bromochloroacetic-acid and Ureteral-Neoplasms

A tumor mass resected from the anterior bladder wall of a 68-year-old woman displayed unusual histologic features: sheets of hepatoid cells merging focally with a secondary glandular pattern of adenocarcinoma. Intracytoplasmic hyaline globules and bile production within the solid areas supported the impression of hepatocytic differentiation. Immunoreactivity for alpha-fetoprotein (AFP) and alpha-1-antitrypsin and a striking canalicular immunostaining pattern for carcinoembryonic antigen and epithelial membrane antigen all indicate hepatocellular differentiation within this bladder tumor. This represents a case of a hepatoid adenocarcinoma located in the urinary bladder. The use of the term "hepatoid" in the literature is reviewed and the reported cases are grouped into two distinct categories of tumors: (1) germ cell tumors with focal hepatoid areas and (2) true hepatoid adenocarcinomas that meet histologic and immunohistochemical criteria for hepatocellular differentiation. AFP-producing tumors without any other feature of hepatocellular differentiation should not be considered as hepatoid tumors. This classification of hepatoid tumors is likely to be important in elucidating the histogenesis and clinicopathologic features of these unusual neoplasms.

Topics: Adenocarcinoma; Aged; alpha 1-Antitrypsin; alpha-Fetoproteins; Antigens, Neoplasm; Carcinoembryonic Antigen; Carcinoma, Endometrioid; Carcinoma, Transitional Cell; Cell Nucleus; Cytoplasm; Female; Humans; Keratins; Liver; Membrane Glycoproteins; Mucin-1; Ureteral Neoplasms; Urinary Bladder Neoplasms; Uterine Neoplasms

Lymphoepithelioma-like carcinoma (LELC) is a rare finding in the upper urinary tract. The presenting clinical findings mimic those of other more common upper-tract tumors, such as urothelial carcinoma. Preoperative imaging has not been shown to reliably predict the diagnosis of LELC. This tumor can be misdiagnosed as a reactive inflammatory lesion or lymphoma if the proper immunohistochemical stains for cytokeratin are not used.

Topics: Aged; Carcinoma in Situ; Carcinoma, Transitional Cell; Female; Humans; Keratins; Kidney Neoplasms; Lymphatic Metastasis; Neoplasms, Multiple Primary; Ureteral Neoplasms

To study the clinical and pathologic characteristics of small cell neuroendocrine carcinoma of urinary tract.. All cases of urinary tract carcinoma encountered in the General Hospital of People Liberation Army during the period from 1999 to 2010 were retrospectively reviewed. The clinicopathologic data of small cell neuroendocrine carcinomas were further analyzed, with literature review.. A total of 16 cases of small cell neuroendocrine carcinoma were identified, including 10 from urinary bladder, 2 from ureter, 3 from renal pelvis, and 1 multifocal tumor involving renal pelvis and ureter. There were altogether 8 males and 8 females. The median age of the patients was 63 years (range = 24 to 79 years). Gross hematuria (11 cases) represented the main presenting symptom. Four patients had flank pain and 4 had urinary irritation symptoms. Seven patients underwent radical cystectomy. Six other patients underwent radical nephroureterectomy, 1 partial cystectomy, 1 TURBT and the remaining case biopsy only. The size of the tumor ranged from 0.8 to 8.0 cm (median = 4.5 cm). Histologically, 15 cases represented mixed small cell neuroendocrine carcinoma (with 13 mixed with transitional cell carcinoma and 2 with adenocarcinoma). Immunohistochemical study showed positive staining for neuroendocrine markers. On presentation, 1 patient was in stage pT1, 7 in stage pT2, 6 in stage pT3, 2 in stage pT4. Six patients died of the disease after operation. The overall survival was 25 months and the 5-year survival rate was 32.4%.. Small cell neuroendocrine carcinoma of urinary bladder is a highly malignant disease and associated with poor prognosis. The diagnosis relies on detailed histologic examination. Early diagnosis, when coupled with cystectomy or nephroureterectomy and adjuvant chemotherapy, represents the mainstay of management.

