Prostatic Ductal Adenocarcinoma with Papillary Features in a Bladder Washing: A Possible Pitfall in Urinary Cytology – Report of One Case

2020 ◽  
Vol 64 (6) ◽  
pp. 607-611
Author(s):  
Jessica Barizzi ◽  
Stefania Freguia ◽  
Rossella Sarro ◽  
Giordano Venzi ◽  
Franco Fulciniti
Keyword(s):  
Urothelial Carcinoma ◽  
Prostatic Adenocarcinoma ◽  
Prostatic Urethra ◽  
Ductal Adenocarcinoma ◽  
Urinary Cytology ◽  
Low Grade ◽  
Cytologic Atypia ◽  
Low Degree ◽  
Cytology Report

In this article, we report on a case of combined, acinar and ductal prostatic adenocarcinoma affecting the prostatic urethra, which, due to a low degree of cytologic atypia and an exclusive papillary architecture with visible fibrovascular core, was erroneously diagnosed as a low-grade urothelial carcinoma based on its peculiar cytologic presentation in a bladder washing sample.

scholarly journals Interobserver reproducibility of The Paris System for Reporting Urinary Cytology

CytoJournal ◽  
2017 ◽  
Vol 14 ◽  
pp. 17 ◽  
Author(s):  
Theresa Long ◽  
Lester J. Layfield ◽  
Magda Esebua ◽  
Shellaine R. Frazier ◽  
D. Tamar Giorgadze ◽  
...  
Keyword(s):  
Urothelial Carcinoma ◽  
Urinary Cytology ◽  
Low Grade ◽  
High Grade ◽  
Urothelial Cells ◽  
Urothelial Carcinomas ◽  
Absolute Agreement ◽  
Potential Impact ◽  
Urine Specimens

Background: The Paris System for Reporting Urinary Cytology represents a significant improvement in classification of urinary specimens. The system acknowledges the difficulty in cytologically diagnosing low-grade urothelial carcinomas and has developed categories to deal with this issue. The system uses six categories: unsatisfactory, negative for high-grade urothelial carcinoma (NHGUC), atypical urothelial cells, suspicious for high-grade urothelial carcinoma, high-grade urothelial carcinoma, other malignancies and a seventh subcategory (low-grade urothelial neoplasm). Methods: Three hundred and fifty-seven urine specimens were independently reviewed by four cytopathologists unaware of the previous diagnoses. Each cytopathologist rendered a diagnosis according to the Paris System categories. Agreement was assessed using absolute agreement and weighted chance-corrected agreement (kappa). Disagreements were classified as low impact and high impact based on the potential impact of a misclassification on clinical management. Results: The average absolute agreement was 65% with an average expected agreement of 44%. The average chance-corrected agreement (kappa) was 0.32. Nine hundred and ninety-nine of 1902 comparisons between rater pairs were in agreement, but 12% of comparisons differed by two or more categories for the category NHGUC. Approximately 15% of the disagreements were classified as high clinical impact. Conclusions: Our findings indicated that the scheme recommended by the Paris System shows adequate precision for the category NHGUC, but the other categories demonstrated unacceptable interobserver variability. This low level of diagnostic precision may negatively impact the applicability of the Paris System for widespread clinical application.

scholarly journals A Diagnostic Nomogram of Pathologic Grade for Preoperative Risk Stratification in Upper Tract Urothelial Carcinoma

2020 ◽  
Vol 14 ◽  
pp. 117955492092766
Author(s):  
Runzhuo Ma ◽  
Haizhui Xia ◽  
Min Qiu ◽  
Liyuan Tao ◽  
Min Lu ◽  
...  
Keyword(s):  
Urothelial Carcinoma ◽  
Tumor Grade ◽  
Upper Tract Urothelial Carcinoma ◽  
Calibration Plot ◽  
Urinary Cytology ◽  
Low Grade ◽  
High Grade ◽  
Pathological Grade ◽  
Upper Tract ◽  
Better Than

Background: To develop a novel nomogram to improve the preoperative diagnosis of pathological grade of upper tract urothelial carcinoma (UTUC). Methods: Retrospective study was conducted with 245 patients with UTUC treated by radical nephroureterectomy from 2002 to 2016. Of the cohort, 57.6% received ureteroscopic (URS) biopsy and 35.9% received urine cytology examination. Preoperative clinical characteristics and examination results were collected. Final pathological grade was diagnosed by postoperative pathology. Univariable and multivariable binary logistic regressions were applied to establish a preoperative predictive model for tumor grade, and significant factors were included in the nomogram. The area under curve (AUC) was used to show the predictive efficacy, and the calibration plot was drawn for validation. Results: Of the 245 patients, 72.7% were diagnosed with pathological high-grade disease. Age (odds ratio [OR] = 1.03, P = .039), sessile (OR = 3.86, P = .021), positive urinary cytology (OR = 6.87, P = .035), and biopsy high-grade result (OR = 10.85, P < .001) were independent predictors for pathological high-grade disease. The predictive nomogram containing these factors achieved an AUC of 0.78, which was significantly better than URS biopsy alone (AUC = 0.62, P = .003) in the whole cohort. In the URS biopsy subgroup, the nomogram achieved an AUC of 0.79, better than biopsy alone (AUC = 0.76), but was not statistically significant ( P = .431). When the cutoff value of the nomogram was set at 0.64, the sensitivity of detecting a high-grade lesion versus low-grade lesion was 80.3%, better than that of URS biopsy alone (sensitivity = 65.7%). Conclusions: Advanced age, sessile, positive urinary cytology, and biopsy high-grade were independent predictors of pathological high-grade disease in patients with UTUC. A nomogram containing these factors can improve diagnostic accuracy, potentially reducing the risk of “undergrading” by URS biopsy.

