1755 UROTHELIAL CARCINOMA WITH VARIANT HISTOLOGY: ANALYSIS OF DISTINCT PATTERNS OF INVASION (2013)

You have accessJournal of UrologyBladder Cancer: Invasive (III)1 Apr 20131755 UROTHELIAL CARCINOMA WITH VARIANT HISTOLOGY: ANALYSIS OF DISTINCT PATTERNS OF INVASION Kevin Rice, Jose Pedrosa, Derek Thomas, Timothy Masterson, Stephen Beck, Thomas Gardner, Noah Hahn, Richard Foster, Richard Bihrle, David Grignon, Liang Cheng, and Michael Koch Kevin RiceKevin Rice Indianapolis, IN More articles by this author , Jose PedrosaJose Pedrosa Indianapolis, IN More articles by this author , Derek ThomasDerek Thomas Indianapolis, IN More articles by this author , Timothy MastersonTimothy Masterson Indianapolis, IN More articles by this author , Stephen BeckStephen Beck Indianapolis, IN More articles by this author , Thomas GardnerThomas Gardner Indianapolis, IN More articles by this author , Noah HahnNoah Hahn Indianapolis, IN More articles by this author , Richard FosterRichard Foster Indianapolis, IN More articles by this author , Richard BihrleRichard Bihrle Indianapolis, IN More articles by this author , David GrignonDavid Grignon Indianapolis, IN More articles by this author , Liang ChengLiang Cheng Indianapolis, IN More articles by this author , and Michael KochMichael Koch Indianapolis, IN More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2013.02.2884AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Several variant histologic patterns have been reported to occur in the setting of urothelial carcinoma (UC). While unique behavior has been suggested for some of these variants, a comparative analysis has not been performed. METHODS The Indiana University Cystectomy Database was queried from January 2000 to August 2012 for patients demonstrating variant histologic patterns associated with primary UC. Patients were excluded if they had primary adenocarcinoma of the bladder or urachus, squamous cell carcinoma, or primary sarcoma of the bladder. Patients with multiple variants were designated by the predominant or most advanced variant. RESULTS During the study period 1,245 patients underwent cystectomy for UC at Indiana University, of which 141 patients met inclusion criteria. The number of patients with each variant were as follows: UC with glandular differentiation - 25, lymphoepithelioma-like - 9, micropapillary - 35, sarcomatoid - 27, nested - 6, neuroendocrine - 17, and plasmacytoid - 22. The mean age at cystectomy was 66.7 (Range 41 - 92). 113 patients (80.1%) were male. 86 patients (61%) had locally-advanced disease (T3-4) disease at cystectomy. This was encountered most frequently with the nested (83.4%) and plasmacytoid (72.8%) variants. 82 patients (58.2%) demonstrated lymphovascular invasion. This was seen most frequently in micropapillary (91.2%) and nested (100%) variants. 64 patients (45.4%) had positive lymph nodes. This was seen most frequently in micropapillary (71.4%) and plasmacytoid (77.3%) variants. Tumor extension along peritoneal surfaces occurred in 18 (12.9%) patients. This was seen most commonly in micropapillary (20%) and plasmacytoid (31.8%) variants. 31 patients (22%) demonstrated direct invasion into adjacent pelvic organs/sidewall. This was seen most commonly with the plasmacytoid variant (40.9%). 29 patients (20.6%) had positive surgical margins. This was seen most frequently in the plasmacytoid (40.9%) variant. CONCLUSIONS Individual urothelial carcinoma variants demonstrate distinct patterns of invasion as well as divergent pathologic markers of aggressiveness. The most aggressive histologies appear to be plasmacytoid and micropapillary variants. The nested variant also demonstrated distinctly invasive characteristics, although the strength of the data for this histology is limited by a small study subpopulation. © 2013 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 189Issue 4SApril 2013Page: e721-e722 Advertisement Copyright & Permissions© 2013 by American Urological Association Education and Research, Inc.MetricsAuthor Information Kevin Rice Indianapolis, IN More articles by this author Jose Pedrosa Indianapolis, IN More articles by this author Derek Thomas Indianapolis, IN More articles by this author Timothy Masterson Indianapolis, IN More articles by this author Stephen Beck Indianapolis, IN More articles by this author Thomas Gardner Indianapolis, IN More articles by this author Noah Hahn Indianapolis, IN More articles by this author Richard Foster Indianapolis, IN More articles by this author Richard Bihrle Indianapolis, IN More articles by this author David Grignon Indianapolis, IN More articles by this author Liang Cheng Indianapolis, IN More articles by this author Michael Koch Indianapolis, IN More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...