Topics: Adult; Aged; Carcinoma, Neuroendocrine; Carcinoma, Small Cell; CD56 Antigen; Chemotherapy, Adjuvant; Cystectomy; Female; Follow-Up Studies; Humans; Keratins; Kidney Neoplasms; Male; Middle Aged; Neoplasm Staging; Nephrectomy; Phosphopyruvate Hydratase; Retrospective Studies; Survival Rate; Synaptophysin; Ureteral Neoplasms; Urinary Bladder Neoplasms; Urologic Neoplasms; Young Adult

Topics: Aged; Biomarkers, Tumor; Carcinoma, Transitional Cell; Female; Humans; Keratins; Ureteral Neoplasms; Urothelium

Small cell carcinoma (SCC) of the renal pelvis and/or ureter is very rare, with only case reports published in the literature.. To describe the clinicopathologic and immunohistochemical findings in the largest series to date.. A review of a regional cancer registry identified 10 cases diagnosed as SCC from 930 patients with renal pelvic and/or ureteral cancer from 1971 to 1998. The original slides, demographics, treatment, and clinical outcome were reviewed. Representative sections were immunostained for AE1/AE3, cytokeratin 7, cytokeratin 20, CD56, synaptophysin, chromogranin, and thyroid transcription factor 1.. Of the 10 cases, 5 were pure SCC, 2 were mixed (SCC and urothelial carcinoma), 2 were reclassified as poorly differentiated squamous carcinoma, and 1 was reclassified as urothelial carcinoma. The patients with SCC had an age range of 50 to 80 years (median, 72 years) with a female to male ratio of 2.5:1. All patients had non-organ confined disease. Five of 7 patients died of disease; 4 of those 5 had been clinically followed (median survival, 23 months) and 1 was diagnosed at autopsy. The SCC cases revealed positive staining of the SCC component as follows: AE1/AE3 (7 of 7), CD56 (7 of 7), synaptophysin (6 of 7), thyroid transcription factor 1 (5 of 7), chromogranin (4 of 7), and cytokeratin 7 (1 of 7). None were positive for cytokeratin 20 (0 of 7).. SCC of the renal pelvis/ureter is seen in a predominately female population in Sweden, is clinically aggressive, and has poor survival when presenting at an advanced stage in patients only treated by surgery. An immunostain panel serves as a useful adjunct in classifying these tumors.

Topics: Aged; Aged, 80 and over; Carcinoma, Small Cell; Chromogranins; Female; Humans; Immunohistochemistry; Keratins; Kidney Neoplasms; Kidney Pelvis; Male; Middle Aged; Prognosis; Registries; Sweden; Synaptophysin; Ureteral Neoplasms; Vesicular Transport Proteins

Topics: Carcinoma, Renal Cell; Carcinoma, Transitional Cell; Carcinosarcoma; Female; Follow-Up Studies; Humans; Keratins; Kidney Neoplasms; Lymphatic Metastasis; Male; Prostatic Neoplasms; Retrospective Studies; Survival Rate; Ureteral Neoplasms; Urinary Bladder Neoplasms; Urologic Neoplasms; Vimentin

Lymphoepithelioma-like carcinoma (LELC) is an uncommon tumor of the urinary tract. We present a case of LELC involving the ureter of a 71-year-old male patient with gross hematuria. On biopsy, the patient was diagnosed with invasive poorly differentiated carcinoma, with a final diagnosis of LELC on subsequent nephroureterectomy. On resection, the neoplasm was solitary and consisted of undifferentiated neoplastic cells demonstrating a syncytial growth pattern, vesicular nuclei, prominent nucleoli, and an admixed polyclonal lymphoid infiltrate. Immunohistochemistry showed that the tumor cells were positive for Cam5.2 and CK7; focally positive for cytokeratinAE1/3, EMA, CK20, and p63; and negative for CK903. Epstein-Barr virus in situ hybridization was negative. No disease progression was noted at 5-month follow-up. Only 6 previous cases of LELC involving the ureter have been reported in the literature. We document an additional example of this uncommon entity and present a comprehensive review of LELC involving the ureter.

