Urothelial CIS with Microinvasion: A Morphologic and Prognostic Study
Roni Cox, Jonathan I Epstein. The Johns Hopkins Hospital, Baltimore
Background: CIS is rarely accompanied by early superficial invasive urothelial carcinoma (UC). There is no standard definition of microinvasion and some definitions have included cases with quite extensive invasion. As a result, the significance of small foci of invasion is unknown. One one hand limited invasion could be associated with a good prognosis, and on the other hand once CIS shows the ability to invade it is possible it is associated with a poor prognosis.
Design: 14 cases of CIS with microinvasion were reviewed from the consultation files of one of the authors. Cases with previous diagnoses of invasive UC were excluded. Microinvasion was defined as tumor invading less than a 40x high dry lens (i.e. <0.5mm) from the basement membrane. The inflammatory reaction was categorized from 0 for no reaction to 3+ for extensive reaction.
Results: Patients ranged in age from 57-89 (mean 73). 12/14 patients were male. 2 patients had a prior history of non-invasive high grade papillary UC, while 1 patient had a history of non-invasive low grade papillary UC of the kidney. 1 patient was diagnosed with concurrent non-invasive high grade papillary UC. Microscopically, 10 cases had a depth of invasion less than one-half of a 40x field with the remaining 4 cases deeper yet still less than a 40x field. 6 cases had invasive nests of cells, 4 had individual invasive cells, and 4 cases had both nests and individual cells. One case had invasive micropapillary features. The inflammatory response was 0 in 2 cases, 1+ in 2 cases, 2+ in 8 cases, and 3+ in 2 cases. Desmoplastic stromal reaction was noted in only 2 cases. 4 cases had focal (<50% surface area) and 2 cases had extensive denudation. Follow up information was available for 12/14 patients (mean: 40.2 mos., range: 4 mos. to 14 ys.). 9 patients showed no evidence of disease at the last follow-up. 2 patients were alive with recurrent disease (one 15 mos. after the original diagnosis and one at 3 yrs.). 1 patient died of unknown causes at 7.5 yrs. The mode of treatment was known for 8 patients: 4 received BCG only; 3 had cystectomy (2 for BCG refractory disease, 1 for invasive UC into the muscularis propria); and 1 received no additional treatment.
Conclusions: CIS with microinvasion is relatively rare and foci of invasion can be very subtle, sometimes highlighted by keratin immunohistochemistry. Using the currently proposed definition, these patients have an overall favorable prognosis, although the presence of BCG refractory disease and progression of the disease into deeper invasion can lead to cystectomy.
Category: Genitourinary (including renal tumors)
Wednesday, March 21, 2012 1:00 PM
Poster Session VI # 149, Wednesday Afternoon