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Micropapillary bladder cancer: a clinico-pathological characterization and treatment analysis

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Abstract

Purpose

Micropapillary bladder cancer (MPBC) is a very rare and aggressive variant of urothelial carcinoma (UC). The aim of this study was to investigate the clinico-pathological characteristics, treatment, and prognosis of MPBC to improve the understanding of this invasive disease.

Methods

We reviewed the records of 6 patients with MPBC who were evaluated and treated at our hospital between 2009 and 2015, and additionally reviewed 38 cases reported in the literature.

Results

In 44 cases, 36 cases (81.8%) were male and 8 cases (18.2%) were female, with a male:female ratio of 4.5:1; the median age of the patients was 68 years (range 45–91 years). A majority (81.8%) of patients with cT1 above or with lymph node and distant metastasis (cT2N0 in 18.2%, cT3-4N0 in 13.6%, cTanyN+ in 43.2%, and cTanyM+ in 6.8%). There was a high grade in 70.5% of patients. Lymphovascular invasion (LVI) was present in 61.4% of patients, and LVI in cT2 was more common than in cT1 (71.4 vs 22.2%). 52.3% of patients were treated with radical cystectomy (RC). After a mean follow-up of 16.2 months, 77.3% of patients developed distant metastases, and 47.7% of patients died of the disease. The mean overall survival (OS) was 28.9 months and the median OS was 20 months, and the amount of micropapillary (MPP) is correlated inversely with prognosis.

Conclusions

Micropapillary bladder cancer is a rare variant of UC associated with a poor prognosis, which often presents at an advanced stage with LVI and distant metastases. The optimal treatment strategy is early RC combined with chemotherapy.

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References

  1. Humphrey PA, Moch H, Cubilla AL, Ulbright TM, Reuter VE. The 2016 WHO classification of tumours of the urinary system and male genital organs—part B: prostate and bladder tumours. Eur Urol. 2016;70:106–19.

    Article  PubMed  Google Scholar 

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

    Article  PubMed  Google Scholar 

  3. Heudel P, Karak FE, Ismaili N, Droz JP, Flechon A. Micropapillary bladder cancer: a review of Léon Bérard Cancer Center experience. BMC Urol. 2009;9:1–5.

    Article  Google Scholar 

  4. McQuitty E, Ro JY, Truong LD, Shen SS, Zhai Q, Ayala AG. Lymphovascular invasion in micropapillary urothelial carcinoma a study of 22 cases. Arch Pathol Lab Med. 2012;136:635–9.

    Article  PubMed  Google Scholar 

  5. Hansel DE, Amin MB, Comperat E, Cote RJ, Knüchel R, Montironi R, et al. A contemporary update on pathology standards for bladder cancer: transurethral resection and radical cystectomy specimens. Eur Urol. 2013;63:321–32.

    Article  PubMed  Google Scholar 

  6. Lopez-Beltran A, Montironi R, Blanca A, Cheng L. Invasive micropapillary urothelial carcinoma of the bladder. Hum Pathol. 2010;41:1159–64.

    Article  PubMed  Google Scholar 

  7. Pons F, Orsola A, Morote J, Bellmunt J. Variant forms of bladder cancer: basic considerations on treatment approaches. Curr Oncol Rep. 2011;13:216–21.

    Article  PubMed  Google Scholar 

  8. Alkibay T, Sozen S, Gurocak S, Işik Gonul I, Poyraz A, Ure I. Micropapillary pattern in urothelial carcinoma: a clinicopathological analysis. Urol Int. 2009;83:300–5.

    Article  PubMed  Google Scholar 

  9. Amin MB. Histological variants of urothelial carcinoma: diagnostic, therapeutic and prognostic implications. Mod Pathol. 2009;22(suppl 2):96–118.

    Article  Google Scholar 

  10. Kamat AM, Dinney CPN, 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.

    Article  PubMed  Google Scholar 

  11. Wang J, Wang FW. The natural history, treatment pattern, and outcomes of patients with micropapillary bladder carcinom. Am J Clin Oncol. 2015;38:472–8.

    Article  PubMed  Google Scholar 

  12. Watts KE, Hansel DE. Emerging concepts in micropapillary urothelial carcinoma. Adv Anat Pathol. 2010;17:182–6.

    Article  PubMed  Google Scholar 

  13. Humphrey PA. Micropapillary urothelial carcinoma of the urinary tract. J Urol. 2011;186:1071–2.

    Article  PubMed  Google Scholar 

  14. Perepletchikov AM, Parwani AV. Micropapillary urothelial carcinoma: clinico-pathologic review. Pathol Res Pract. 2009;205:807–10.

