Características clínico-patológicas de las lesiones malignas del tracto urinario inferior / Clinicopathological features of malignant lesions of the lower urinary tract / Características clínico-patológicas de lesões malignas do trato urinário inferior

RESUMEN Introducción: El cáncer de vejiga es un tumor mucho más frecuente de lo que a veces nos transmiten las estadísticas o los medios de comunicación. Ocupa el noveno lugar en cuanto al número de diagnósticos de cáncer a nivel mundial y se reporta aproximadamente cinco veces más frecuente en varones que en mujeres. Objetivo: Describir las características clínico-patológicas de los tumores malignos del tracto urinario inferior. Método: Se realizó un estudio descriptivo y transversal de 186 pacientes con tumores malignas del tracto urinario inferior diagnosticados anatomo-patológicamente en el Hospital Provincial Clínico Quirúrgico Docente "Saturnino Lora Torres", de Santiago de Cuba, entre los años 2017 al 2020. Una vez recopilados los datos se procesaron mediante el sistema estadístico SPSS, en su versión 21.0. Resultados: En la serie la mayoría de los afectados fueron hombres entre los 60 y 79 años de edad, siendo más frecuente en el sexo masculino. Predominaron los carcinomas uroteliales con el 96,4 % del total en su variedad papilar y de alto grado de malignidad. Conclusiones: Los tumores malignos del tracto urinario inferior son un problema de salud de baja frecuencia cuya trascendencia es la afectación individual a quien lo padece, y su comportamiento clínico patológico, en sentido general, fue similar a lo reportado por la literatura nacional e internacional, salvo pequeñas y puntuales diferencias relativo a los síntomas, el diagnóstico histológico, en parte, y el grado de malignidad de las lesiones.

ABSTRACT Introduction: Bladder cancer is a more common tumor that sometimes the statistics database or media conveyed to us. It ranks ninth concerning cancer diagnoses worldwide and it is reported to be approximately five times more frequent in males than in females. Objective: To describe the clinicopathologic features of malignant lower urinary tract tumors. Method: A descriptive and cross-sectional study involving a total of 186 patients was conducted. Anatomical and pathological diagnoses were carried out to all patients with malignant lower urinary tract tumor at the Hospital Provincial Clínico Quirúrgico Docente "Saturnino Lora Torres" in Santiago de Cuba, from 2017 throughout 2020. Once the data were collected, they were processed using the SPSS statistical system, version 21.0. Results: Most affected patients with lower urinary tract tumor had an average age of 60 to 70, arising most frequently in males. The 96.4 % of the total of the patients were diagnosed with urothelial carcinomas (predominant), described in its papillary variety and the high degree of malignant transformation. Conclusions: Malignant lower urinary tract tumors are health problems labeled as the low frequency which differ in their transformation according to the patient. The clinical pathological behavior of the tumor, in a general sense, was similar to that reported in the national and international literature, except for small and pointed differences regarding symptoms, histological diagnosis, and the degree of the lesions´ malignant transformation.

RESUMO Introdução: O câncer de bexiga é um tumor mais comum do que às vezes o banco de dados de estatísticas ou a mídia veiculada por nós. Ele ocupa o nono lugar em diagnósticos de câncer em todo o mundo e é relatado ser aproximadamente cinco vezes mais frequente em homens do que em mulheres. Objetivo: Descrever as características clínico-patológicas dos tumores malignos do trato urinário inferior. Método: Foi realizado um estudo descritivo e transversal envolvendo um total de 186 pacientes. Os diagnósticos anatômicos e patológicos foram realizados a todos os pacientes com tumor maligno do trato urinário inferior no Hospital Provincial Clínico Quirúrgico Docente "Saturnino Lora Torres" em Santiago de Cuba, de 2017 a 2020. Uma vez coletados os dados, eles foram processados ​​no SPSS sistema estatístico, versão 21.0. Resultados: A maioria dos pacientes afetados com tumor do trato urinário inferior tinha uma idade média de 60 a 70 anos, surgindo mais frequentemente no sexo masculino. 96,4% do total dos pacientes foram diagnosticados com carcinomas uroteliais (predominantes), descritos em sua variedade papilar e alto grau de transformação maligna. Conclusões: Os tumores malignos do trato urinário inferior são problemas de saúde rotulados como de baixa frequência e que diferem em sua transformação de acordo com o paciente. O comportamento clínico-patológico do tumor, de um modo geral, foi semelhante ao relatado na literatura nacional e internacional, exceto por pequenas e pontuadas diferenças quanto à sintomatologia, ao diagnóstico histológico e ao grau de transformação maligna das lesões.

