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Clinicopathologic analysis of patients undergoing repeat transurethral resection of bladder tumour following an initial diagnosis of urothelial carcinoma with lamina propria invasion and variant/divergent histology
  1. Patrick Mullane1,
  2. Shreyas Joshi2,
  3. Mehmet Bilen3,
  4. Adeboye O Osunkoya1,2
  1. 1Department of Pathology, Emory University School of Medicine, Atlanta, Georgia, USA
  2. 2Department of Urology, Emory University School of Medicine, Atlanta, Georgia, USA
  3. 3Department of Hematology and Medical Oncology, Emory University School of Medicine, Atlanta, Georgia, USA
  1. Correspondence to Professor Adeboye O Osunkoya, Department of Pathology, Emory University School of Medicine, Atlanta, Georgia, USA; adeboye.osunkoya{at}emory.edu

Abstract

Aims A subset of patients with urothelial carcinoma (UCa) and lamina propria (LP) invasion in bladder biopsies/transurethral resections (TURs) are at significant risk for recurrence and have increased rates of progression to UCa with muscularis propria (MP) invasion. The clinicopathologic features of this patient population has not been well characterised in the Pathology literature.

Methods We performed a search through our urologic pathology files and expert consult cases of the senior author for bladder biopsies/TURs of UCa with LP invasion and variant/divergent histology from 2014 to 2020. Patients with a prior diagnosis of UCa with MP invasion or upper tract UCa were excluded. Clinicopathologic data were obtained.

Results Ninety-five patients with at least one biopsy/TUR of UCa with LP invasion and variant/divergent histology were identified. Mean patient age was 72 years (range: 46–92 years) with a male predominance 2.3:1. Initial variant/divergent histologies identified were: glandular (35.8%), squamous (23.2%), micropapillary (20%), clear cell/lipid rich (12.6%), diffuse/signet ring/plasmacytoid (10.5%), nested (9.5%), sarcomatoid (6.3%), poorly differentiated/anaplastic (4.2%), small cell (2.1%), lymphoepithelioma-like (2.1%), osteoclast-like giant cells (1.1%) and tumour giant cells (1.1%). Two or more variant histologies were identified in 18.9% of these cases. The rate of micropapillary UCa was significantly higher in multifocal tumours compared with unifocal tumours (37% vs 7.1%).

Conclusions In our cohort of patients undergoing early repeat biopsy/TUR, 75% of patients had persistent UCa. Additionally, almost 25% of patients had a prior diagnosis of UCa without a variant/divergent histology identified. Our findings highlight the critical role of repeat biopsy/TUR especially in a subset of patients who have variant/divergent histology, even in the absence of MP invasion.

  • pathology
  • surgical
  • urinary bladder
  • carcinoma
  • urologic neoplasms

Data availability statement

All data relevant to the study are included in the article.

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Data availability statement

All data relevant to the study are included in the article.

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Footnotes

  • Handling editor Runjan Chetty.

  • Contributors PM: Methodology, data curation, investigation and writing—original draft and review and editing. SJ and MB: Writing—review and editing. AOO: Conceptualisation, methodology, data curation, investigation and writing—original draft and review and editing.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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