[1026] Upper Urinary Tract Urothelial Carcinoma with Intratubular Spread

Judy Sarungbam, Muhammad Choudhury, Ximing Yang, Minghao Zhong. New York Medical College, Valhalla, NY; Northwestern University Feinberg School of Medicine, Chicago, IL

Background: Upper urinary tract urothelial cell carcinomas (UUT-UCs) are uncommon, accounting 7% to 8% of all renal malignancies and representing 5 to 10% of all urothelial tumors. One of well-known and peculiar histopathological finding in UUT-UC is urothelial carcinoma with (retrograde) intratubular spread. However, this special feature has not been systematically studied.
Design: All cases of UUT-UC with nephrouretrectomy from 2006 to 2012 were retrieved from the archives of pathology department. All clinic-pathological information were evaluated with emphasis on the presence of intratubular spread. A cocktail stain which contains immunohistochemistry stains of PAX8 and P63 with PAS was developed and validated to facilitate the study of intratubular spread.
Results: A total of 54consecutive cases of upper urinary tract urothelial carcinomas were identified. The clinical-pathological features of these cases were similar to those that had been published before. Seventeen cases (31.5%) showed intratubular spread confirmed by either H & E stain or the cocktail stains. All of 17 cases (100%) with intratubular spread had tumor involvement of the renal calyx; 14 of 17 (82.4%) cases were high grade urothelial carcinoma; 13 of 17 cases (76.5%) were invasive urothelial carcinoma. According to diverse pathological patterns, we also further classified intratubular spread into 4 different types: typical; pagetoid; florid and intratubular spread with focal invasion.

TypeLocation# of tubules involvementRecognizable on H&EArchitectureAssociation of tumor gradeAssociation of invasion
TypicalClose to calyxFewYesTubular, pseuglandularHigh/LowInvasion and non-invasion
PagetoidClose to calyxFewMaybePagetoid, few cellsHigh/LowInvasion and non-invasion
FloridExtended to medulla/cortex junctionMore than 10YesPseuglandular, solid nest with smooth contourHighInvasion
Invasion from tubular spreadMay reach cortexMult-focal, more than 10 on each focusYesSolid nest with irregular contourHighInvasion
Pathological features of different types of intratubular spread.

Conclusions: 1. Intratubular spread of urothelial carcinoma is a frequent phenomenon in UUT-UCs.
2. All intratubular spread cases had tumor involvement at renal calyx; most cases are high grade and associated with true invasion. However, it also can be seen in cases with low grade and non-invasive carcinoma.
3. In conjunction with morphological features, the cocktail stain comprising of PAX 8, p63, and PAS is helpful test to evaluate intratubular spread of urothelial carcinoma.
Category: Genitourinary (including renal tumors)

Wednesday, March 6, 2013 1:00 PM

Poster Session VI # 173, Wednesday Afternoon


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