BACKGROUND: Pathologic grading, one of the most important prognostic factors of papillary urothelial neoplasia (PUN) of the urinary bladder, has been revised continuously. The current study focused on the analysis of interobserver agreement on PUN of the urinary bladder bet- ween 1973 WHO classification (WHO 1973) and 1998 WHO/ISUP classification. METHODS: Seventy five cases from 15 institutions were collected, and after review by Korean Society of Urogenital Pathology (KSUP), 30 cases were selected as follows; group I, WHO grade 1 and papillary urothelial neoplasm of low malignant potential by ISUP (7 cases), group II, WHO grade 2 and low-grade papillary urothelial carcinoma (16 cases), and group III, WHO grade 3 and high-grade papillary urothelial carcinoma (7 cases). Seventy five general surgical pathologists who participated in this study were asked to grade the tumors based on WHO/ISUP classification. Interobserver agreement between the participants' diagnosis and KSUP consensus diagnosis was analyzed by kappa value. RESULTS: Interobserver agreement assessed by kappa value for all diagnostic groups was very low; for group I, kappa value was -0.900893722; for group II, -0.944650025, and for group III, -0.876728996. The overall kappa value of pathology residents was better than that of practicing pathologists. CONCLUSIONS: The 1998 WHO/ ISUP classification could not be easily translated from the 1973 WHO classification and because of poor interobserver agreement, it appears that further work would be needed before it can be practically applied.
Carcinoma, Transitional Cell ; Classification* ; Consensus* ; Diagnosis ; Pathology* ; Urinary Bladder Neoplasms ; Urinary Bladder*

Carcinoma in Situ ; diagnosis ; pathology ; surgery ; Carcinoma, Transitional Cell ; diagnosis ; pathology ; surgery ; Cystectomy ; Humans ; Neoplasm Invasiveness ; Neoplasm Staging ; methods ; Urinary Bladder ; pathology ; surgery ; Urinary Bladder Neoplasms ; diagnosis ; pathology ; surgery

Intraductal carcinoma of the prostate (IDC-P) is characterized by prostatic carcinoma involving ducts and/or acini. The presence of IDC-P is usually associated with a high-grade Gleason score, large tumor volume, and adverse prognostic parameters, including extraprostatic extension and seminal vesicle invasion. When present, IDC-P is associated with worse outcomes, regardless of treatment status. IDC-P is included in a broader diagnostic category of atypical cribriform lesions of the prostate gland. This category of lesions also includes high-grade prostatic intraepithelial neoplasia (HGPIN), urothelial carcinoma involving prostatic ducts or acini, and prostatic ductal adenocarcinoma, amongst other intraductal proliferations. Differentiating between these entities is important as they have differing therapeutic and prognostic implications for patients, although differential diagnosis thereof is not always straightforward. The present review discusses IDC-P in regards to its morphological characteristics, molecular features, and clinical outcomes. Given the current state of knowledge, the presence of IDC-P should be evaluated and documented correctly in both radical prostatectomy and needle biopsy specimens, and the clinical implications thereof should be taken into consideration during treatment and follow up.
Carcinoma, Acinar Cell/chemistry/*diagnosis/pathology ; Carcinoma, Ductal/chemistry/*diagnosis/pathology ; Carcinoma, Transitional Cell/chemistry/*diagnosis/pathology ; Diagnosis, Differential ; Humans ; Male ; Neoplasm Grading ; Prostatic Intraepithelial Neoplasia/chemistry/*diagnosis/pathology ; Prostatic Neoplasms/chemically induced/*diagnosis/*pathology ; Tumor Burden

OBJECTIVETo improve the diagnosis and treatment of coincident vesical transitional cell carcinoma (VTCC) and prostate cancer.

METHODSWe analyzed the clinical data of 5 cases of coincident VTCC and prostate cancer.

RESULTSThe 5 patients, at the mean age of 66.2 years, were diagnosed as having grade II - III VTCC by cystoscopy and biopsy, 1 with a history of prostate cancer, and the other 4 with prostate cancer confirmed by postoperative pathological examination. Two of the patients were treated by radical cystoprostatectomy, 1 by radical cystoprostatectomy and ileum conduit surgery, 1 by transurethral resection of bladder tumor, and the other 1 by palliative ureterocutaneostomy due to cardiopulmonary problems. The follow-up lasted 8 -26 months. One of them died of diffused metastasis 20 months after surgery, 1 survived with the tumor untreated, and the other 3 remained tumor free.