scholarly journals Urinary Cytology in the Diagnosis of Bladder Cancer

2021 ◽  
pp. 1-5
Author(s):  
R. B. Nerli ◽  
R. B. Nerli ◽  
Shadab Rangrez ◽  
Saziya Bidi ◽  
Shridhar C. Ghagane ◽  
...  
Keyword(s):  
Bladder Cancer ◽  
Urinary Tract ◽  
Urothelial Carcinoma ◽  
Urinary Cytology ◽  
Specific Method ◽  
Low Grade ◽  
Medical Procedure ◽  
High Grade ◽  
Exfoliated Cells ◽  
Criteria For Diagnosis

The examination of urine is an ancient medical procedure dating back thousands of years. Microscopic examination of cells in the urine is being done since the invention of microscope. Presently the cytological examination of urine or other fluid samples from the urinary tract is a routine non-invasive diagnostic procedure to detect cancer of the urinary tract, especially in patients with painless haematuria. It is also used in the follow-up of patients previously treated for bladder cancer to detect recurrence or a new primary. It is a highly specific method for the diagnosis of invasive and in situ urothelial carcinoma and high-grade papillary carcinoma. However, it is unreliable for the detection of low-grade papillary neoplasms. Malignant cytomorphological characteristics of the exfoliated cells in urine or bladder washing can facilitate the diagnosis of bladder cancer. The Paris System (TPS) Working Group has proposed. The Paris System (TPS) authorities have proposed a standard reporting stem which includes specified diagnostic categories and cytomorphologic criteria for diagnosis of High-grade Urothelial Carcinoma (HGUC).

Value of p16INK4a in the diagnosis of low-grade urothelial carcinoma of the urinary bladder in urinary cytology

2012 ◽  
Vol 120 (4) ◽  
pp. 276-282 ◽  
Author(s):  
Francesc Alameda ◽  
Nuria Juanpere ◽  
Lara Pijuan ◽  
Belen Lloveras ◽  
Javier Gimeno ◽  
...  
Keyword(s):  
Urinary Bladder ◽  
Urothelial Carcinoma ◽  
Urinary Cytology ◽  
Low Grade

scholarly journals Expression of Semaphorin 3A in Malignant and Normal Bladder Tissue: Immunohistochemistry Staining and Morphometric Evaluation

Biology ◽  
2021 ◽  
Vol 10 (2) ◽  
pp. 109
Author(s):  
Ilan Bejar ◽  
Jacob Rubinstein ◽  
Jacob Bejar ◽  
Edmond Sabo ◽  
Hilla K Sheffer ◽  
...  
Keyword(s):  
Urothelial Carcinoma ◽  
Carcinoma In Situ ◽  
Urothelial Cancer ◽  
Basal Layer ◽  
Low Grade ◽  
High Grade ◽  
Bladder Tissue ◽  
Normal Bladder ◽  
Normal Bladder Tissue

Introduction: Our previous studies showed elevated levels of Semaphorin3a (Sema3A) in the urine of patients with urothelial cancer compared to healthy patients. The aim of this study was to analyze the extent of Sema3A expression in normal and malignant urothelial tissue using immune-staining microscopic and morphometric analysis. Materials and Methods: Fifty-seven paraffin-embedded bladder samples were retrieved from our pathology archive and analyzed: 14 samples of normal urothelium, 21 samples containing low-grade urothelial carcinoma, 13 samples of patients with high-grade urothelial carcinoma, 7 samples containing muscle invasive urothelial carcinoma, and 2 samples with pure urothelial carcinoma in situ. All samples were immunostained with anti Sema3A antibodies. The area of tissue stained with Sema3A and its intensity were analyzed using computerized morphometry and compared between the samples’ groups. Results: In normal bladder tissue, very light Sema3A staining was demonstrated on the mucosal basal layer and completely disappeared on the apical layer. In low-grade tumor samples, cells in the basal layer of the mucosa were also lightly stained with Sema3A, but Seama3A expression intensified upon moving apically, reaching its highest level on apical cells exfoliating to the urine. In high grade urothelial tumors, Seama3A staining was intense in the entire thickness of the mucosa. In samples containing carcinoma in situ, staining intensity was high and homogenous in all the neoplastic cells. Conclusions: Sema3A may be serve as a potential non-invasive marker of urothelial cancer.

