Stromal lymphoid response status in micropapillary urothelial carcinomas diagnosed in bladder transurethral resections and its comparison with conventional urothelial carcinomas

Objective: Micropapillary urothelial carcinoma is an aggressive variant of urothelial carcinoma. Evidence suggests that the relationship between the tumor and inflammatory cells is important in tumor progression and the treatment response. We evaluated the stromal lymphoid response in micropapillary urothelial carcinomas and compared it with conventional urothelial carcinomas. Material and Method: Among bladder transurethral resection materials diagnosed as 'invasive urothelial carcinoma' between January 2010-March 2017, cases with at least 5% micropapillary urothdial carcinoma were evaluated for age, gender, grade, stage, micropapillary urothelial carcinoma percentage, presence/percentage of accompanying conventional urothelial carcinoma/urothelial carcinoma variants, in situ urothelial carcinoma/micropapillary urothelial carcinoma, lymphovascular invasion, necrosis, and stromal lymphoid response. Stromal lymphoid response was scored as 0-1-2-3. All parameters were evaluated in 50 pure conventional urothelial carcinomas. Results: Among 47 micropapillary urothelial carcinomas, 41 were male. The mean age was 69 years. pT1/pT2 was 23/24. Six cases were pure MPUC. Lymphovascular invasion was present in 8, necrosis in 9 cases. Stromal lymphoid response was present and scored as 1-2-3 in 32 micropapillary urothelial carcinomas (68.1%) and 48 conventional urothelial carcinomas (96%). Micropapillary urothelial carcinomas had significantly higher lymphovascular invasion and pT2 rates and lower stromal lymphoid response. Conclusion: Low stromal lymphoid response in micropapillary urothelial carcinomas can be responsible for the poor clinical outcome and impaired response to treatment of these tumors. This is the first study in the English literature to demonstrate a lower stromal lymphoid response rate in micropapillary urothelial carcinomas compared to conventional urothelial carcinomas

A synchronous occurrence of urothelial carcinoma with abundant myxoid stroma and inverted papilloma of the urinary bladder

Abundant myxoid stroma rarely occurs in urothelial carcinomas, and may cause diagnostic challenges when cells with eosinophilic cytoplasm forming nests and cords in a myxoid background are seen, particularly in the absence of typical carcinomatous appearance. Microscopic examination of transurethral resection specimen of a 71-year-old male patient revealed non-cohesive oval or elongated tumor cells with eosinophilic cytoplasm arranged in cord-like filigree pattern in an abundant myxoid stroma. Immunohisto chemically the tumor was positive for cytokeratin 7, cytokeratin 20, and 34BE12. About 90 to 100% nuclear staining was observed with p63, p53, and Ki-67. A second neoplasm with a flat overlying urothelial epithelium and a complete inverted cellular growth pattern was also noted. The neoplasm exhibited less than 2% and 10% nuclear staining with Ki-67 and p53, respectively. Considering histological, histochemical, and immunohistochemical findings, a diagnosis of synchronous urothelial carcinoma with abundant myxoid stroma and inverted papilloma was made

Inverted (hobnail) high-grade prostatic intraepithelial neoplasia and invasive inverted pattern

High-grade prostatic intraepithelial neoplasia (HGPIN) is considered to be an important precursor for prostatic adenocarcinoma. The present study aimed to investigate the histological features of the uncommon inverted (hobnail) pattern of HGPIN in transrectal ultrasonographic (TRUS) prostatic needle biopsies from 13 cases. These 13 diagnosed cases of inverted HGPIN were identified out of a total of 2,034 TRUS biopsies (0.63%), obtained from patients suspected to have prostate cancer. The hobnail pattern is comprised of secretory cell nuclei, which are histologically localized at the luminal surface of the prostate gland, rather than the periphery, and exhibit reverse polarity. Histological examinations were performed and the results demonstrated that 5 of the 13 cases exhibited pure inverted histology, while HGPIN was observed to be histologically associated with other patterns in the remaining 8 patients. In addition, an association with adenocarcinoma was identified in 7 of the 13 cases. All 7 carcinomas accompanied by inverted HGPIN were conventional acinar adenocarcinoma cases; of note, for these 7 cases, the Gleason score was 7 for each. One acinar adenocarcinoma case accompanying inverted HGPIN demonstrated hobnail characteristics in large areas of the invasive component. It was observed that nuclei were proliferated in the invasive cribriform glands, which was comparable to that of inverted HGPIN, and were located on the cytoplasmic luminal surface; a similar morphology was also observed in individual glands. In conclusion, the results of the present study suggested that the hobnail HGPIN pattern may be of diagnostic importance due to its high association with adenocarcinoma and the high Gleason scores in the accompanying carcinomas

