Urothelial Tumors in Patients under the Age of 30 Years: A Report of 58 Cases
ML Stanton, L Xiao, BA Czerniak, CC Guo. University of Texas MD Anderson Cacner Center, Houston, TX
Background: Urothelial tumors occur mainly in patients between the ages of 50 to 80 years, and they are distinctively rare in young patients under the age of 30 years. Here we studied the clinicopathologic features of a large series of young patients with urothelial tumors.
Design: We retrospectively searched our pathology file and identified 58 patients under the age of 30 years with an urothelial tumor. Histologic slides were reviewed for pathologic analysis, and clinical information was collected from medical records.
Results: The mean age of patients was 23 years (range, 5-30 years). Forty patients were male and 18 were female. Clinical history was available for 32 patients, and 16 patients had a history of smoking tobacco. The most common presenting symptom was hematuria (n=26), followed by abdominal pain (n=8) and urinary tract infections (n=6). The tumors were found in the urinary bladder (n=53), renal pelvis (n=5) and ureter (n=1). The tumors were divided into non-invasive (n=45) and invasive (n=13) groups. The non-invasive tumors included papillary urothelial neoplasm of low malignant potential (PUNLMP) (n=7), low- grade papillary urothelial carcinoma (n=33) and high-grade papillary urothelial carcinoma (n=5). The invasive tumors were all high-grade urothelial carcinoma (n=13), and some showed focal small cell carcinoma (n=2) and sarcomatoid features (n=1). The invasive tumors invaded lamina propria (n=4), muscularis propria (n=4), and perivesical adipose tissue (n=1) in the bladder; the invasive tumors all invaded renal parenchyma in the renal pelvis (n=4). Follow-up information was available for 39 patients (mean 55 months, range 3-250 months): 2 patients with PUNLMP had no evidence of disease (NED); in 25 patients with low-grade papillary urothelial carcinoma, 23 had NED, 1 was alive with disease, and 1 subsequently developed invasive tumor and died at 160 months; 1 patient with non-invasive high grade papillary urothelial carcinoma had NED; in 11 patient with invasive high grade urothelial carcinoma, 7 died at 45 months (range, 15-102 months), 2 had NED, and 2 were alive with disease.
Conclusions: The majority of urothelial tumors in patients under the age of 30 years are non-invasive low-grade papillary urothelial carcinoma and PUNLMP, which are generally associated with an excellent prognosis. However, a small number of young patients can develop a high-grade invasive urothelial carcinoma at an advanced stage, and their clinical outcome is poor despite therapy.
Category: Genitourinary (including renal tumors)
Monday, March 22, 2010 9:30 AM
Poster Session I Stowell-Orbison/Surgical Pathology/Autopsy Awards Poster Session # 138, Monday Morning