scholarly journals Pancreatic Cancers with High Grade Tumor Budding Exhibit Hallmarks of Diminished Anti-Tumor Immunity

Cancers ◽  
2021 ◽  
Vol 13 (5) ◽  
pp. 1090
Author(s):  
Hassan Sadozai ◽  
Animesh Acharjee ◽  
Thomas Gruber ◽  
Beat Gloor ◽  
Eva Karamitopoulou
Keyword(s):  
Gene Expression ◽  
Pancreatic Cancer ◽  
Disease Progression ◽  
Immune Escape ◽  
Epithelial Mesenchymal Transition ◽  
Tumor Budding ◽  
Ductal Adenocarcinoma ◽  
Low Grade ◽  
High Grade ◽  
Mesenchymal Transition

Tumor budding is associated with epithelial-mesenchymal transition and diminished survival in a number of cancer types including pancreatic ductal adenocarcinoma (PDAC). In this study, we dissect the immune landscapes of patients with high grade versus low grade tumor budding to determine the features associated with immune escape and disease progression in pancreatic cancer. We performed immunohistochemistry-based quantification of tumor-infiltrating leukocytes and tumor bud assessment in a cohort of n = 111 PDAC patients in a tissue microarray (TMA) format. Patients were divided based on the ITBCC categories of tumor budding as Low Grade (LG: categories 1 and 2) and High Grade (HG: category 3). Tumor budding numbers and tumor budding grade demonstrated a significant association with diminished overall survival (OS). HG cases exhibit notably reduced densities of stromal (S) and intratumoral (IT) T cells. HG cases also display lower M1 macrophages (S) and increased M2 macrophages (IT). These findings were validated using gene expression data from TCGA. A published tumor budding gene signature demonstrated a significant association with diminished survival in PDAC patients in TCGA. Immune-related gene expression revealed an immunosuppressive TME in PDAC cases with high expression of the budding signature. Our findings highlight a number of immune features that permit an improved understanding of disease progression and EMT in pancreatic cancer.

scholarly journals Systematic Review of the Role of BCG in the Treatment of Urothelial Carcinoma of the Prostatic Urethra

2021 ◽  
pp. 1-8
Author(s):  
Oliver Patschan ◽  
Philippe E. Spiess ◽  
George N. Thalmann ◽  
Joan Palou Redorta ◽  
Georgios Gakis
Keyword(s):  
Side Effects ◽  
Urothelial Carcinoma ◽  
Evidence Synthesis ◽  
Tnm Classification ◽  
Transitional Cell ◽  
Prostatic Urethra ◽  
Local Response ◽  
Pubmed Database ◽  
Bcg Therapy ◽  
Tumor Stages

BACKGROUND: In patients with non-invasive urothelial carcinoma of the prostatic urethra (PUC), treatment with Bacillus Calmette-Guárin (BCG) could be beneficial. OBJECTIVE: To assess the response rates to BCG in the different tumor stages, to describe the clinical impact of transurethral resection of the prostate (TURP) before BCG treatment, and to review the side effects of BCG treatment for PUC. METHODS: A systematic search was conducted using the PubMed database to identify original studies between 1977 and 2019 reporting on PUC and BCG. RESULTS: Of a total of 865 studies, ten were considered for evidence synthesis. An indication for BCG treatment was found in non-stromal invasive stages (Tis pu, Tis pd) and in stromal infiltrating cases (T1) of primary and secondary PUC when transitional cell carcinoma was the histology of origin. Studies including patients treated with TURP before BCG showed a better local response in the prostatic urethra with a higher DFS (80–100% vs. 63–89%) and PFS (90–100% vs. 75–94%) than patients in studies in which no TURP was performed. However, this difference in recurrence and progression in the prostate neither affected the total PFS (57–75% vs. 58–93%), nor the disease specific survival (70–100% vs. 66–100%). CONCLUSIONS: The use of resection loop biopsies of the prostatic urethra in appropriate cases during the primary work-up for suspected PUC, as well as the use of the current TNM classification for PUC, need to be improved. BCG therapy for non-stromal invasive stages of PUC show a good local response. Local response is further improved by a TURP before BCG therapy, although the overall prognosis does not seem to be affected. Further evidence for BCG treatment in the rare cases of stromal invasive PUC is needed. Specific side effects of BCG treatment for PUC are not reported.

scholarly journals Prostatic Adenocarcinoma Diagnosed by Urinary Cytology

2000 ◽  
Vol 113 (1) ◽  
pp. 29-34 ◽  
Author(s):  
Bhuvaneswari Krishnan ◽  
Luan D. Truong
Keyword(s):  
Prostatic Adenocarcinoma ◽  
Urinary Cytology
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