Trophoblastic differentiation (including choriocarcinoma) arising in urothelial carcinoma has been described in numerous case reports, but never in a single series. We present a series of these tumors, describing the morphologic spectrum, applying traditional and novel immunohistochemical stains, and characterizing clinical follow-up. We identified 16 cases, arising predominantly in the bladder (N=14), but also the ureter (N=1) and prostatic urethra (N=1). Six of our cases (38%) contained invasive urothelial carcinoma with admixed syncytiotrophoblasts, 8 cases (50%) consisted of invasive urothelial carcinoma with choriocarcinoma, 1 case (6%) showed urothelial carcinoma in situ with associated choriocarcinoma, and 1 case (6%) consisted of pure choriocarcinoma. Other subtypes of variant morphology were seen in 5 of our cases (31%) and included squamous, glandular, lipoid, chordoid/myxoid, and sarcomatoid features. Given the limited specificity of human chorionic gonadotropin immunohistochemistry, we also studied the expression of a novel specific trophoblastic marker, hydroxyl-δ-5-steroid dehydrogenase, as well as Sal-like protein 4. Human chorionic gonadotropin expression was seen in nearly all cases (93%) but was often not limited to the trophoblastic component, staining the urothelial component also in 85% of the cases. Expression of hydroxyl-δ-5-steroid dehydrogenase was more sensitive and more specific, staining 100% of the cases and limited to trophoblasts in all but 1 case. Sal-like protein 4 expression was variable, staining trophoblast in only 50% of cases and staining the urothelial carcinoma component in 43% of those positive cases. Most of our tumors presented at a high stage and were associated with poor clinical outcomes, with at least muscle-invasive disease (pT2) in 10 of the 14 bladder tumors (71%), periureteric fat invasion in the ureter tumor (pT3), distant metastases in 7 of 16 cases (44%) and death of disease in 3 of the 15 patients with follow-up (20%). Our study describes a series of urothelial carcinomas with trophoblastic differentiation, demonstrating the morphologic spectrum of this entity, its frequent association with other subtypes of variant morphology, its characteristic immunoprofile, and its aggressive clinical behavior.

The International Consultations on Urological Diseases are international consensus meetings, supported by the World Health Organization and the Union Internationale Contre le Cancer, which have occurred since 1981. Each consultation has the goal of convening experts to review data and provide evidence-based recommendations to improve practice. In 2012, the selected subject was bladder cancer, a disease which remains a major public health problem with little improvement in many years. The proceedings of the 2nd International Consultation on Bladder Cancer, which included a 'Pathology of Bladder Cancer Work Group,' have recently been published; herein, we provide a summary of developments and consensus relevant to the practicing pathologist. Although the published proceedings have tackled a comprehensive set of issues regarding the pathology of bladder cancer, this update summarizes the recommendations regarding selected issues for the practicing pathologist. These include guidelines for classification and grading of urothelial neoplasia, with particular emphasis on the approach to inverted lesions, the handling of incipient papillary lesions frequently seen during surveillance of bladder cancer patients, descriptions of newer variants, and terminology for urine cytology reporting.

Currently there is no global agreement as to how extensively a radical prostatectomy specimen should be sectioned and histologically examined. We analyzed the ability of different methods of partial sampling in detecting positive margin (PM) and extraprostatic extension (EPE)-2 pathologic features of prostate cancer that are most easily missed by partial sampling of the prostate. Radical prostatectomy specimens from 617 patients treated with open radical prostatectomy between 1992 and 2011 were analyzed. Examination of the entirely submitted prostate detected only PM in 370 (60%), only EPE in 100 (16%), and both in 147 (24%) specimens. We determined whether these pathologic features would have been diagnosed had the examination of the specimen been limited only to alternate sections (method 1), alternate sections representing the posterior aspect of the gland in addition to one of the mid-anterior aspects (method 2), and every section representing the posterior aspect of the gland in addition to one of the mid-anterior aspects, supplemented by the remaining ipsilateral anterior sections if a sizeable tumor is seen (method 3). Methods 1 and 2 missed 13% and 21% of PMs and 28% and 47% of EPEs, respectively. Method 3 demonstrated better results missing only 5% of PMs and 7% of EPEs. Partial sampling techniques missed slightly more PMs and EPEs in patients with low-risk to intermediate-risk prostate cancer, although even in high-risk cases none of the methods detected all of the studied aggressive pathologic features.

