We reviewed 268 cases of consecutive upper urinary tract carcinomas with respect to the presence of squamous and/or glandular differentiation and different patterns of invasion (nodular, trabecular, and infiltrative) and correlated data with patient outcome. Squamous or glandular differentiation occurred in 47/268 (18%) tumors and its presence correlated with high tumor stage (P<0.001) and grade (P<0.001). Invasive patterns were nodular in 49/227 (22%), trabecular in 95/227 (42%), and infiltrative in 83/227 (37%) tumors. The nodular pattern prevailed in low stage (P<0.001) and low-grade (P<0.001) tumors, whereas the infiltrative pattern prevailed in high stage (P<0.001) and high-grade (P<0.001) tumors. Multivariate analysis proved that tumor stage (P<0.001) and the infiltrative pattern (P<0.001) are independent predictors of metastasis-free survival, whereas tumor grade and squamous and glandular differentiation lacked independent influence on patient outcome. In conclusion, the infiltrative pattern of invasion significantly correlated with advanced disease and poor patient outcome. In contrast, the presence of squamous and/or glandular invasion did not prove independent influence on patient outcome. The pattern of invasion should be commented upon separately in the pathology report.

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References

  1. Billis A, Schenka AA, Ramos CC, Carneiro LT, Araujo V (2001) Squamous and/or glandular differentiation in urothelial carcinoma: prevalence and significance intransurethral resections of the bladder. Int Urol Nephrol 33:631–633

    Article  PubMed  CAS  Google Scholar 

  2. Bol MG, Baak JP, Buhr-Wildhagen S, Kruse AJ, Kjellevold KH, Janssen EA, Mestad O, Ogreid P (2003) Reproducibility and prognostic variability of grade and lamina propria invasion in stages Ta, T1 urothelial carcinoma of the bladder. J Urol 169:1291–1294

    Article  PubMed  Google Scholar 

  3. Charbit L, Gendreau MC, Mee S, Cukier J (1991) Tumors of the upper urinary tract: 10 years of experience. J Urol 146:1243–1246

    PubMed  CAS  Google Scholar 

  4. Cheng L, Neumann RM, Nehra A, Spotts BE, Weaver AL, Bostwick DG (2000) Cancer heterogeneity and its biologic implications in the grading of urothelial carcinoma. Cancer 88:1663–1770

    Article  PubMed  CAS  Google Scholar 

  5. Corrado F, Ferri C, Mannini D, Corrado G, Bertoni F, Bacchini P, Lelli G, Lieber MM, Song JM (1991) Transitional cell carcinoma of the upper urinary tract: evaluation of prognostic factors by histopathology and flow cytometric analysis. J Urol 145:1159–1163

    PubMed  CAS  Google Scholar 

  6. Cozad SC, Smalley SR, Austenfeld M, Noble M, Jennings S, Raymond R (1995) Transitional cell carcinoma of the renal pelvis or ureter: patterns of failure. Urology 46:796–800

    Article  PubMed  CAS  Google Scholar 

  7. Das AK, Carson CC, Bolick D, Paulson DF (1990) Primary carcinoma of the upper urinary tract. Effect of primary and secondary therapy on survival. Cancer 66:1919–1923

    Article  PubMed  CAS  Google Scholar 

  8. Fiori E, Cavallaro G, Paparelli C, Decesare A, Bononi M, Galati G, Tiziano G, Cavallaro A, Cangemi V (2004) Significance of T stadium and grading as prognostic factors in transitional cell carcinoma of the ureter. Anticancer Res 24:1921–1924

    PubMed  Google Scholar 

  9. Fung CY, Shipley WU, Young RH, Griffin PP, Convery KM, Kaufman DS, Althausen AF, Heney NM, Prout GR Jr (1991) Prognostic factors in invasive bladder carcinoma in a prospective trial of preoperative adjuvant chemotherapy and radiotherapy. J Clin Oncol 9:1533–1542

