ABSTRACT
BACKGROUND: Urothelial carcinoma (UC) variants can be difficult to differentiate from carcinoma metastatic to the bladder. MATERIALS AND METHODS: We examined immunostaining for uroplakin III in 43 cases of primary bladder UC variants including micropapillary UC (n=19), nested variant of UC (n=2), pleomorphic giant-cell carcinoma (n=8), plasmacytoid UC (n=4), lymphoepithelioma-like carcinoma (n=2), large cell undifferentiated carcinoma (n=2), UC with abundant myxoid stroma (n=3) and lipid cell variant (n=3) and in 11 tumors from other organs metastatic to the bladder. These tumors included invasive ductal carcinoma of the breast (n=2), colorectal adenocarcinoma (n=4), endometrioid adenocarcinoma (n=1) and serous papillary carcinoma of the uterus (n=1) melanoma (n=1), embryonal carcinoma of the testis (n=1), and renal clear cell carcinoma (n=1). RESULTS: Out of the 43 UC variants, 35 (81%) were positive for uroplakin III, including micropapillary, lipid cell variant and UC with abundant myxoid stroma. Pleomorphic giant cell carcinoma, plasmacytoid UC and nested variant of UC were less commonly positive. Of the 11 metastatic tumors, six were found to be positive for uropIakin III: metastatic colorectal adenocarcinoma, clear cell carcinoma of the kidney and embryonal carcinoma of testis. CONCLUSION: UP III Positivity for uroplakin III is not found only in primary bladder UC variants, but in some tumors that have metastatized to the bladder. Staining for uroplakin III alone should not be taken as evidence of UC.
Subject(s)
Biomarkers, Tumor/metabolism , Carcinoma, Giant Cell/secondary , Carcinoma, Large Cell/secondary , Carcinoma, Papillary/secondary , Urinary Bladder Neoplasms/pathology , Uroplakin III/metabolism , Adult , Aged , Aged, 80 and over , Carcinoma, Giant Cell/metabolism , Carcinoma, Large Cell/metabolism , Carcinoma, Papillary/metabolism , Female , Follow-Up Studies , Humans , Immunoenzyme Techniques , Male , Middle Aged , Neoplasm Metastasis , Neoplasm Staging , Prognosis , Urinary Bladder Neoplasms/metabolismABSTRACT
OBJECTIVES: The modified Gleason system of 2005 recommends incorporating higher grade tertiary patterns on needle biopsy into final Gleason scores to better correlate with radical prostatectomy findings. However, limited literature exists on the validity of this practice and the significance of tertiary Gleason patterns in needle biopsy. METHODS: Over a 20 month period there were 25 cases of Gleason score 7 with tertiary pattern 5 on needle biopsy with follow-up radical prostatectomy reported at our institution. Pathological findings at radical prostatectomy from these cases were compared with those from patients with Gleason score 4â+â3â=â7 tumours (50 cases) and Gleason score 4â+â5â=â9 tumours (63 cases) on needle biopsy. RESULTS: Comparison of Gleason score 4â+â3â=â7 with 4â+â3â=â7(+5) tumours on needle biopsy, showed a significant difference in tumour volume in the corresponding radical prostatectomy specimen (pâ=â0.02). Differences in patient age, serum prostate specific antigen levels at diagnosis, positive surgical margins, extraprostatic extension, seminal vesicle invasion and lymph node metastases were not statistically significant between the two patient groups or when Gleason score 4â+â3â=â7(+5) and Gleason score 9 tumours were compared. CONCLUSION: Tertiary pattern 5 on needle biopsy predicts greater tumour volume. This suggests that for thin core biopsies, if tertiary pattern 5 is present this should be incorporated into the final Gleason score.