Primary Urothelial Dysplasia: Histopathologic Findings and Outcomes in a Consecutive Patient Series.
Ed Diaz, Donna E Hansel. Cleveland Clinic, OH
Background: Primary urothelial dysplasia is a uncommon with a 14-19% chance of progressing to high grade urothelial carcinoma (HGUC) within 4-5 years of diagnosis. There are very few clinical series for primary urothelial dysplasia, and no series since the 2004 WHO classification recommended grouping of severe dysplasia with carcinoma in situ. The objective of this study is to review cases of primary urothelial dysplasia and provide an updated cohort for primary urothelial dysplasia.
Design: The pathologic database for our institution was queried for specimens with a final diagnosis of dysplasia of the bladder from 1995 to 2010. Primary urothelial dysplasia was defined as a de novo diagnosis of dysplasia without precedent urothelial pathology. Specimens were reviewed to determine histopathologic features. Patient follow-up was obtained by a retrospective review of clinical records.
Results: Thirty-three patients with urothelial dysplasia were identified, with specimens that included biopsy (84%), TUR (11%) and excision for non-neoplastic causes (5%). Gross hematuria (42%) and microhematuria (12%) were the most frequent presenting symptoms. Precedent cytology was negative (44%), atypical (24%), positive (3%), or unavailable (29%). Cystoscopic findings included erythema (40%), raised lesions (30%), negative findings (18%), or unavailable (9%). Only two of the 33 cases (6%) progressed to invasive carcinoma. One case progressed after 2.5 years, and the second case after 3 years. The former case demonstrated squamous features with atypia and would be re-classified as moderate squamous dysplasia; this case progressed to invasive squamous cell carcinoma with continued negative cytology. The latter case demonstrated moderate atypia and progressed to HGUC, with associated cytology progressing from negative to atypical. Upon re-review, the most common features that contributed to urothelial dysplasia diagnosis included increased mitotic activity in the basal and mid aspects of the urothelium (16%), urothelial hyperplasia including papillary hyperplasia (16%), reactive nuclear enlargement (16%), early squamous metaplasia (21%), and mechanical or staining artifact (21%). Nuclear atypia was generally minimal, with occasional moderate atypia of umbrella cells (10%) and binucleation with negative viral stains (5%). Inflammation was generally minimal.
Conclusions: Primary urothelial dysplasia diagnoses are uncommon. In our cohort, only 6% of urothelial dysplasia progressed to invasive carcinoma over 3 years, with the most common contributors to diagnosis including tissue and processing artifact and early squamous metaplasia.
Category: Genitourinary (including renal tumors)
Tuesday, March 1, 2011 9:30 AM
Poster Session III # 198, Tuesday Morning