Histologically confirmed distant metastatic urothelial carcinoma from the urinary bladder: a retrospective review of one institution’s 20-year experience
1
조회
0
다운로드
0
인용
0
참고문헌
키워드
초록
Background: Urothelial carcinoma (UC) accounts for roughly 90% of bladder cancer, and has a high propensity for diverse differentiation. Recently, certain histologic variants of UC have been recognized to be associated with unfavorable clinical outcomes. Several UC studies have also suggested that tumor budding is a poor prognostic marker. Distant metastasis of UC after radical cystectomy is not uncommon. However, these metastatic lesions are not routinely confirmed with histology. Methods: We investigated the histopathologic features of 13 cases of UC with biopsy-proven distant metastases, with a special emphasis on histologic variants and tumor budding. Results: Lymph nodes (6/13, 46%) were the most common metastatic sites, followed by the lung (4/13, 31%), liver (4/13, 31%), and the adrenal gland (2/13, 15%). The histologic variants including squamous (n = 1), micropapillary (n = 4), and plasmacytoid (n = 1) variants in five cases of UC. Most histologic variants (4/5, 80%) of primary UCs appeared in the metastatic lesions. In contrast, high-grade tumor budding was detected in six cases (46%), including one case of non-muscle invasive UC. Our study demonstrates that histologic variants are not uncommonly detected in distant metastatic UCs. Most histologic variants seen in primary UCs persist in the distant metastatic lesions. In addition, high-grade tumor budding, which occurs frequently in primary tumors, may contribute to the development of distant metastasis. Conclusions: Therefore, assessing the presence or absence of histologic variants and tumor budding in UCs of the urinary bladder, even in non-muscle invasive UCs, may be useful to predict distant metastasis.
Abstract
Background: Urothelial carcinoma (UC) accounts for roughly 90% of bladder cancer, and has a high propensity for diverse differentiation. Recently, certain histologic variants of UC have been recognized to be associated with unfavorable clinical outcomes. Several UC studies have also suggested that tumor budding is a poor prognostic marker. Distant metastasis of UC after radical cystectomy is not uncommon. However, these metastatic lesions are not routinely confirmed with histology. Methods: We investigated the histopathologic features of 13 cases of UC with biopsy-proven distant metastases, with a special emphasis on histologic variants and tumor budding. Results: Lymph nodes (6/13, 46%) were the most common metastatic sites, followed by the lung (4/13, 31%), liver (4/13, 31%), and the adrenal gland (2/13, 15%). The histologic variants including squamous (n = 1), micropapillary (n = 4), and plasmacytoid (n = 1) variants in five cases of UC. Most histologic variants (4/5, 80%) of primary UCs appeared in the metastatic lesions. In contrast, high-grade tumor budding was detected in six cases (46%), including one case of non-muscle invasive UC. Our study demonstrates that histologic variants are not uncommonly detected in distant metastatic UCs. Most histologic variants seen in primary UCs persist in the distant metastatic lesions. In addition, high-grade tumor budding, which occurs frequently in primary tumors, may contribute to the development of distant metastasis. Conclusions: Therefore, assessing the presence or absence of histologic variants and tumor budding in UCs of the urinary bladder, even in non-muscle invasive UCs, may be useful to predict distant metastasis.