    PubMed  CAS  Google Scholar 

  10. Genega EM, Porter CR (2002) Urothelial neoplasms of the kidney and ureter. An epidemiologic, pathologic, and clinical review. Am J Clin Pathol 117(Suppl):S36–S48

    Google Scholar 

  11. Genega EM, Kapali M, Torres-Quinones M, Huang WC, Knauss JS, Wang LP, Raghunath PN, Kozlowski C, Malkowicz SB, Tomaszewski JE (2005) Impact of the 1998 World Health Organization/International Society of Urological Pathology classification system for urothelial neoplasms of the kidney. Mod Pathol 18:11–18

    Article  PubMed  Google Scholar 

  12. Guinan P, Vogelzang NJ, Randazzo R, Sener S, Chmiel J, Fremgen A, Sylvester J (1992) Renal pelvic cancer: a review of 611 patients treated in Illinois 1975–1985. Cancer incidence and end results committee. Urology 40:393–399

    Article  PubMed  CAS  Google Scholar 

  13. Hall MC, Womack S, Sagalowsky AI, Carmody T, Erickstad MD, Roehrborn CG (1998) Prognostic factors, recurrence, and survival in transitional cell carcinoma of the upper urinary tract: a 30-year experience in 252 patients. Urology 52:594–601

    Article  PubMed  CAS  Google Scholar 

  14. Huben RP, Mounzer AM, Murphy GP (1988) Tumor grade and stage as prognostic variables in upper urinary tract urothelial tumors. Cancer 62:2016–2020

    Article  PubMed  CAS  Google Scholar 

  15. Inoue K, Kamada M, Slaton JW, Fukata S, Yoshikawa C, Tamboli P, Dinney CP, Shuin T (2002) The prognostic value of angiogenesis and metastasis-related genes for progression of transitional cell carcinoma of the renal pelvis and ureter. Clin Cancer Res 8:1863–1870

    PubMed  CAS  Google Scholar 

  16. Jenkins BJ, Martin JE, Baithun SI, Zuk RJ, Oliver RT, Blandy JP (1990) Prediction of response to radiotherapy in invasive bladder cancer. Br J Urol 65:345–348

    PubMed  CAS  Google Scholar 

  17. Jimenez RE, Gheiler E, Oskanian P, Tiguert R, Sakr W, Wood DP Jr, Pontes JE, Grignon DJ (2000) Grading the invasive component of urothelial carcinoma of the bladder and its relationship with progression-free survival. Am J Surg Pathol 24:980–987

    Article  PubMed  CAS  Google Scholar 

  18. Kirkali Z, Tuzel E (2003) Transitional cell carcinoma of the ureter and renal pelvis. Crit Rev Oncol Hematol 47:155–169

    Article  PubMed  Google Scholar 

  19. Krogh J, Kvist E, Rye B (1991) Transitional cell carcinoma of the upper urinary tract: prognostic variables and post-operative recurrences. Br J Urol 67:23–36

    Article  Google Scholar 

  20. Krüger S, Noack F, Bohle A, Feller AC (2004) Histologic tumor growth pattern is significantly associated with disease-related survival in muscle-invasive transitional cell carcinoma of the urinary bladder. Oncol Rep 12:609–613

    PubMed  Google Scholar 

  21. Kunze E (1998) Histogenesis of nonurothelial carcinomas in the human and rat urinary bladder. Exp Toxicol Pathol 50:341–355

    PubMed  CAS  Google Scholar 

  22. Kunze E, Francksen B (2002) Histogenesis of nonurothelial carcinomas of the urinary bladder from pre-existent transitional cell carcinomas. A histopathological and immunohistochemical study. Urol Res 30:66–78

    Article  PubMed  CAS  Google Scholar 

  23. Lauritzen AF, Kvist E, Bredesen J, Luke M (1987) Primary carcinoma of the upper urinary tract. Acta Pathol Microbiol Immunol Scand [A] 95:7–10

