Clinicopathologic analysis of upper urinary tract carcinoma with variant histology

Abstract

We report on the clinicopathologic features of 115 cases of high-grade urothelial carcinoma of the upper urinary tract with variant histology present in 39 (34%). Variant histology was typically seen in high pathological stage (pT2-pT4) (82%, 32 cases) patients with lower survival rate (70%, 27 cases, median survival 31 months) and consisted in urothelial with one (23%), two (3%), and three or more variants (3%); 4% of cases presented with pure variant histology. Squamous divergent differentiation was the most common variant (7%) followed by sarcomatoid (6%) and glandular (4%), followed by 3% each of micropapillary, diffuse-plasmacytoid, inverted growth, clear cell glycogenic, or lipid-rich. The pseudo-angiosarcomatous variant is seen in 2%, and 1% each of nested, giant-cell, lymphoepithelioma-like, small-cell, trophoblastic, rhabdoid, microcystic, lymphoid-rich stroma, or myxoid stroma/chordoid completed the study series. Loss of mismatch repair protein expression was identified in one case of upper urinary tract carcinoma with inverted growth variant (3.6%). Variant histology was associated to pathological stage (p = 0.007) and survival status (p = 0.039). The univariate survival analysis identified variant histology as a feature of lower recurrence-free survival (p = 0.046). Our findings suggest that variant histology is a feature of aggressiveness in urothelial carcinoma of the upper urinary tract worth it to be reported.

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Funding

This study was supported in part by the Grant PI17/01981 [FIS (Ministry of Health), Madrid, Spain].

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IR, VH, and ALB drafted the article. ALB, IR, NR, RM, MV, RCM, MRR, and LC formulated and designed the study. IC and IR conducted the immunohistochemical analysis of MMR proteins. RCM, MRR, AC, and VH made the literature search. AB completed the statistical analysis. All the authors critically read, edited, and approved the final manuscript.

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Correspondence to Antonio Lopez-Beltran.

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Rolim, I., Henriques, V., Rolim, N. et al. Clinicopathologic analysis of upper urinary tract carcinoma with variant histology. Virchows Arch 477, 111–120 (2020). https://doi.org/10.1007/s00428-020-02745-4

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Keywords

  • Renal pelvis
  • Ureter
  • Urothelial carcinoma
  • Variant histology
  • Micropapillary
  • Nested
  • Plasmacytoid
  • Sarcomatoid
  • Squamous
  • Glandular
  • Divergent
  • MMR