참고문헌 (35)
- Bray F, "Global cancer statistics 2018 : GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries", CA Cancer J Clin, 68, pp.394~424 (2018)
- Lopez-Beltran A, "Variants and new entities of bladder cancer", Histopathology, 74, pp.77~96 (2019)
- Warrick JI, "Clinical significance of histologic variants of bladder cancer", J Natl Compr Canc Netw, 15, pp.1268~1274 (2017)
- WHO classification of tumours ot the uinary system and male genital organs, "Moch H", International Agency for Research on Cancer, 77~98 (2016)
- Moschini M, "Characteristics and clinical significance of histological variants of bladder cancer", Nat Rev Urol, 14, pp.651~668 (2017)
- Amin MB, "Histological variants of urothelial carcinoma: diagnostic, therapeutic and prognostic implications", Mod Pathol., 22(Suppl 2), pp.S96~S118 (2009)
- Liu Y, "Urothelial carcinoma with squamous differentiation is associated with high tumor stage and pelvic lymphnode metastasis", Cancer Control, 24, pp.78~82 (2017)
- Perepletchikov AM, "Micropapillary urothelial carcinoma : clinico-pathologic review", Pathol Res Pract, 205, pp.807~810 (2009)
- Keck B, "Plasmacytoid variant of bladder cancer defines patients with poor prognosis if treated with cystectomy and adjuvant cisplatin-based chemotherapy", BMC Cancer, 13, pp.71~ (2013)
- Sanfrancesco J, "Sarcomatoid urothelial carcinoma of the bladder : analysis of 28 cases with emphasis on clinicopathologic features and markers of epithelial-to-mesenchymal transition", Arch Pathol Lab Med, 140, pp.543~551 (2016)
- Venyo AK, "Nested variant of urothelial carcinoma", Adv Urol, 2014, pp.192720~ (2014)
- Lorenzo Soriano L, "Tumor budding : prognostic value in muscle-invasive bladder cancer", Urology, 130, pp.93~98 (2019)
- Fukumoto K, "Tumor budding, a novel prognostic indicator for predicting stage progression in T1 bladder cancers", Cancer Sci, 107, pp.1338~1344 (2016)
- Ueno H, "Tumour ‘budding’as an index to estimate the potential of aggressiveness in rectal cancer", Histopathology, 40, pp.127~132 (2002)
- Lugli A, "Tumour budding : a promising parameter in colorectal cancer", Br J Cancer, 106, pp.1713~1717 (2012)
- Salhia B, "High tumor budding stratifies breast cancer with metastatic properties", Breast Cancer Res Treat, 150, pp.363~371 (2015)
- Kemi N, "Tumor budding and prognosis in gastric adenocarcinoma", Am J Surg Pathol, 43, pp.229~234 (2019)
- Grigore AD, "Tumor budding: the name is EMT. Partial EMT", J Clin Med, 5, pp.51~ (2016)
- Manig L, "Predicting survival after irradiation of metastases from transitional carcinoma of the bladder", Anticancer Res, 36, pp.6663~6665 (2016)
- Shelley MD, "Gemcitabine chemotherapy for the treatment of metastatic bladder carcinoma", BJU Int, 108, pp.168~179 (2011)
- Sood S, "Plasmacytoid urothelial carcinoma : an unusual variant that warrants aggressive management and critical distinction on transurethral resections", Arch Pathol Lab Med, 143, pp.1562~1567 (2019)
- Ricardo-Gonzalez RR, "Plasmacytoid carcinoma of the bladder : a urothelial carcinoma variant with a predilection for intraperitoneal spread", J Urol, 187, pp.852~855 (2012)
- Bochner BH, "AJCC cancer staging manual", pp.346~355 (2017), Springer
- Lugli A, "Recommendations for reporting tumor budding in colorectal cancer based on the International Tumor Budding Consensus Conference(ITBCC)2016", Mod Pathol, 30, pp.1299~1311 (2017)
- Shankar PR, "A pictorial review of bladder cancer nodal metastases", Transl Androl Urol, 7, pp.804~813 (2018)
- MacVicar AD, "Bladder cancer staging", BJU Int., 86(Suppl 1), pp.111~122 (2000)
- Jessen C, "Predictive factors for response and prognostic factors for long-term survival in consecutive, single institution patients with locally advanced and", or metastatic transitional cell carcinoma following cisplatin-based chemotherapy, 2009, pp.48, 411~417
- Wallmeroth A, "Patterns of metastasis in muscle-invasive bladder cancer(pT2-4) : an autopsy study on 367 patients", Urol Int, 62, pp.69~75 (1999)
- Shinagare AB, "Metastatic pattern of bladder cancer : correlation with the characteristics of the primary tumor", AJR Am J Roentgenol, 196, pp.117~122 (2011)
- Melms JC, "Alpha-fetoprotein(AFP)as tumor marker in a patient with urothelial cancer with exceptional response to anti-PD-1 therapy and an escape lesion mimic", J Immunother Cancer, 6, pp.89~ (2018)
- El-Bahrawy M, "Alpha-fetoprotein-producing non-germ cell tumors of the urological system", Rev Urol, 13, pp.14~19 (2011)
- Klaile Y, "Variant histology in bladder cancer : how it should change the management in non-muscle invasive and muscle invasive disease?", Transl Androl Urol, 5, pp.692~701 (2016)
- Nigwekar P, "The many faces of urothelial carcinoma : an update with an emphasis on recently described variants", Adv Anat Pathol, 15, pp.218~233 (2008)
- Jayasinghe C, "Histopathological features predict metastatic potential in locally advanced colon carcinomas", BMC Cancer, 15, pp.14~ (2015)
- Matthews PN, "The clinicopathological features of metastatic superficial papillary bladder cancer", J Urol, 132, pp.904~906 (1984)