CONCLUSIONCoincident VTCC and prostate cancer is easy to be missed in diagnosis. PSA detection, rectal palpation, transrectal ultrasonography, biopsy, and cystoscopy are the main diagnostic options for this disease. Its treatment should be based on the classification and clinical staging of the two cancers. Coincident VTCC and prostate cancer does not suggest poor prognosis.

Aged ; Carcinoma, Transitional Cell ; diagnosis ; pathology ; surgery ; Humans ; Male ; Middle Aged ; Neoplasm Staging ; Prognosis ; Prostatic Neoplasms ; diagnosis ; pathology ; surgery ; Urinary Bladder Neoplasms ; diagnosis ; pathology ; surgery

To evaluate the ability of fluorescence in situ hybridization (FISH) in detecting bladder urothelial carcinoma (BUC), FISH and cytology were compared for the evaluation of 308 consecutive urine samples from patients suspected of having BUC. All patients underwent cystoscopy for identification of bladder lesions. The FISH results were compared with the cytology assessment. In all, 122 patients had confirmed BUC. Among them, 68 (55.7%) were FISH-positive, while only 33 (27%) were positive on cytology. According to disease stage (superficial vs. invasive) and grade (low vs. high), the sensitivities of FISH were also significantly higher than those of cytology in all categories. Moreover, in 36 patients who had no visible tumor with flat, erythematous mucosa (suspicious lesion), FISH was more sensitive than cytology for the detection of BUC (83.3% vs. 33.3%, P=0.002). The FISH was negative in 168 (90.3%) of 186 patients with no histological evidence of BUC or negative cystoscopy findings. The sensitivity of FISH for detecting BUC was superior to that of cytology, regardless of tumor stage and grade. FISH is a significant additional and complementary method for detection of BUC in patients who have suspicious lesions on cystoscopy.
Aged ; Carcinoma, Transitional Cell/diagnosis/*pathology ; Female ; Humans ; *In Situ Hybridization, Fluorescence/methods ; Male ; Middle Aged ; Reproducibility of Results ; Sensitivity and Specificity ; Urinary Bladder Neoplasms/*diagnosis/pathology ; Urine/cytology ; Urothelium/*pathology

Objective: To investigate the gene mutation of telomerase reverse transcriptase (TERT) promoter in inverted urothelial lesions of the bladder and its significance in differential diagnosis. Methods: From March 2016 to February 2022, a total of 32 patients with inverted urothelial lesions diagnosed in Department of Pathology at Qingdao Chengyang People's Hospital and 24 patients at the Affiliated Hospital of Qingdao University were collected, including 7 cases of florid glandular cystitis, 13 cases of inverted urothelial papilloma, 8 cases of inverted urothelial neoplasm with low malignant potential, 17 cases of low-grade non-invasive inverted urothelial carcinoma, 5 cases of high-grade non-invasive inverted urothelial carcinoma, and 6 cases of nested subtype of urothelial carcinoma were retrospectively analyzed for their clinical data and histopathological features. TERT promoter mutations were analyzed by Sanger sequencing in all the cases. Results: No mutations in the TERT promoter were found in the florid glandular cystitis and inverted urothelial papilloma. The mutation rates of the TERT promoter in inverted urothelial neoplasm with low malignant potential, low grade non-invasive inverter urothelial carcinoma, high grade non-invasive inverted urothelial carcinoma and nested subtype urothelial carcinoma were 1/8, 8/17, 2/5 and 6/6, respectively. There was no significant difference in the mutation rate of TERT promoter among inverted urothelial neoplasm with low malignant potential, low-grade non-invasive inverted urothelial carcinoma, and high-grade non-invasive inverted urothelial carcinoma (P>0.05). All 6 cases of nested subtype of urothelial carcinoma were found to harbor the mutation, which was significantly different from inverted urothelial neoplasm with low malignant potential and non-invasive inverted urothelial carcinoma (P<0.05). In terms of mutation pattern, 13/17 of TERT promoter mutations were C228T, 4/17 were C250T. Conclusions: The morphology combined with TERT promoter mutation detection is helpful for the differential diagnosis of bladder non-invasive inverted urothelial lesions.
Humans ; Urinary Bladder Neoplasms/genetics* ; Carcinoma, Transitional Cell/pathology* ; Urinary Bladder/pathology* ; Diagnosis, Differential ; Retrospective Studies ; Mutation ; Cystitis/genetics* ; Neoplasms, Glandular and Epithelial/diagnosis* ; Papilloma/diagnosis* ; Telomerase/genetics*

