Micropapillary urothelial carcinoma: Cytologic features in a retrospective series of urine specimens

Jonas John Heymann, Anjali Saqi, Andrew Thomas Turk, John Crapanzano

CytoJournal 2013 10(1):4-4

Comments Regarding This Article: The authors provide a retrospective review of a small series of cases in order to evaluate the features of micropapillary urothelial carcinoma (uPC). They conclude that the cytologic features in exfoliative urine samples can be difficult to distinguish from high grade conventional  urothelial carcinoma (CUC).  In addition, “[t]he molecular characteristics of uPC are incompletely defined, although recent studies have suggested that uPC may harbor molecular alterations distinct from CUC. These include alterations in mucine-1 (MUC1), [28] Krebs von den Lungen-6 (KL-6), [29] and serine/threonine kinase 15 (Aurora-A/STK-15), [30] none of which are directly detected by ImmunoCyt/uCyt. The cytogenetic characteristics of uPC have not been described. The efficacy of molecular and cytogenetic testing for detection of uPC in urine and its differentiation from CUC requires further investigation.”

Background : The micropapillary variant of urothelial carcinoma (uPC) is a rare variant of urothelial carcinoma that carries a poor prognosis. Definitive surgery may represent optimal management of low stage tumors. Urine cytology is indispensable in the screening and follow-up of urinary tract cancer. However, cytopathological criteria for diagnosis of uPC and its differentiation from conventional urothelial carcinoma (CUC) are not well-defined.

Materials and Methods : Twenty-five cases of histologically confirmed micropapillary uPC from 21 patients were compared to 25 cases of histologically confirmed high-grade CUC.

Results : In uPC cases, cell clusters were identified in 13 of 25 specimens from 10 patients. Six of the 13 specimens containing cell clusters corresponded to surgical pathology specimens in which micropapillary carcinoma accounted for at least 50% of total carcinoma. In contrast, only 1 of the 12 urine specimens devoid of cell clusters corresponded to surgical specimens in which micropapillary carcinoma accounted for at least 50% of total carcinoma. Cytomorphologic features of urinary specimens from patients with histologically confirmed micropapillary carcinoma were generally similar to those from patients with high-grade CUC, making it difficult to distinguish these entities in exfoliative urine specimens.

Conclusions and Summary : Further investigation of the core cytopathological characteristics of uPC is warranted to refine its diagnostic criteria by exfoliative urine cytology.
(Articles : CytoJournal as on March 1, 2013)

About Jana Sullinger

GYN Pathologist and Cytopathologist. Special interest in quality assessment and use of online social media in sharing educational information about cytology and quality.

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