Low Grade Urothelial Carcinoma of the Upper Urinary Tract: A Clinicopathological Analysis of 63 Cases
AA Thomas, AK Smith, SC Campbell, AJ Stephenson, JS Jones, DE Hansel. Cleveland Clinic, Cleveland, OH
Background: Urothelial carcinomas of the upper urinary tract are relatively uncommon, with limited pathological data and outcomes for patients with low grade tumors. We examined our series of patients with low grade upper urinary tract cancers who underwent conservative management or radical excision to identify histopathological findings and clinical outcomes associated with these tumors.
Design: The clinicopathological records of patients treated at our institution from 1992 to 2008 for urothelial cancers were reviewed. Sixty-three patients with low grade upper urinary tract urothelial carcinoma were identified.
Results: Of the patients reviewed, the median patient age was 71 years (range 42 to 92) with a male to female ratio of 1:5. Twenty-six patients (41%) had a prior history of bladder carcinoma. Patients underwent nephroureterectomy (55), distal ureterectomy (4), and percutaneous resection (3) or fulguration (1) of their upper urothelial tract tumors. All tumors from biopsy of final pathological analysis were low grade with papillary urothelial carcinoma (98%), ureteritis (6%), urothelial hyperplasia (4%), squamous metaplasia (2%), and squamous differentiation in 2% of cases. Lymphovascular invasion was present in one case. Pathological staging confimed all cases were lower stage (pTis, pTa, or pT1), with one pTx. At a median follow-up of 42 months, 4 (6%) patients were dead from their disease, 8 (13%) died from unknown/other causes, and 51 (81%) were alive.
Conclusions: From our series low grade upper tract urothelial carcinoma was associated with favorable survival outcomes. Close monitoring and follow up of patients managed with conservative therapy is warranted to prevent disease progression.
Category: Genitourinary (including renal tumors)
Tuesday, March 10, 2009 9:30 AM
Poster Session III # 96, Tuesday Morning