Difference between revisions of "Micropapillary urothelial carcinoma"

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{{ Infobox diagnosis
{{ Infobox diagnosis
| Name      = {{PAGENAME}}
| Name      = {{PAGENAME}}
| Image      = Micropapillary urothelial carcinoma -- intermed mag.jpg
| Image      = Urothelial carcinoma with micropapillary features -- high mag.jpg
| Width      =
| Width      =
| Caption    = Urothelial carcinoma with micropapillary features. [[H&E stain]].
| Caption    = Urothelial carcinoma with invasive micropapillary features. [[H&E stain]].
| Synonyms  =
| Synonyms  =
| Micro      =
| Micro      = nests of tumour cells with clefting to the surrounding stroma (invasive pattern) ''or'' micropapillae (nipple-like structures without fibrovascular cores)
| Subtypes  = (subtype of [[urothelial carcinoma]])
| Subtypes  = (subtype of [[urothelial carcinoma]])
| LMDDx      = conventional [[urothelial carcinoma]], other micropapillary carcinomas ([[metastases]])  
| LMDDx      = conventional [[urothelial carcinoma]], other micropapillary carcinomas ([[metastases]])  
| Stains    =
| Stains    =
| IHC        = CK7 +ve, CK20 +ve/-ve, GATA3 +ve, p63 -ve/+ve
| IHC        = CK7 +ve, CK20 +ve/-ve, [[GATA3]] +ve, [[p63]] -ve/+ve
| EM        =
| EM        =
| Molecular  =
| Molecular  =
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==Microscopic==
==Microscopic==
Features:<ref name=pmid21080874/>
Features - either:
*Micropapillae - '''definitional'''.
#Micropapillae:<ref name=pmid21080874/>
**Nipple-like structures without fibrovascular cores.
#*Nipple-like structures without fibrovascular cores.
**Quantity of micropapillary pattern (percentage) is variable.<ref name=pmid25673582/>
#Nests of tumour cells with clefting to the surrounding stroma - this is the invasive pattern of ''micropapillary urothelial carcinoma''.
*Conventional [[urothelial carcinoma]] (typical).
*+/-Conventional [[urothelial carcinoma]] (common).


Note:
Notes:
*In other organs, [[adenocarcinoma]] would be in the differential diagnosis. It should be noted that [[adenocarcinoma of the urinary bladder]] looks quite different than ''micropapillary urothelial carcinoma''.
*In other organs, [[adenocarcinoma]] would be in the differential diagnosis. It should be noted that (primary) [[adenocarcinoma of the urinary bladder]] looks quite different than ''micropapillary urothelial carcinoma''.
*Quantity of micropapillary pattern (percentage) is variable.<ref name=pmid25673582/>


DDx:
DDx:
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==Sign out==
==Sign out==
*Report percentage of micropapillary pattern - suggested.{{fact}}
*Report percentage of micropapillary pattern - suggested.{{fact}}
*In 2012, Amin and Epstein suggested that one distinguish between the invasive and non-invasive micropapillary pattern.<ref name=pmid22939957>{{Cite journal  | last1 = Amin | first1 = A. | last2 = Epstein | first2 = JI. | title = Noninvasive micropapillary urothelial carcinoma: a clinicopathologic study of 18 cases. | journal = Hum Pathol | volume = 43 | issue = 12 | pages = 2124-8 | month = Dec | year = 2012 | doi = 10.1016/j.humpath.2012.04.013 | PMID = 22939957 }}</ref> The WHO GU Book of 2016 suggests ''not'' using  the term ''micropapillary carcinoma'' if only the non-invasive pattern is present (micropapillae ''without'' (invasive) nests of tumour with clefting to the surrounding stroma).<ref name=whogu2016_90>{{Ref WHOGU2016|90}}</ref>


==See also==
==See also==

Latest revision as of 13:45, 6 September 2018

Micropapillary urothelial carcinoma
Diagnosis in short

Urothelial carcinoma with invasive micropapillary features. H&E stain.
LM nests of tumour cells with clefting to the surrounding stroma (invasive pattern) or micropapillae (nipple-like structures without fibrovascular cores)
Subtypes (subtype of urothelial carcinoma)
LM DDx conventional urothelial carcinoma, other micropapillary carcinomas (metastases)
IHC CK7 +ve, CK20 +ve/-ve, GATA3 +ve, p63 -ve/+ve
Grossing notes radical cystectomy grossing, cystoprostatectomy grossing, nephroureterectomy grossing
Staging bladder cancer staging
Site urothelium - urinary bladder, ureter, renal pelvis, urethra (males)
Signs hematuria (typical presentation)
Prevalence rare
Prognosis poor (aggressive course)
Treatment cystectomy/cytoprostatectomy - advocated for cT1 disease by some