Silicone lymphadenopathy is a recognized complication of silicone gel implant rupture; the ipsilateral axillary lymph nodes are most commonly involved. We report imaging findings on a range of different imaging modalities and biopsy results in a case of biopsy-proven silicone lymphadenitis involving contralateral intramammary and axillary lymph nodes in a patient with an intact standard dual-lumen breast implant in the opposite reconstructed breast. This case demonstrates that in a patient with disrupted lymph drainage due to prior mastectomy and axillary node dissection for breast cancer treatment, silicone particles can migrate in a retrograde fashion via the ipsilateral internal mammary lymph nodes and reach not only the contralateral axilla but also the outer quadrants of the contralateral breast, even in the presence of an intact breast implant.

Context: Pathology standards for the diagnosis of bladder cancer (BCa) have recently evolved to better reflect patient diagnosis and clinical outcomes.Objective: To update pathology reporting standards for BCa.Evidence acquisition: We searched the international medical literature and reviewed all articles that addressed BCa gross dissection, pathologic diagnosis, staging, and reporting as of June 6, 2012. We also reviewed the proceedings from the recent Second International Consultation on Bladder Cancer (Vienna, Austria). The literature selected for review focuses on evidence-based studies that address histopathologic factors in BCa, with emphasis placed on factors that influence patient diagnosis and clinical outcomes.Evidence synthesis: We separated data into three main components for analysis based on the type of specimen obtained: (1) transurethral resection specimens, with an emphasis on pathologic staging, variants of urothelial carcinoma, angiolymphatic invasion, and relevant ancillary techniques such as immunohistochemistry in assessing these features; (2) cystectomy specimens, with an emphasis on pT0 disease, prostatic involvement by urothelial carcinoma and lymph node dissection and analysis; and (3) cytology correlates, with recommendations for the use of cytology paired with tissue-based sampling. Areas of controversy are described and recommendations based on existing guidelines are provided. The value of a multidisciplinary team is highlighted.Conclusions: Ongoing international collaborations amongst pathologists have led to emerging standards in the reporting and microscopic diagnosis of BCa specimens. Although some areas remain controversial, we present the most up-to-date data and guidelines relevant to neoplastic pathology of the urinary bladder. (C) 2012 European Association of Urology. Published by Elsevier B. V. All rights reserved.

BACKGROUND:The distinction between renal cell carcinoma conventional (clear cell) type with eosinophilic morphology (ccRCC), chromophobe renal cell carcinoma eosinophilic variant (chRCC), and renal oncocytoma (RO) is a common diagnostic dilemma. We aimed to identify an immunohistochemical panel to discriminate ccRCC from its morphologic mimics.MATERIALS AND METHODS:Fifty-three renal neoplasms (19 ccRCC, 18 chRCC, and 16 RO) were selected. Immunohistochemical stains for CD10, cytokeratin 7 (CK7), c-Kit, E-cadherin, N-cadherin, kidney-specific cadherin (Ksp-cadherin), and Recepteur d'origine nantais (RON) were performed.RESULTS:Ten (53%) of 19 ccRCC were positive for CD10, 11 (58%) for E-cadherin, 8 (42%) for N-cadherin, 5 (26%) for Ksp-cadherin, 9 (47%) for RON, 6 (32%) for CK7, and 5 (26%) for c-Kit. In chRCC/RO group, 5 of 34 (15%) were positive for CD10, 32 (94%) for E-cadherin, 2 (6%) for N-cadherin, 1 (3%) for Ksp-cadherin, 22 (65%) for RON, 14 (41%) for CK7, and 25 (25/32, 76%) for c-kit. Univariately, negative c-Kit [odds ratio (OR)=8.75, P=0.001, area under the receiver operating characteristic curve (AUC)=0.747], negative E-cadherin (OR=11.64, P=0.005, AUC=0.681), positive N-cadherin (OR=11.64, P=0.005, AUC=0.681), positive Ksp-cadherin (OR=11.79, P=0.031, AUC=0.617), and positive CD10 (OR=6.44, P=0.005, AUC=0.690) detects ccRCC versus chRCC/RO. Multivariate analysis showed significant association between CD10 positivity and ccRCC (OR=16.90, P=0.007) and between RON negativity and ccRCC (OR=7.17, P=0.047) when CK7 is negative.CONCLUSIONS:The best single predictors for ccRCC are negative c-Kit, negative E-cadherin, positive N-cadherin, positive Ksp-cadherin, and positive CD10. However, considering the studied markers, a combination of positive CD10 and negative CK7 and RON is considered the best immunohistochemical panel in distinguishing ccRCC from chRCC/RO.