The Histomorphogenetic Relationship between Melanocytes and Langerhans Cells in Ovarian Mature Cystic Teratomas

Amaç: Biz bu çalışmada; hücre birimleri, organizasyon ve arşitektürel yapılanmalar bakımından orijinaline yakın sayılabilecek genel anlamda bir vücut yapımı gösteren matür kistik teratomlarda epidermisteki melanositler ve Langerhans hücrelerinin varlığı, birbiri ile sayısal ilişkileri ve birlikte bulunmaları halinde embriyolojik kaynakları hakkında fikir yürütebilmeyi amaçladık. Yöntemler: Sağlık Bakanlığı İstanbul Eğitim ve Araştırma Hastanesi Patoloji Bölümü'nde 2006-2009 yılları arasında rapor edilen 45 matür kistik teratom olgusu çalışmaya alındı. İmmünohistokimyasal olarak; melanositler için Human Melanoma Black-45 (HMB-45) ve Melanoma Antigens (Melan-A) recognized by T cells-1), Langerhans hücreleri için Cluster of Differentiation 1a (CD1a) ve Langerin uygulandı. Bulgular: Langerhans hücreleri olguların %100'ünde tespit edilmekle birlikte, melanositler %88,2'sinde mevcuttu. Sonuç: Bizim çalışmamıza göre Langerhans hücrelerinin, melanositlerin köken aldığı bilinen nöral krest dışında bir kaynaktan gelişmiş olabileceği ve bu iki hücre arasında ilişki olamayabileceği sonucuna vardık.Objective: The purpose of this study was to form a view about the existence, numerical relationship and embryological origin of melanocytes and Langerhans cells when they are found together in mature cystic teratomas which have similar cell types and architectural structure to the original vertebrated body. Methods: Forty five mature cystic teratomas cases, diagnosed in the Ministry of Health İstanbul Education and Research Hospital Pathology Department between 2006-2009 were included in the study. Immunohistochemically, Human Melanoma Black-45 (HMB-45) and Melanoma Antigens (Melan-A) recognized by T cells-1) for melanocytes, Cluster of Differentiation 1a (CD1a) and Langerin for Langerhans cells were applied. Results: Although Langerhans cells were detected in 100%, melanocytes were established in 88.2% of cases. Conclusion: According to our study, Langerhans cells could derive from another source except the neural crest where melanocytes evolve and there is no relationship between them

Giant cell tumor-like lesion of the urinary bladder: a report of two cases and literature review; giant cell tumor or undifferentiated carcinoma?

<p>Summary</p> <p>Giant cell tumor, excluding its prototype in bone, is usually a benign but local aggressive neoplasm originating from tendon sheath or soft tissue. Malignant behavior is uncommon. Visceral organ involvement including urinary bladder is rare. Giant cell tumors in visceral organs usually accompany epithelial tumors and the clinical behavior of giant cell tumor in urinary bladder is similar to its bone counterpart. Here, we report two cases of giant cell tumor located in urinary bladder in comparison with nine reported cases in the English literature. Concurrent noninvasive urothelial carcinoma was also described in all these previous reports and only one patient with follow-up died of disease. One of the two cases we present had no concurrent urothelial tumor at the time of diagnosis but had a history of a low grade noninvasive urothelial carcinoma with three recurrences. The histology of these two cases was similar to the giant cell tumor of bone and composed of oval to spindle mononuclear cells with evenly spaced osteoclast-like giant cells. Immunohistochemically, the giant cells showed staining with osteoclastic markers including CD68, TRAP, and LCA. Immunohistochemical expression of vimentin, CD68, LCA, and smooth muscle actin in mononuclear cells supported a mesenchymal origin with histiocytic lineage. The histologic and immunohistochemical properties in our cases as well as their clinical courses were consistent with a giant cell tumor. Consequently, tumors in urinary bladder showing features of giant cell tumor of bone may also be considered and termed "giant cell tumor".</p

Primary Clear Cell Renal Cell Carcinoma with Marked Intraluminal Mucin Secretion

Clear cell renal cell carcinoma with mucin secretion is an unexpected situation. Primary renal adenocarcinoma and various metastatic carcinomas should be considered in the differential diagnosis. Prognostic significance is not yet fully known due to the limited number of reported cases, and these lesions have been grouped under unclassified renal cell carcinoma. In our study, clear cell renal cell carcinoma with significant luminal mucin secretion is discussed with its histological, histochemical and immunohistochemical features

