What is new in Genitourinary Pathology? Recent developments and highlights of the new 2016 World Health Organization classification of tumors of the urinary system and male genital organs

The recently published 2016 World Health Organization (WHO) Classification of Tumors of the Urinary System and Male Genital Organs stems from the accumulated knowledge and data collected during the last 12 years, since the previous edition of the WHO "blue book" 2004. The major changes in prostate pathology include the introduction of a novel grading system for prostate cancer (Grade Groups/International Society of Urological Pathology (ISUP) grades 1­5), the recognition of intraductal carcinoma as a new entity, and the terminological changes regarding the neuroendocrine prostatic neoplasms. In bladder and urothelial tract, within the spectrum of flat and non-invasive lesions, a newly introduced term "urothelial proliferation of uncertain malignant potential" replaced the term "urothelial hyperplasia", and the term "urothelial dysplasia" was better defined. A category of "invasive urothelial carcinoma with divergent differentiation" was introduced for tumors showing a component of "usual type" urothelial carcinoma combined with other morphologies. A new WHO/ISUP renal tumor grading system was recommended (Grade 1­4). The definition of renal papillary adenoma was modified and expanded to include papillary neoplasms measuring up to 1.5 cm. Several new epithelial renal tumors were recognized as new entities including: hereditary leiomyomatosis and renal cell carcinoma (RCC) syndrome­associated RCC, succinate dehydrogenase­deficient RCC, tubulocystic RCC, acquired cystic disease­associated RCC, and clear cell papillary RCC. In testis pathology, intratubular proliferations of testicular germ cell tumors were renamed as "germ cell neoplasia in-situ" (GCNIS), and the testicular neoplasms were divided into two main groups: derived from or unrelated to GCNIS. A major change in penile pathology was the introduction of a new classification of penile squamous cell carcinoma, based on the presence of human papillomavirus (HPV), which characterizes penile tumor subtypes as HPV-related or non-HPV-related. A similar distinction was introduced for the preneoplastic penile intraepithelial precursor lesion (PeIN) into non-HPV related (differentiated PeIN) and HPV-related types (undifferentiated PeIN). In this review, we provide a summary and highlight the changes in the genitourinary pathology introduced by the 2016 WHO blue book, and we also discuss some recent developments that may impact the practice of genitourinary pathology in the near future (AU)

clinicopathological study of urinary bladder neoplasms in patients at three centers in Khartoum, Sudan

To present the histopathological pattern of urinary bladder neoplasms using the WHO/ISUP classification system and relate it to the outcome. This study was conducted in the period from January 2004 through December 2005 at f three centres in Khartoum, Sudan. One hundred and six patients with urinary bladder neoplasms were included in the study. The commonest affected age group was 60-80 years with male to female ratio 4.6:1. Urothelial neoplasms were found in 72 [67.9%], Squamous cell carcinoma [SCC] in 26 [24.5%], Urothelial neoplasms with Squamous differentiation in 3 [2.8%], and other types in 5 [4.7%] of the patients. There were 43.4% of the urothelial neoplasms graded as papillary carcinoma of high grade, 52.6% papillary carcinoma of low grade, 1.3% papillary neoplasm of low malignant potential, 1.3% papilloma, and 1.3% was graded as flat neoplasm. Of the SCCs, twelve [42.9%] were poorly differentiated SCCs, nine [32.1%] moderately differentiated, and seven [25%] cases were well differentiated SCCs. Follow-up information was available in 32 patients. At last follow-up, fifteen [46.9%] patients were dead of the disease, twelve [35.5%] were alive with no evidence of disease, four [12.5%] were alive with disease, and one [3.1%] was alive and terminally ill. Histological grade [P: 0.006], and muscle invasion [P: 0.002] were significantly associated with survival. A subset of the cases could not be assessed for muscle invasion due to madequate sampling; we thus recommend proper trans-urethral bladder biopsy [TUEP] sampling

Study of grading of urothelial carcinoma in transurethral resection of urinary bladder tumor specimens.

