Difference between revisions of "Micropapillary urothelial carcinoma"

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Micropapillary urothelial carcinoma (view source)

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'''Micropapillary urothelial carcinoma''' is an aggressive variant of [[urothelial carcinoma]].<ref name=pmid21080874>{{Cite journal  | last1 = Compérat | first1 = E. | last2 = Roupret | first2 = M. | last3 = Yaxley | first3 = J. | last4 = Reynolds | first4 = J. | last5 = Varinot | first5 = J. | last6 = Ouzaïd | first6 = I. | last7 = Cussenot | first7 = O. | last8 = Samaratunga | first8 = H. | title = Micropapillary urothelial carcinoma of the urinary bladder: a clinicopathological analysis of 72 cases. | journal = Pathology | volume = 42 | issue = 7 | pages = 650-4 | month = Dec | year = 2010 | doi = 10.3109/00313025.2010.522173 | PMID = 21080874 }}</ref>
{{ Infobox diagnosis
| Name      = {{PAGENAME}}
| Image      = Urothelial carcinoma with micropapillary features -- high mag.jpg
| Width      =
| Caption    = Urothelial carcinoma with invasive micropapillary features. [[H&E stain]].
| Synonyms  =
| 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]])
| LMDDx      = conventional [[urothelial carcinoma]], other micropapillary carcinomas ([[metastases]])
| Stains    =
| IHC        = CK7 +ve, CK20 +ve/-ve, [[GATA3]] +ve, [[p63]] -ve/+ve
| EM        =
| Molecular  =
| IF        =
| Gross      =
| Grossing  = [[radical cystectomy grossing]], [[cystoprostatectomy grossing]], [[nephroureterectomy grossing]]
| Staging    = [[bladder cancer staging]]
| Site      = [[urothelium]] - [[urinary bladder]], [[ureter]], renal pelvis, [[urethra]] (males)
| Assdx      =
| Syndromes  =
| Clinicalhx =
| Signs      = [[hematuria]] (typical presentation)
| Symptoms  =
| Prevalence = rare
| Bloodwork  =
| Rads      =
| Endoscopy  =
| Prognosis  = poor (aggressive course)
| Other      =
| ClinDDx    =
| Tx        = 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]].<ref name=pmid21080874>{{Cite journal  | last1 = Compérat | first1 = E. | last2 = Roupret | first2 = M. | last3 = Yaxley | first3 = J. | last4 = Reynolds | first4 = J. | last5 = Varinot | first5 = J. | last6 = Ouzaïd | first6 = I. | last7 = Cussenot | first7 = O. | last8 = Samaratunga | first8 = H. | title = Micropapillary urothelial carcinoma of the urinary bladder: a clinicopathological analysis of 72 cases. | journal = Pathology | volume = 42 | issue = 7 | pages = 650-4 | month = Dec | year = 2010 | doi = 10.3109/00313025.2010.522173 | PMID = 21080874 }}</ref>


==General==
==General==
*Aggressive behaviour.<ref name=pmid21080874/>
*Aggressive behaviour.<ref name=pmid21080874/>
*Typically presents with [[hematuria]].<ref name=pmid25673582>{{Cite journal  | last1 = Chatterjee | first1 = D. | last2 = Das | first2 = A. | last3 = Radotra | first3 = BD. | title = Invasive micropapillary carcinoma of urinary bladder: a clinicopathological study. | journal = Indian J Pathol Microbiol | volume = 58 | issue = 1 | pages = 2-6 | month =  | year =  | doi = 10.4103/0377-4929.151153 | PMID = 25673582 }}</ref>
Treatment:
*cT1 disease treated by radical cystectomy in some centres.<ref name=pmid25254936>{{Cite journal  | last1 = Willis | first1 = DL. | last2 = Fernandez | first2 = MI. | last3 = Dickstein | first3 = RJ. | last4 = Parikh | first4 = S. | last5 = Shah | first5 = JB. | last6 = Pisters | first6 = LL. | last7 = Guo | first7 = CC. | last8 = Henderson | first8 = S. | last9 = Czerniak | first9 = BA. | title = Clinical outcomes of cT1 micropapillary bladder cancer. | journal = J Urol | volume = 193 | issue = 4 | pages = 1129-34 | month = Apr | year = 2015 | doi = 10.1016/j.juro.2014.09.092 | PMID = 25254936 }}</ref>