Micropapillary urothelial carcinoma (abbreviated MPUC), also micropapillary urothelial cell carcinoma (abbreviated MPUCC), is an aggressive variant of urothelial carcinoma.[1]

General

Treatment:

  • cT1 disease treated by radical cystectomy in some centres.[3]

Microscopic

Features - either:

  1. Micropapillae:[1]
    • Nipple-like structures without fibrovascular cores.
  2. Nests of tumour cells with clefting to the surrounding stroma - this is the invasive pattern of micropapillary urothelial carcinoma.

Notes:

  • In other organs, adenocarcinoma would be in the differential diagnosis. It should be noted that (primary) adenocarcinoma of the urinary bladder looks quite different than micropapillary urothelial carcinoma.
  • Quantity of micropapillary pattern (percentage) is variable.[2]

DDx:

  • Metastasis (breast, ovary, lung, pancreas, salivary gland).

Images

Case 1

  • UCCMPF - low mag.

  • UCCMPF - low mag.

  • UCCMPF - intermed. mag.

  • UCCMPF - high mag.

  • UCCMPF - high mag.

  • UCCMPF - very high mag.

Case 2

  • MPUC - low mag.

  • MPUC - intermed. mag.

  • MPUC - intermed. mag.

  • MPUC - high mag.

  • MPUC - high mag.

www

IHC

Features:

Others:[4]

  • p63 -ve/+ve.
  • p40 -ve/+ve.

Sign out

  • Report percentage of micropapillary pattern - suggested.[citation needed]
  • In 2012, Amin and Epstein suggested that one distinguish between the invasive and non-invasive micropapillary pattern.[5] The WHO GU Book of 2016 suggests not using the term micropapillary carcinoma if only the non-invasive pattern is present (micropapillae without (invasive) nests of tumour with clefting to the surrounding stroma).[6]

See also

References

  1. ↑ 1.0 1.1 1.2 Compérat, E.; Roupret, M.; Yaxley, J.; Reynolds, J.; Varinot, J.; Ouzaïd, I.; Cussenot, O.; Samaratunga, H. (Dec 2010). "Micropapillary urothelial carcinoma of the urinary bladder: a clinicopathological analysis of 72 cases.". Pathology 42 (7): 650-4. doi:10.3109/00313025.2010.522173. PMID 21080874.
  2. ↑ 2.0 2.1 2.2 2.3 2.4 2.5 2.6 Chatterjee, D.; Das, A.; Radotra, BD.. "Invasive micropapillary carcinoma of urinary bladder: a clinicopathological study.". Indian J Pathol Microbiol 58 (1): 2-6. doi:10.4103/0377-4929.151153. PMID 25673582.
  3. ↑ Willis, DL.; Fernandez, MI.; Dickstein, RJ.; Parikh, S.; Shah, JB.; Pisters, LL.; Guo, CC.; Henderson, S. et al. (Apr 2015). "Clinical outcomes of cT1 micropapillary bladder cancer.". J Urol 193 (4): 1129-34. doi:10.1016/j.juro.2014.09.092. PMID 25254936.
  4. ↑ 4.0 4.1 Lin, X.; Zhu, B.; Villa, C.; Zhong, M.; Kundu, S.; Rohan, SM.; Yang, XJ. (Sep 2014). "The utility of p63, p40, and GATA-binding protein 3 immunohistochemistry in diagnosing micropapillary urothelial carcinoma.". Hum Pathol 45 (9): 1824-9. doi:10.1016/j.humpath.2014.04.015. PMID 24993315.
  5. ↑ Amin, A.; Epstein, JI. (Dec 2012). "Noninvasive micropapillary urothelial carcinoma: a clinicopathologic study of 18 cases.". Hum Pathol 43 (12): 2124-8. doi:10.1016/j.humpath.2012.04.013. PMID 22939957.
  6. ↑ The International Agency for Research on Cancer (Author), H. Moch (Editor), P.A. Humphrey (Editor), T.M. Ulbright (Editor), V.E. Reuter (Editor) (2016). WHO Classification of Tumours of the Urinary System and Male Genital Organs (4th ed.). Lyon: World Health Organization. pp. 90. ISBN 978-9283224372.
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