Histopathological Evaluation of Patients with Bladder Urothelial Carcinoma Diagnosed in Our Clinic

Amaç: Çalışmamızda mesanenin en sık görülen kanserleri olan ürotelyal karsinomların (ÜK) yaş, evre, derece ve cinsiyete göre dağılımları ile ÜK'larda varyantların evre ve cinsiyete göre izlenme oranları araştırılmıştır. Yöntemler: Patoloji kliniğimizde 2010-2015 yılları arasında tanı alan ÜK olguları elektronik veri tabanından tarandı. Her bir olgu Dünya Sağlık Örgütü (DSÖ) 2004 sınıflaması dikkate alınarak tekrar incelenmiş; olgular derece, evre ve eşlik eden ÜK varyantları açısından taranmış ve bu verilere ek olarak cinsiyet ve yaş bilgileri elektronik veri tabanından elde edilmiştir. Bulgular: 2010-2015 yılları arasında bölümüzde ÜK tanısı almış 1081 hastaya ait 1355 biyopsi materyalinden çoğunluğunu nüks olguların oluşturduğu 676 olgu çalışma dışı bırakılarak toplamda 679 olgu çalışmaya dâhil edilmiştir. DSÖ 2004 ÜK sınıflaması ve ingilizce yazılı literatürde yeni tanımlanmış varyantlar açısından mesane ÜK olguları tarandığında 153 olguda (%22,5) biyopsi alanının en az %10 kadarını oluşturan ÜK varyantı tespit edilmiştir. Çalışmamızda skuamöz, glanduler ve küçük hücreli, mikropapiller, sarkomatoid, lenfoepitelyoma benzeri, nested, büyük nested, büyük hücreli nöroendokrin, plazmasitoid, pleomorfik, trofoblastik, rabdoid, kordoid ve andiferansiye olmak üzere 15 farklı ÜK varyantı saptanmıştır. Sonuç: Çalışmamız ülkemizde bugüne kadar yapılmış en geniş ürotelyal karsinom olgu serisi olduğu için cinsiyet, tanı alma yaşı, evre ve histolojik varyantların bulunma oranlarını içeren verilerin anlamlı olduğunu düşünüyoruz.Objective: In our study, the age and gender of patients and the stage and grade of conventional bladder urothelial carcinoma (UC) and bladder UC variants were investigated. Methods: Patients with UC diagnosed in our pathology clinic between 2010 and 2015 were identified using an electronic database. They were re-examined according to the World Health Organization 2004 (WHO ) classification system, and the grade and stage of UC and concomitant UC variants were documented for each patient. In addition to these data, the age and gender of each patient were obtained from the electronic database. Results: Between 2010 and 2015, 1355 biopsies from 1081 different patients were present with the diagnosis of UC. Totally, 676 patients with recurrence were excluded. Finally, 679 patients were included. When all patients were screened in terms of newly identified variants in the WHO 2004 classification system, 153 patients (22.6%) had UC variants, forming at least 10% of the biopsy specimen. We identified 15 UC variants: squamous differentiation, glandular differentiation, and small cell, micropapillary, sarcomatoid, lymphoepithelioma-like, nested, large nested, large cell neuroendocrine, plasmacytoid, pleomorphic, trophoblastic, rhabdoid, chordoid, and undifferentiated carcinomas. Conclusion: Our study is the largest case series on UC in Turkey . Due to the large number of patients, we believe that the results reflect the present status of the frequency and stage of UC variants and the gender and age of patients at diagnosis

The Histomorphogenetic Relationship between Melanocytes and Langerhans Cells in Ovarian Mature Cystic Teratomas

Objective: The purpose of this study was to form a view about the existence, numerical relationship and embryological origin of melanocytes and Langerhans cells when they are found together in mature cystic teratomas which have similar cell types and architectural structure to the original vertebrated body. Methods: Forty five mature cystic teratomas cases, diagnosed in the Ministry of Health Istanbul Education and Research Hospital Pathology Department between 2006-2009 were included in the study. Immunohistochemically, Human Melanoma Black-45 (HMB-45) and Melanoma Antigens (Melan-A) recognized by T cells-1) for melanocytes, Cluster of Differentiation 1a (CD1a) and Langerin for Langerhans cells were applied. Results: Although Langerhans cells were detected in 100%, melanocytes were established in 88.2% of cases. Conclusion: According to our study, Langerhans cells could derive from another source except the neural crest where melanocytes evolve and there is no relationship between them