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Difference between revisions of "Micropapillary urothelial carcinoma"
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{{ Infobox diagnosis | {{ Infobox diagnosis | ||
| Name = {{PAGENAME}} | | Name = {{PAGENAME}} | ||
| Image = Urothelial carcinoma with micropapillary features -- | | 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 = | ||
| IF = | | IF = | ||
| Gross = | | Gross = | ||
| Grossing = | | Grossing = [[radical cystectomy grossing]], [[cystoprostatectomy grossing]], [[nephroureterectomy grossing]] | ||
| Staging = [[bladder cancer staging]] | |||
| Site = [[urothelium]] - [[urinary bladder]], [[ureter]], renal pelvis, [[urethra]] (males) | | Site = [[urothelium]] - [[urinary bladder]], [[ureter]], renal pelvis, [[urethra]] (males) | ||
| Assdx = | | Assdx = | ||
| Line 28: | Line 29: | ||
| Other = | | Other = | ||
| ClinDDx = | | ClinDDx = | ||
| Tx = | | Tx = cystectomy/cytoprostatectomy - advocated for cT1 disease by some | ||
}} | }} | ||
'''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> | '''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> | *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:<ref name=pmid21080874/> | ||
**Quantity of micropapillary (percentage) is variable.<ref name=pmid25673582/> | #*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: | DDx: | ||
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===Images=== | ===Images=== | ||
====Case==== | ====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. | ||
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Image: Urothelial carcinoma with micropapillary features - alt -- high mag.jpg | UCCMPF - high mag. | Image: Urothelial carcinoma with micropapillary features - alt -- high mag.jpg | UCCMPF - high mag. | ||
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> | |||
====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> | </gallery> | ||
====www==== | ====www==== | ||
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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> | |||
===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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[[Category:Genitourinary pathology]] | [[Category:Genitourinary pathology]] | ||
[[Category:Urothelium]] | |||
[[Category:Diagnosis]] | |||