Gross Morphology Correlates with Non-Organ Confined Disease (Non-OC) in Cystectomy Specimens
Luciana Schultz, Gilcy R Damm, Walter H da Costa, Gustavo C Guimaraes, Isabela W da Cunha, Fernando A Soares. Fundação Antonio Prudente, Sao Paulo, Brazil; AC Camargo Hospital, São Paulo, Brazil
Background: Gross and microscopic features correlate with pathological staging in cystectomy specimens. Current recommendations suggest that size and location are relevant but do not contemplate presence of ulceration or gross morphology of the lesion.
Design: We reviewed slides from 100 patients with urothelial carcinoma treated by cystectomy at our institution (2000-2010). Adequate gross info was available on 98 reports. Gross morphology description was categorized in 4 groups: I. Papillary (n=2); II. Exophytic (n=18); III. Vegetant, Sessile or Nodular (n=32); IV: Infiltrative, Ulcerative or Flat ulcerated (n=46). Presence of ulceration was accessed independent of Gross category. Pathological stage (pT) was grouped in Superficial (pTis/pTa/pT1; n=20), Muscle-invasive (pT2; n=24) and non-OC (pT3/pT4; n=56). Dome, anterior wall and bladder neck were considered adverse locations. Tumor volume was obtained in 80 reports multiplying the 3 largest dimensions. Microscopic features such as arterial and perineural invasion, node density and positive margins were also accessed.
Results: Mean patient age, tumor size and volume was 66 (34-90), 3.8 cm (0.8-8.5) and 35 cm3 (0.4 – 194), respectively and M:F ratio was 1.85. Gross morphology and presence of ulceration significantly correlated with pT (p=0.003 and p=0.001, respectively). All tumors from adverse locations were at least muscle invasive (p=0.09). Tumors from Gross category IV were smaller (p=0.003 for cm and 0.007 for cm3), despite association with non-OC disease. Gross category IV and presence of ulceration did not correlate with microscopic parameters but all microscopic parameters correlated with non-OC disease and among each other (p<0.03). On a multivariate analysis for non-OC disease, Gross category IV was an independent predictor of non-OC disease (p=0.009), along with arterial and perineural invasion. Node density and positive margins did not keep the significance.
Conclusions: Ulceration and tumor gross morphology are strongly associated with non-OC bladder cancer. Therefore including this data in the cystectomy report may optimize prognostic information, along with other classic gross and microscopic parameters.
Category: Genitourinary (including renal tumors)
Monday, March 4, 2013 9:30 AM
Poster Session I Stowell-Orbison/Surgical Pathology/Autopsy Awards Poster Session # 156, Monday Morning