You have accessJournal of UrologyProstate Cancer: Staging II1 Apr 2012366 IS PARTIAL SAMPLING OF A RADICAL PROSTATECTOMY SPECIMENS ASSOCIATED WITH MISSING OF POSITIVE MARGINS OR EXTRAPROSTATIC EXTENSIONS? Viacheslav Iremashvili, Soum Lokeshwar, Merce Jorda, Murugesan Manoharan, Saleem A. Umar, and Mark S. Soloway Viacheslav IremashviliViacheslav Iremashvili Miami, FL More articles by this author , Soum LokeshwarSoum Lokeshwar Miami, FL More articles by this author , Merce JordaMerce Jorda Miami, FL More articles by this author , Murugesan ManoharanMurugesan Manoharan Miami, FL More articles by this author , Saleem A. UmarSaleem A. Umar Miami, FL More articles by this author , and Mark S. SolowayMark S. Soloway Miami, FL More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2012.02.428AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES The pathologic stage and surgical margin status of a radical prostatectomy (RP) specimen may directly impact subsequent patient management. The aim of our study was to determine if different methods of partial sampling affect the accuracy of detection of positive margins (PMs) and/or extraprostatic extensions (EPEs). METHODS Between January 1992 and May 2011 1,975 patients underwent open RP performed by one surgeon. We identified 808 cases that had either PM or EPE or both. In all cases a 2 mm apical margin was obtained from the most distal part of the prostate. The gland was than step-sectioned at 3-4-mm intervals in transverse planes into separate blocks according to the Stanford protocol. 697 of our cases had a diagram describing the outline of cancer areas as well as location of PM and EPE in each of the blocks. Using these diagrams we analyzed the potential outcomes of four published methods of partial sampling (Table 1). The rates of PM § and EPEs that could have been identified using each of these techniques were compared to the actual rates obtained by entire sampling. Table 1. Studied methods of partial prostate sampling No. Description Publication 1 Three “representative” sections including apical, mid and basal parts of the gland Samaratunga H, et al. Mod Pathol. 2011; 24: 6-15. 2 Alternate sections Cohen MB, et al. Am J Clin Pathol. 1994; 101: 250-2. 3 Alternate sections representing the posterior aspect of the gland in addition to one of the mid-anterior Salem S, et al. J Urol. 2010; 184: 1334-40. 4 Every section representing the posterior aspect of the gland in addition to one of the mid-anterior, supplemented by additional sections based on tumor size Sehdev AES, et al. Hum Pathol. 2001; 32: 494-9. RESULTS Of 697 RP specimens, only PMwas identified in 387 (56%) cases, only EPE in 136 (20%), and both were identified in 174 (25%). All alternative sampling methods missed a significant number of PM § and/or EPEs (p<0.001 (McNemar test) for all pairs of comparison), however the numbers of missed cases varied considerably (Figure 1) among the studied techniques. The lowest rates were noted for method 4, which would have missed only 6% of PM § and 7% of EPEs. CONCLUSIONS Most methods of partial sampling miss considerable proportion of PM § and/or EPEs. The latter was particularly dependent on the sampling technique. The only method which missed less than 10% of PM §/EPEs found on entire sampling was the technique described by Sedhev et al. © 2012 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 187Issue 4SApril 2012Page: e150 Peer Review Report Advertisement Copyright & Permissions© 2012 by American Urological Association Education and Research, Inc.MetricsAuthor Information Viacheslav Iremashvili Miami, FL More articles by this author Soum Lokeshwar Miami, FL More articles by this author Merce Jorda Miami, FL More articles by this author Murugesan Manoharan Miami, FL More articles by this author Saleem A. Umar Miami, FL More articles by this author Mark S. Soloway Miami, FL More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...