    CAS  Google Scholar 

  24. Lee SH, Lin JS, Tzai TS, Chow NH, Tong YC, Yang WH, Chang CC, Cheng HL (1996) Prognostic factors of primary transitional cell carcinoma of the upper urinary tract. Eur Urol 29:266–270

    PubMed  CAS  Google Scholar 

  25. Logothetis CJ, Dexeus FH, Chong C, Sella A, Ayala AG, Ro JY, Pilat S (1989) Cisplatin, cyclophosphamide and doxorubicin chemotherapy for unresectable urothelial tumors: the M. D. Anderson experience. J Urol 141:33–37

    PubMed  CAS  Google Scholar 

  26. Lopez-Beltran A, Martin J, Garcia J, Toro M (1988) Squamous and glandular differentiation in urothelial bladder carcinomas. Histopathology, histochemistry and immunohistochemical expression of carcinoembryonic antigen. Histol Histopathol 3:63–68

    PubMed  CAS  Google Scholar 

  27. Lopez-Beltran A, Sauter G, Gasser T, Hartmann A, Schmitz-Dräger BJ, Helpap B, Ayala AG, Tamboli P, Knowles MA, Sidransky D, Cordon-Cardo C, Jones PA, Cairns P, Simon R, Amin MB, Tyczynski JE (2004) Tumours of the urinary system. Infiltrating urothelial carcinoma. In: Eble JN, Sauter G, Epstein JI, Sesterhenn IA (eds) World Health Organization classification of tumours. Pathology and genetics. Tumours of the urinary system and male genital organs. IARC, Lyon, pp 93–109

    Google Scholar 

  28. Manunta A, Vincendeau S, Kiriakou G, Lobel B, Guille F (2005) Non-transitional cell bladder carcinomas. BJU Int 95:497–502

    Article  PubMed  Google Scholar 

  29. Martin JE, Jenkins BJ, Zuk RJ, Blandy JP, Baithun SI (1989) Clinical importance of squamous metaplasia in invasive transitional cell carcinoma of the bladder. J Clin Pathol 42:250–253

    Article  PubMed  CAS  Google Scholar 

  30. Mazzucchelli L, Bacchi M, Studer UE, Markwalder R, Sonntag RW, Kraft R (1994) Invasion depth is the most important prognostic factor for transitional-cell carcinoma in a prospective trial of radical cystectomy and adjuvant chemotherapy. Int J Cancer 57:15–20

    Article  PubMed  CAS  Google Scholar 

  31. Miyake H, Hara I, Gohji K, Arakawa S, Kamidono S (1998) The significance of lymphadenectomy in transitional cell carcinoma of the upper urinary tract. Br J Urol 82:494–498

    PubMed  CAS  Google Scholar 

  32. Mullerad M, Russo P, Golijanin D, Chen HN, Tsai HH, Donat SM, Bochner BH, Herr HW, Sheinfeld J, Sogani PC, Kattan MW, Dalbagni G (2004) Bladder cancer as a prognostic factor for upper tract transitional cell carcinoma. J Urol 172:2177–2181

    Article  PubMed  Google Scholar 

  33. Nativ O, Reiman HM, Lieber MM, Zincke H (1991) Treatment of primary squamous cell carcinoma of the upper urinary tract. Cancer 68:2575–2578

    Article  PubMed  CAS  Google Scholar 

  34. Olgac S, Mazumdar M, Dalbagni G, Reuter VE (2004) Urothelial carcinoma of the renal pelvis. A clinicopathologic study of 130 cases. Am J Surg Pathol 28:1545–1552

    Article  PubMed  Google Scholar 

  35. Ozsahin M, Zouhair A, Villa S, Storme G, Chauvet B, Taussky D, Gouders D, Ries G, Bontemps P, Coucke PA, Mirimanoff RO (1999) Prognostic factors in urothelial renal pelvis and ureter tumours: a multicentre Rare Cancer Network study. Eur J Cancer 35:738–743

