Korean J Urol.  2007 Sep;48(9):910-914. 10.4111/kju.2007.48.9.910.

Clinical and Pathological Characteristics of Micropapillary Transitional Cell Carcinoma of the Bladder

• Sung HH
• Woo KJ
• Kwon GY
• Choi HY
• Lee HM

• KMID: 2061290
• DOI: http://doi.org/10.4111/kju.2007.48.9.910

Abstract

PURPOSE
Micropapillary bladder carcinoma is a rare variant of urothelial cancer. The clinical course is more aggressive than that of conventional urothelial cancer, but the optimal treatment for this malady has not been confirmed. There are few studies about micropapillary bladder cancer. So, we performed a clinico-pathololic review on 10 cases with micropapillary bladder cancer.
MATERIALS AND METHODS
Between December 1994 and May 2003, of the 1,170 cases that had undergone transurethral resection of bladder tumor (TURB), we reviewed the pathology of 440 patients who had stage T1 or T2 disease. Of these, we identified 10 patients(2.3%) with micropapillary bladder cancer, and then the medical records of these 10 patients were reviewed retrospectively.
RESULTS
At the initial diagnosis, the average age was 66 years old(range: 48-79) and the male-to-female ratio was 4:1. After initially performing TURB, the pathological stages were T1G2(1 case), T1G3(5 cases) and T2G3(4 cases), and the clinical stages were T1N0M0(5 cases), T2N0M0(2 cases), T3N0M0(1 case), T2N2M0(1 case) and T2N0M1(1 case). Before the initial diagnosis, 75.0%(6/8 cases) of the urine cytology revealed malignancy. There were 4 cases of carcinoma-in-situ(CIS, 40%) and 5 cases of lympho-vascular invasion(50%). p53 gene mutation was reported in 66.7% (4/6 cases). Three quarters of the patients(6/8 cases) needed more aggressive treatments such as radical cystectomy or chemotherapy, with the exception of 2 patients who were lost to follow-up.
CONCLUSIONS
At the initial diagnosis, the patients with micropapillary bladder cancer had a high stage and grade. These patients were highly associated with poor prognostic factors such as CIS, lympho-vascular invasion and p53 gene mutation. Three quarters of the patients needed more aggressive treatments, so they need to undergo active surveillance and treatment before progression.

Keyword

Bladder cancer; Micropapillary; Transitional cell

MeSH Terms

Carcinoma, Transitional Cell*
Cystectomy
Diagnosis
Drug Therapy
Genes, p53
Humans
Lost to Follow-Up
Medical Records
Pathology
Retrospective Studies
Urinary Bladder Neoplasms
Urinary Bladder*

Figure

• 

  Fig. 1. (A) Micropapillary transitional cell carcinoma of the bladder is characterized by a small papillary tuft. (B) Muscle invasive micro-papillary carcinoma is characterized by small tight nests.

Reference

References

1. Ministry of Health and Welfare. 2002 Annual Report of the Korea Central Cancer Registry. 2002.

2. Wein AJ, Kavoussi LR, Novick AC, Partin AC, Peters CA. Campbell-Walsh urology. 9th ed.Philadelphia: Saunders;2006. p. 2447–62.

3. Amin MB, Ro JY, el-Sharkawy T, Lee KM, Troncoso P, Silva EG, et al. Micropapillary variant of transitional cell carcinoma of the urinary bladder. Histologic pattern resembling ovarian papillary serous carcinoma. Am J Surg Pathol. 1994; 18:1224–32.

4. Kamat AM, Gee JR, Dinney CP, Grossman HB, Swanson DA, Millikan RE, et al. The case for early cystectomy in the treatment of nonmuscle invasive micropapillary bladder carcinoma. J Urol. 2006; 175:881–5.

5. Kim YS, Kwag DH, Kim JS, Park CS, Oh KH, Lee KM. A case of micropapillary transitional cell carcinoma of the urinary bladder. Korean J Urol. 1999; 40:250–1.

6. Johansson SL, Borghede G, Holmang S. Micropapillary bladder carcinoma: a clinicopathological study of 20 cases. J Urol. 1999; 161:1798–802.

7. Maranchie JK, Bouyounes BT, Zhang PL, O'Donnell MA, Summerhayes IC, DeWolf WC. Clinical and pathological characteristics of micropapillary transitional cell carcinoma: a highly aggressive variant. J Urol. 2000; 163:748–51.

8. Amin MB, Tamboli P, Merchant SH, Ordonez NG, Ro J, Ayala AG, et al. Micropapillary component in lung adenocarcinoma: a distinctive histologic feature with possible prognostic significance. Am J Surg Pathol. 2002; 26:358–64.

9. Luna-More S, de los Santos F, Breton JJ, Canadas MA. Estrogen and progesterone receptors, c-erbB-2, p53, and Bcl-2 in thirty-three invasive micropapillary breast carcinomas. Pathol Res Pract. 1996; 192:27–32.

10. Walsh MM, Bleiweiss IJ. Invasive micropapillary carcinoma of the breast: eighty cases of an underrecognized entity. Hum Pathol. 2001; 32:583–9.

11. Middleton LP, Tressera F, Sobel ME, Bryant BR, Alburquerque A, Grases P, et al. Infiltrating micropapillary carcinoma of the breast. Mod Pathol. 1999; 12:499–504.

12. Siriaunkgul S, Tavassoli FA. Invasive micropapillary carcinoma of the breast. Mod Pathol. 1993; 6:660–2.

13. De La Cruz C, Moriya T, Endoh M, Watanabe M, Takeyama J, Yang M, et al. Invasive micropapillary carcinoma of the breast: clinicopathological and immunohistochemical study. Pathol Int. 2004; 54:90–6.

14. Pettinato G, Manivel CJ, Panico L, Sparano L, Petrella G. Invasive micropapillary carcinoma of the breast: clinicopathologic study of 62 cases of a poorly recognized variant with highly aggressive behavior. Am J Clin Pathol. 2004; 121:857–66.

15. Luna-More S, Casquero S, Perez-Mellado A, Rius F, Weill B, Gornemann I. Importance of estrogen receptors for the behavior of invasive micropapillary carcinoma of the breast. Review of 68 cases with follow-up of 54. Pathol Res Pract. 2000; 196:35–9.

16. Peterson JL. Breast carcinomas with an unexpected inside-out growth pattern. Rotation of polarization associated with angioinvasion. Pathol Res Pract. 1993; 189:780A.

17. Alvarado-Cabrero I, Sierra-Santiesteban FI, Mantilla-Morales A, Hernandez-Hernandez DM. Micropapillary carcinoma of the urothelial tract. A clinicopathologic study of 38 cases. Ann Diagn Pathol. 2005; 9:1–5.

18. Samaratunga H, Khoo K. Micropapillary variant of urothelial carcinoma of the urinary bladder: a clinicopathological and immunohistochemical study. Histopathology. 2004; 45:55–64.