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LETTER TO EDITOR Table of Contents   
Year : 2008  |  Volume : 51  |  Issue : 2  |  Page : 308
Micropapillary carcinoma of urinary bladder


1 Department of Pathology, TN Medical College and BYL Nair Charitable Hospital, Mumbai Central, Mumbai - 400 008, India
2 Department of Urology, TN Medical College and BYL Nair Charitable Hospital, Mumbai Central, Mumbai - 400 008, India

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How to cite this article:
Shah VB, Rupani AB, Pathak HR. Micropapillary carcinoma of urinary bladder. Indian J Pathol Microbiol 2008;51:308

How to cite this URL:
Shah VB, Rupani AB, Pathak HR. Micropapillary carcinoma of urinary bladder. Indian J Pathol Microbiol [serial online] 2008 [cited 2019 Oct 20];51:308. Available from: http://www.ijpmonline.org/text.asp?2008/51/2/308/41705


Sir,

The histopathological spectrum of urothelial carcinoma of urinary bladder is broad with several variants which may cause diagnostic difficulties. It is important to recognize these variants as they have prognostic significance. [1],[2] Micropapillary variant of urothelial carcinoma of urinary bladder is a rare, distinctive entity recently described with aggressive clinical course and very few cases described in the western literature so far. [2],[3] Hence we report, probably the first case of micropapillary carcinoma of urinary bladder from India.

A 60-year-old male patient presented with painless hematuria on and off since one year. Cystoscopy revealed a solid growth overlying the left postero-lateral wall. An excisional biopsy was performed followed by radical cystectomy. Intraoperatively, there were large fixed nodes along the iliac vessels. Grossly, on opening the urinary bladder specimen, there was no evident surface growth; however, the posterior wall showed diffuse thickening. The biopsy as well as the cystectomy, on histopathology showed a tumor composed of tight clusters of cells with clear space around them and thin fibrovascular septae along with numerous lymphovascular emboli. Nuclei showed high degree of pleomorphism [Figure 1]. No areas of conventional urothelial carcinoma were noted. The surrounding bladder mucosa was unremarkable. The tumor infiltrated the muscularis propria along with right seminal vesicles and the right external iliac node. The tumor was staged at T 4a, N2, M0. The patient was not given postsurgery chemotherapy or radiotherapy and is fine now with 5 months of follow-up.

Amin and colleagues reported micropapillary variant of urothelial carcinoma of the urinary bladder in a series of 18 cases in 1994 for the first time. [3] It presents in fifth to ninth decade of life with hematuria and in advanced stage of the disease as in our case. [1],[2],[3],[4] The clear spaces as noted in our case are not true lymphovascular spaces as they do not have any lining and do not contain red blood cells. [3] This variant usually shows areas of conventional urothelial carcinoma which was not seen in our case as also noted by Johansson et al. , in 2 out of their 20 cases. [3],[4] Even focal presence of this pattern in urothelial carcinoma should be labelled as micropapillary carcinoma as it indicates poor prognosis. There are studies, where extent of the micropapillary pattern present was correlated with the prognosis and it was found that cases with extensive micropapillary pattern presented in higher stages and behaved worst. [4],[5] The differential diagnosis of micropapillary urothelial carcinoma includes metastatic micropapillary adenocarcinoma of lung, breast and ovary which must be ruled out before making a definite diagnosis. [2] Also it is important to be aware of this variant as in dealing with metastasis from unknown primary. Diagnosis of this variant is not difficult because of its unique morphology and therefore does not require immunohistochemistry for diagnosis.

If micropapillary pattern in seen in the biopsy specimen without muscularis propria, then a deeper biopsy should be advised as a very high incidence of muscularis propria invasion is reported with this tumor. [3] Because of low number of successfully diagnosed cases, optimal treatment has not been clarified. [2] Radical cystectomy is done in light of minimal success with chemotherapy or radiation therapy alone. The 5- and 10-year survival has been reported as 51% and 24%, respectively. [1] To conclude, it is important to recognize this pattern as it is associated with high propensity for lymphovascular invasion, lymphnode metastasis and poor clinical outcome as compared to conventional urothelial carcinoma

 
   References Top

1.Kamat AM, Dinney CP, Gee JR, Grossman HB, Siefker-Radtke AO, Tamboli P, et al. Micropapillary bladder cancer: A review of the University of Texas MD Anderson Cancer Center experience with 100 consecutive patients. Cancer 2007;110:62-7.  Back to cited text no. 1  [PUBMED]  [FULLTEXT]
2.Qihui JZ, Jennifer B, Alberto GA, Jae YR. Histologic variants of infiltrating urothelial carcinoma. Arch Pathol Lab Med 2007;131:1244-56.  Back to cited text no. 2    
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.  Back to cited text no. 3  [PUBMED]  
4.Johansson SL, Borghede G, Holmang S. Micropapillary bladder carcinoma: A clinicopathological study of 20 cases. J Urol 1999;161:1798-802.  Back to cited text no. 4    
5.Samaratunga H, Khoo K. Micropapillary variant of urothelial carcinoma of the urinary bladder: A clinicopathological and immunohistochemical study. Histopathology 2004;45:55- 64.  Back to cited text no. 5  [PUBMED]  [FULLTEXT]

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Correspondence Address:
Vinaya B Shah
Flat No: 38, Bldg 2, Govt Quarters, Next to Race Course, K. K. Marg, Haji-Ali, Mumbai - 400 034
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0377-4929.41705

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