Topics: Aged; Biomarkers; Carcinoma, Transitional Cell; Humans; Immunohistochemistry; In Situ Hybridization; Keratin-7; Keratins; Male; Treatment Outcome; Ureter; Ureteral Neoplasms; Urothelium

Topics: Carcinoma, Squamous Cell; Humans; Immunohistochemistry; Keratins; Leukocyte Common Antigens; Male; Middle Aged; Tumor Suppressor Protein p53; Ureteral Neoplasms

The presence of squamous differentiation in transitional cell carcinomas has been variably related to prognosis and response to radiotherapy. This study sought to establish whether cytokeratin (CK) 14, normally expressed in the basal cells of squamous epithelium, could be used as a reliable marker of the emergence of a squamous phenotype in transitional cell carcinomas. In a series of 42 tumours, CK14 was expressed in areas of squamous morphology, whereas CK20 identified continuing urothelial differentiation. Furthermore, focal positivity for CK14 was present in a proportion of tumours with no morphological evidence of squamous differentiation, suggesting that it is a more sensitive marker of phenotypic switch. Investigation of CK subtypes may be more powerful than morphology alone in clinical studies of transitional cell carcinomas as CK expression profiles have been related to treatment response in other tumour types.

Topics: Biomarkers, Tumor; Carcinoma, Squamous Cell; Carcinoma, Transitional Cell; Cell Differentiation; Humans; Immunohistochemistry; Keratins; Kidney Neoplasms; Prognosis; Ureteral Neoplasms; Urinary Bladder Neoplasms; Urologic Neoplasms

Genuine adenocarcinomas of the ureter are rare tumors and have to be distinguished from other gland-forming malignancies arising from the transitional epithelium, due to the poor clinical outcome. The histopathological features of a tumor combined with intestinal metaplasia of the adjacent urothelium are described. The tumor has to be distinguished from transitional cell cancer with glandular metaplasia, muco-urothelial cancer, microcystic transitional cell cancer and transitional cell cancer with mucoid cytoplasmatic inclusions. Immunohistochemical analysis of the cancer shows positivity for carcinoembryonic antigen and a staining pattern characteristic for adenocarcinomas. The expression of keratin types 7 and 13, which is typically found in transitional cell carcinomas, is lost.

Topics: Adenocarcinoma; Aged; Carcinoembryonic Antigen; Carcinoma, Transitional Cell; Diagnosis, Differential; Humans; Immunoenzyme Techniques; Keratins; Male; Metaplasia; Mucin-1; Neoplasm Proteins; Ureteral Neoplasms

Topics: Adenocarcinoma, Mucinous; Biomarkers, Tumor; Carcinoma, Transitional Cell; Diagnosis, Differential; Humans; Immunoenzyme Techniques; Keratins; Male; Microscopy, Electron; Middle Aged; Neoplasm Staging; Ureter; Ureteral Neoplasms; Urinary Bladder; Urinary Bladder Neoplasms; Vimentin

The results of the study of three implanted ureteric tumors from a primary transitional cell carcinoma of the renal pelvis are reported. Using both light microscopic immunohistochemistry and transmission electron microscopy, the stroma of the tumor showed consistent evidence for the production of at least its collagenous component by the neoplastic cells. Our findings argue with the notion that occasional fibroblasts and other cells of mesenchymal origin could play a major role in this phenomenon. Therefore, it seems plausible to suggest that what is happening in these tumors is similar to the behavior of malignant cells in scirrhous 'infiltrating' carcinoma of the breast and other sites.

Topics: Carcinoma, Transitional Cell; Collagen; Histocytochemistry; Humans; Keratins; Kidney Neoplasms; Neoplasm Invasiveness; Ureteral Neoplasms