    Article  PubMed  CAS  Google Scholar 

  36. Papadopoulos I, Wirth B, Weichert-Jacobsen K, Loch T, Wacker HH (1996) Primary squamous cell carcinoma of the ureter and squamous adenocarcinoma of the renal pelvis: 2 case reports. J Urol 155:288–289

    Article  PubMed  CAS  Google Scholar 

  37. Racioppi M, D’Addessi A, Alcini A, Destito A, Alcini E (1997) Clinical review of 100 consecutive surgically treated patients with upper urinary tract transitional tumours. Br J Urol 80:707–711

    PubMed  CAS  Google Scholar 

  38. Raghavendran M, Rastogi A, Dubey D, Chaudhary H, Kumar A, Srivastava A, Mandhani A, Krishnani N, Kapoor R (2003) Stones associated renal pelvic malignancies. Indian J Cancer 40:108–112

    PubMed  CAS  Google Scholar 

  39. Sakamoto N, Tsuneyoshi M, Enjoji M (1992) Urinary bladder carcinoma with a neoplastic squamous component: a mapping study of 31 cases. Histopathology 21:135–141

    Article  PubMed  CAS  Google Scholar 

  40. Sivaramakrishna B, Aron M, Ansari MS, Seth A, Goel R, Mundada OP, Balchander (2004) Squamous cell carcinoma of the renal pelvis manifesting after percutaneous nephrolithotomy for long standing calculus. Int Urol Nephrol 36:149–151

    Article  PubMed  CAS  Google Scholar 

  41. Sobin LH, Wittekind C (eds) (2002) TNM classification of malignant tumors, 6th edn. Wiley-Liss, New York

    Google Scholar 

  42. Starklint H, Kjaergaard J, Jensen NK (1976) Types of metaplasia in forty urothelial bladder carcinomas. A systematic histological investigation. Acta Pathol Microbiol Scand [A] 84:137–142

    CAS  Google Scholar 

  43. Strobel SL, Jasper WS, Gogate SA, Sharma HM (1984) Primary carcinoma of the renal pelvis and ureter. Evaluation of clinical and pathologic features. Arch Pathol Lab Med 108:697–700

    PubMed  CAS  Google Scholar 

  44. Tosoni I, Wagner U, Sauter G, Egloff M, Knonagel H, Alund G, Bannwart F, Mihatsch MJ, Gasser TC, Maurer R (2000) Clinical significance of interobserver differences in the staging and grading of superficial bladder cancer. BJU Int 85:48–53

    Article  PubMed  CAS  Google Scholar 

  45. Young RH, Eble JN (1991) Unusual forms of carcinoma of the urinary bladder. Hum Pathol 22:948–965

    Article  PubMed  CAS  Google Scholar 

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Acknowledgements

The authors thank Mr. R. Christof and Ms. A. Kaps for photographic expertise and excellent technical support.

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Authors and Affiliations

  1. Institute of Pathology, Medical University Graz, Auenbruggerplatz 25, Graz, 8036, Austria

    C. Langner

  2. Department of Urology, Medical University Graz, Auenbruggerplatz 7, Graz, 8036, Austria

    G. Hutterer, T. Chromecki & R. Zigeuner

  3. Department of Surgery, Research Unit for Biomedical Engineering & Computing, Medical University Graz, Auenbruggerplatz 29, Graz, 8036, Austria

    P. Rehak

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  1. C. Langner
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Correspondence to C. Langner.

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Langner, C., Hutterer, G., Chromecki, T. et al. Patterns of invasion and histological growth as prognostic indicators in urothelial carcinoma of the upper urinary tract. Virchows Arch 448, 604–611 (2006). https://doi.org/10.1007/s00428-006-0150-4

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  • DOI: https://doi.org/10.1007/s00428-006-0150-4

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