This study is conducted to evaluate prognostic significance of recently introduced WHO (World Health Organization) 1999 grading system for urothelial carcinoma on transurethral resection of urinary bladder tumor (TURBT) specimens reported during the period from 1996 to 2000. Progression free survival estimates were obtained by Kaplan-Meier method on SPSS software with log rank test application. Among 70 cases, progression occurred in 38 patients from which grade I were 3, grade II were 11 and grade III were 24. The mean period from diagnosis to progression was 76.8, 19.2 and 3.5 months for grade I, II, III respectively. The progression free survival rates at one year were 100% for grade I, 42% for grade II and 5% for grade III. (Log rank test: p < 0.001). WHO 1999 grading system can classify urothelial carcinomas into prognostically different groups, which is statistically significant.

Carcinoma sarcomatóide de bexiga: relato de caso / Sarcomatoid carcinoma of the bladder: a case report

Os carcinomas sarcomatóides de bexiga são neoplasias raras, representando apenas 0,3 por cento das patologias malignas da bexiga. Por apresentarem marcado grau de malignidade e agressividade, devem ser sempre consideradas no diagnóstico diferencial dos tumores da bexiga. Os autores revisam a literatura e relatam o caso de um paciente de 62 anos de idade, branco e tabagista, com queixa de hematúria macroscópica, investigada por cistocopia e biópsia. Um exame histológico do tumor sugeriu carcinoma sarcomatóide de bexiga. O diagnóstico foi confirmado por um exame imunohistoquímico. Como o paciente apresentava severa disfunção ventilatória, foi tratado com ressecção transuretral do tumor, recusou a indicação de terapia adjuvante evoluindo para óbito 5 meses após o diagnóstico

Câncer de bexiga: antígeno carcinoembrionário na avaliaçäo do potencial de infiltraçäo muscular / Bladder cancer: carcinoembryonic antigen to evaluate potential of muscle invasion

Em amostra de lavado vesical de 76 pacientes com carcinoma de células transicionais de bexiga realizou-se pesquisa do antígeno carcinoembrionário (CEA) pelo método imunocitoquímico. Histologicamente, 10,5 por cento, 47,4 por cento, 32,9 por cento e 9,2 por cento dos tumores eram grau I, grau II, grau III e grau IV, respectivamente. O CEA estava presente em 69,7 por cento e ausente em 27,2 por cento das amostras. Observou-se presença de infiltraçäo muscular pelo tumor em 64,4 por cento dos pacientes e ausência em 31,6 por cento. Os autores concluíram que o estudo do CEA em amostra de lavado vesical näo contribuiu para a avaliaçäo do potencial de infiltraçäo do tumor em portadores de carcinoma da célula transicional de bexiga

Cáncer visical / Bladder cancer

Se analiza la frecuencia creciente con la edad del cáncer vesical. El gran síntoma es la hematuria que en ausencia de infección obliga a estudios endoscópicos y a biopsia vesical múltiple sistematizada. La citología es positiva en forma creciente mientras más indiferenciado es el tumor. La radiología y Ecografía contribuye al diagnóstico de lesiones vesicales y detectan lesiones altas. La resección del tumor y biopsia de mapeo permiten etapificar cada caso. En los tumores superficiales la R.T.U., será procedimiento de elección, asociada a Quimioterapia o Inmunoterapia con B.C.9 que controlan el Carcinoma in situ en un 70% a 2 años. El Carcinoma in situ es un factor de mal pronóstico. Los cánceres invasores deben ser tratados con cistectomía total si las condiciones del paciente lo permiten. La sobrevida es de 60% a 5 años para T1+ T2 y de 33% para T3a + T3b. Existen posibilidades de mejorar esta sobrevida con quimioterapia preoperatoria. La Radioterapia ha sido progresivamente abandonada como tratamiento coadjuvante