==Microscopic==
==Microscopic==
Features:<ref name=pmid21080874/>
Features - either:
*Micropapillae.
#Micropapillae:<ref name=pmid21080874/>
#*Nipple-like structures without fibrovascular cores.
#Nests of tumour cells with clefting to the surrounding stroma - this is the invasive pattern of ''micropapillary urothelial carcinoma''.
*+/-Conventional [[urothelial carcinoma]] (common).
 
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.<ref name=pmid25673582/>
 
DDx:
*[[Metastasis]] (breast, ovary, lung, pancreas, salivary gland).  


===Images===
===Images===
====Case 1====
<gallery>
<gallery>
Image: Urothelial carcinoma with micropapillary features -- low mag.jpg | UCCMPF - low mag.
Image: Urothelial carcinoma with micropapillary features -- low mag.jpg | UCCMPF - low mag.
Line 17: Line 64:
Image: Urothelial carcinoma with micropapillary features -- very high mag.jpg | UCCMPF - very high mag.
Image: Urothelial carcinoma with micropapillary features -- very high mag.jpg | UCCMPF - very high mag.
</gallery>
</gallery>
====Case 2====
<gallery>
Image: Micropapillary urothelial carcinoma -- low mag.jpg | MPUC - low mag.
Image: Micropapillary urothelial carcinoma -- intermed mag.jpg | MPUC - intermed. mag.
Image: Micropapillary urothelial carcinoma - alt -- intermed mag.jpg | MPUC - intermed. mag.
Image: Micropapillary urothelial carcinoma -- high mag.jpg | MPUC - high mag.
Image: Micropapillary urothelial carcinoma - alt -- high mag.jpg | MPUC - high mag.
</gallery>
====www====
*[http://www.ijpmonline.org/viewimage.asp?img=IndianJPatholMicrobiol_2015_58_1_2_151153_u1.jpg Micropapillary UCC (ijpmonline.org)].<ref name=pmid25673582/>
==IHC==
Features:
*CK7 +ve.<ref name=pmid25673582/>
*CK20 +ve/-ve.<ref name=pmid25673582/>
*EMA +ve.<ref name=pmid25673582/>
*HER2 +ve/-ve.<ref name=pmid25673582/>
*GATA3 +ve.<ref name=pmid24993315/>
Others:<ref name=pmid24993315>{{Cite journal  | last1 = Lin | first1 = X. | last2 = Zhu | first2 = B. | last3 = Villa | first3 = C. | last4 = Zhong | first4 = M. | last5 = Kundu | first5 = S. | last6 = Rohan | first6 = SM. | last7 = Yang | first7 = XJ. | title = The utility of p63, p40, and GATA-binding protein 3 immunohistochemistry in diagnosing micropapillary urothelial carcinoma. | journal = Hum Pathol | volume = 45 | issue = 9 | pages = 1824-9 | month = Sep | year = 2014 | doi = 10.1016/j.humpath.2014.04.015 | PMID = 24993315 }}</ref>
*p63 -ve/+ve.
*p40 -ve/+ve.
==Sign out==
*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>
===Microscopic in surface micropapillary change only===
<pre>
The surface of the tumour shows papillae without fibrovascular cores.
</pre>


==See also==
==See also==
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==References==
==References==
{{Reflist|1}}
{{Reflist|2}}


[[Category:Genitourinary pathology]]
[[Category:Genitourinary pathology]]
[[Category:Urothelium]]
[[Category:Diagnosis]]
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