    Article  PubMed  Google Scholar 

  15. Edgerton N, Sirintrapun SJ, Munoz M, Chen Z, Osunkoya AO. Micropapillary urothelial carcinoma of the urinary bladder: a clinicopathological analysis of 24 cases. Int J Urol. 2011;18:49–54.

    Article  PubMed  Google Scholar 

  16. Comperat E, Roupret M, Yaxley J, et al. Micropapillary urothelial carcinoma of the urinary bladder: a clinicopathological analysis of 72 cases. Pathology. 2010;42:650–4.

    Article  PubMed  Google Scholar 

  17. Guo CC, Dadhania V, Zhang L, Majewski T, Bondaruk J, Sykulski M, et al. Gene expression profile of the clinically aggressive micropapillary variant of bladder cancer. Eur Urol. 2016;3:1–10.

    CAS  Google Scholar 

  18. Ching CB, Amin MB, Tubbs RR, Elson P, Platt E, Dreicer R, et al. HER2 gene amplification occurs frequently in the micropapillary variant of urothelial carcinoma: analysis by dual-color in situ hybridization. Mod Pathol. 2011;24:1111–9.

    Article  CAS  PubMed  Google Scholar 

  19. Ishii S, Ohbu M, Toomine Y, Nishimura Y, Hattori M, Yokoyama M, et al. Immunohistochemical, molecular, and clinicopathological analyses of urothelial carcinoma, micropapillary variant. Pathol Int. 2011;61:723–30.

    Article  CAS  PubMed  Google Scholar 

  20. Paner GP, Annaiah C, Gulmann C, Rao P, Ro JY, Hansel DE, et al. Immunohistochemical evaluation of novel and traditional markers associated with urothelial differentiation in a spectrum of variants of urothelial carcinoma of the urinary bladder. Hum Pathol. 2014;45:1473–82.

    Article  CAS  PubMed  Google Scholar 

  21. Li WP, Liang Y, Deavers MT, Kamat AM, Matin SF, Dinney CP, et al. Uroplakin II is a more sensitive immunohistochemical marker than uroplakin III in urothelial carcinoma and its variants. Am J Clin Pathol. 2014;142:864–71.

    Article  PubMed  Google Scholar 

  22. Kamat AM, Gee JR, Dinney CPN, 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.

    Article  PubMed  Google Scholar 

  23. Willis DL, Fernandez MI, Dickstein RJ, Parikh S, Shah JB, Pisters LL, et al. Clinical outcomes of cT1 micropapillary bladder cancer. J Urol. 2015;193:1129–34.

    Article  PubMed  Google Scholar 

  24. Ghoneim IA, Miocinovic R, Stephenson AJ, Garcia JA, Gong MC, Campbell SC, et al. Neoadjuvant systemic therapy or early cystectomy? Single-center analysis of outcomes after therapy for patients with clinically localized micropapillary urothelial carcinoma of the bladder. J Urol. 2011;77:867–70.

    Article  Google Scholar 

  25. Suzuki K, Shimada T, Ebine T, Momma T. Local recurrence of micropapillary bladder tumor after radical cystectomy: successful treatment with radiation therapy: a case report. Hinyokika Kiyo. 2011;57:577–9.

    PubMed  Google Scholar 

  26. Fairey AS, Daneshmand S, Wang L, Schuckman A, Lieskovsky G, Djaladat H, et al. Impact of micropapillary urothelial carcinoma variant histology on survival after radical cystectomy. Urol Oncol. 2014;32:110–6.

    Article  PubMed  Google Scholar 

  27. Jackson BL, Mohammeda A, Mayer N, Dormer J, Griffiths TRL. Is immediate radical cystectomy necessary for all patients with non-muscle-invasive micropapillary bladder cancer? Urol Int. 2016;96:32–8.

    Article  CAS  PubMed  Google Scholar 

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Authors and Affiliations

  1. Department of Urology, SiChuan Cancer Hospital, Chengdu, China

    Z. Li, H. Liao, Z. Tan, D. Mao, Y. Wu, Y. M. Xiao, S. K. Yang & L. Zhong

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  1. Z. Li
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  2. H. Liao
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  3. Z. Tan
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  4. D. Mao
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  5. Y. Wu
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  6. Y. M. Xiao
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  7. S. K. Yang
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  8. L. Zhong
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Corresponding author

Correspondence to H. Liao.

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Conflict of interest

The authors declare no conflict of interest.

Ethical approval

The study was approved by the Ethics Committees of all hospitals.

Funding

No funding received for this study.

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Informed consent has been obtained from the patients.

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Cite this article

Li, Z., Liao, H., Tan, Z. et al. Micropapillary bladder cancer: a clinico-pathological characterization and treatment analysis. Clin Transl Oncol 19, 1217–1224 (2017). https://doi.org/10.1007/s12094-017-1658-6

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  • DOI: https://doi.org/10.1007/s12094-017-1658-6

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