Immunohistochemical expression profiles of MUC1 and MUC2 mucins in urothelial tumors of bladder

Background: Mucins may show aberrant expression, localization, and/or glycosylation in multiple malignancies. However, information regarding expression of these mucins is mostly unknown in urothelial tumors. Aim: This study was conducted for examining the expressions of membrane associated and secreted mucin (MUC1) and a secreted gel-forming mucin (MUC2) in urothelial tumors of the urinary bladder. Subjects and Methods: Archival transurethral resection materials of 97 urothelial carcinoma cases were reexamined light microscopically and graded according to the 2004 WHO Classification. Pathological stage was given as pTa, pT1, and pT2. Demonstrative sections were recut for immunohistochemistry for MUC1 and MUC2. The results were statistically analyzed, and P < 0.05 was considered statistically significant. Results: The positivity for MUC1 and MUC2 was 89.7% and 44.3%, respectively. Independent from pathological stage of the tumor, MUC1 expression showed statistically significant correlation with tumor grade (P < 0.05). We did not find any correlation between pathological stage and MUC1 and MUC2 expression (P > 0.05). MUC1 staining pattern in papillary urothelial neoplasm of low malignant potential cases was more commonly apical and superficial (luminal cell layer only). Intermediate cells ± basal cells or isolated cells or islands of tumor cells with cytoplasmic and/or circumferential membrane positivity for MUC1 and MUC2 were more commonly observed in both low- and high-grade carcinomas. The difference between groups in terms of MUC1 and MUC2 staining was statistically significant (P < 0.05). Conclusions: The staining patterns of both mucins are different between urothelial papillary tumors and may be used to make a differentiation, especially for low-grade papillary urothelial lesions. This difference may also be important in the carcinomatous transformation of urothelial neoplastic and preneoplastic lesions.

Utility of p63 immunohistochemical stain in differentiating urothelial carcinomas from adenocarcinomas of prostate.

Background: Prostatic adenocarcinoma and urothelial carcinoma of the urinary bladder are common cancers in men. High grade forms of these tumors may present ambiguous morphologic features that do not permit a definite diagnosis. This distinction between the two tumors has significant staging and therapeutic implications. Hence, an accurate diagnosis is essential for optimal patient care. p63 is a new marker which can be used in this context. It is expressed in most of the urothelial carcinomas and negative in majority of prostatic adenocarcinomas. Aim: To compare the expression of p63 in urothelial carcinomas and adenocarcinomas of prostate. Materials and Methods: Comparative cross--sectional study was carried out at a tertiary cancer hospital from 15 June 2006 to 15 December 2006. Immunohistochemical stain p63 was performed on 50 cases of urothelial carcinoma and 50 prostatic adenocarcinomas. Patients' name, age, histology numbers, grade of tumor, and expression of p63 were recorded. p63 expression was seen in 44 of 50 urothelial carcinomas (88%). None of the prostatic adenocarcinomas expressed p63. The ages of patients with prostatic adenocarcinoma ranged from 49 to 86 years with a median age of 71 years and 41 to 83 years for urothelial carcinomas with a median age of 60.5 years. Conclusion: p63 can be used as a reliable marker to distinguish prostatic adenocarcinomas from urothelial carcinomas in difficult cases in conjunction with other markers like PSA.