Clinicopathologic analysis of upper urinary tract carcinoma with variant histology

• Published in: Virchows Archiv : an international journal of pathology Vol. 477; no. 1; pp. 111 - 120
• Main Authors: Rolim, Inês, Henriques, Vanessa, Rolim, Nídia, Blanca, Ana, Marques, Rita Canas, Volavšek, Metka, Carvalho, Inês, Montironi, Rodolfo, Cimadamore, Alessia, Raspollini, Maria R., Cheng, Liang, Lopez-Beltran, Antonio
• Format: Journal Article
• Language: English
• Published: Berlin/Heidelberg Springer Berlin Heidelberg 01.07.2020; Springer Nature B.V
• Subjects: Bladder cancer; Histology; Lipids; Medicine; Medicine & Public Health; Mismatch repair; Original Article; Pathology; Sarcoma; Stroma; Survival; Survival analysis; Urinary tract; Urogenital system; Urothelial carcinoma; Plasmacytoid; Sarcomatoid; MMR; Variant histology; Renal pelvis; Nested; Squamous; Micropapillary; Glandular; Divergent; Ureter; Urothelial carcinoma
• ISSN: 0945-6317; 1432-2307
• DOI: 10.1007/s00428-020-02745-4

We report on the clinicopathologic features of 115 cases of high-grade urothelial carcinoma of the upper urinary tract with variant histology present in 39 (34%). Variant histology was typically seen in high pathological stage (pT2-pT4) (82%, 32 cases) patients with lower survival rate (70%, 27 cases, median survival 31 months) and consisted in urothelial with one (23%), two (3%), and three or more variants (3%); 4% of cases presented with pure variant histology. Squamous divergent differentiation was the most common variant (7%) followed by sarcomatoid (6%) and glandular (4%), followed by 3% each of micropapillary, diffuse-plasmacytoid, inverted growth, clear cell glycogenic, or lipid-rich. The pseudo-angiosarcomatous variant is seen in 2%, and 1% each of nested, giant-cell, lymphoepithelioma-like, small-cell, trophoblastic, rhabdoid, microcystic, lymphoid-rich stroma, or myxoid stroma/chordoid completed the study series. Loss of mismatch repair protein expression was identified in one case of upper urinary tract carcinoma with inverted growth variant (3.6%). Variant histology was associated to pathological stage ( p  = 0.007) and survival status ( p  = 0.039). The univariate survival analysis identified variant histology as a feature of lower recurrence-free survival ( p  = 0.046). Our findings suggest that variant histology is a feature of aggressiveness in urothelial carcinoma of the upper urinary tract worth it to be reported.