We report a rare case of subepithelial hematoma of the renal pelvis (AntopoI-Goldman Lesion). A 55-year-old women visited our hospital because of gross hematuria. Ultrasonogram showed a 4cm well-defined solid mass of the left renal pelvis. Intravenous pyelography revealed compression of the left upper pelvicocalyceal system by the mass with contrast filling within the mass. CT scan revealed Iobulated well defined mass in the left renal pelvis extending into renal parenchyme. A transitional cell carcinoma or renal cell carcinoma was suspected radiologically, and the patient underwent left total nephrectomy. In pathology, the lesion turned out to be a subepithelial hemaroma. In the differential diagnosis of renal malignancy, a subepithelial hematoma of the renal pelvis may be included.
Carcinoma, Renal Cell ; Carcinoma, Transitional Cell ; Diagnosis, Differential ; Female ; Hematoma* ; Hematuria ; Humans ; Kidney Pelvis* ; Middle Aged ; Nephrectomy ; Pathology ; Tomography, X-Ray Computed ; Ultrasonography ; Urography

Nonmuscle invasive (NMI) urothelial cancer (UC) is associated with varied biological potential. It is characterized by frequent recurrence and progression, which thus worsens the oncological outcome. Nearly three-quarters of NMI UCs recur within 5 years, whereas half can progress during follow-up. Progression is particularly seen in T1 and carcinoma in situ (CIS). Undoubtedly, NMI UC is one of the most expensive cancers to manage. The European Organisation for Research and Treatment of Cancer (EORTC) risk calculator is a commonly used tool for assessing the recurrence and progression potential of a newly diagnosed cancer. The parameters used in the assessment are tumor size and number, pathological stage and grade of the cancer, presence of CIS, and prior recurrence rate. The main advantages of the EORTC tool are its ease of use and the lack of need to run expensive molecular tests. However, reproducibility of pathologic stage and grade is modest, which is a concern to clinicians. Molecular markers have potential for predicting the clinical outcome of NMI UC, given that clinico-pathologic variables are not sufficient for prediction of prognosis in an individual. Significant work has been done in the past 2 decades in understanding the molecular biology of bladder cancer; however, the translational value of this knowledge remains poor. The role for molecular markers in predicting recurrence seems limited because multifocal disease and incomplete treatment are probably more important for recurrence than the molecular features of a resected tumor. Urinary markers have very limited value in prognostication of bladder cancer and are used (mainly as an adjunct to cytology) for detection and surveillance of urothelial cell cancer recurrence. Prediction of progression with molecular markers holds considerable promise. Nevertheless, the contemporary value of molecular markers over clinico-pathologic indexes is limited.
Age Factors ; Biomarkers, Tumor/*metabolism ; Carcinoma, Transitional Cell/*diagnosis/pathology/surgery ; Disease Progression ; Humans ; Prognosis ; Recurrence ; Risk Assessment/methods ; Urinary Bladder Neoplasms/*diagnosis/pathology/surgery

A 70-yr-old man presented with painless gross hematuria. He underwent right nephrectomy for benign disease 9 yr ago. Computed tomography and cystoscopy showed a mass in the distal region of the right ureteral stump. He underwent right ureterectomy and bladder cuff resection. Pathological examination showed T1 and WHO grade 2 transitional cell carcinoma. At 6 months postoperatively, the patient is alive without any evidence of recurrence.
Aged ; Carcinoma, Transitional Cell/*diagnosis/pathology/surgery ; Cystoscopy ; Hematuria/urine ; Humans ; Kidney Diseases/*surgery ; Male ; Nephrectomy ; Tomography, X-Ray Computed ; Ureteral Neoplasms/*diagnosis/pathology/surgery

Today, Ureteroscopy is used for the diagnosis and treatment of various pathologies in the or urinary tract. From March 1987 to September 1996, we retrospectively evaluated our experiences with rigid ureteroscopy in 137 ureteral units in which therapeutic applications were 127 (92.7%) and diagnostic applications were 10 cases (7.3%). The causes ol therapeutic intervention were ureteral stones in 118 cases, upward migrated double J-stent in 6 cases, urethral foreign body (double J stent retention) in 2 cases and stenosis of ileoureteral anastomosis in 1 case. Success rate was 81.9% : 80.5% in the treatment of urethral stones, 100% in the treatment of urethral stenosis, 100% in the reposition or removal of retained catheter. Ureteroscopic stone extracton were performed in 77 cases (before introduction of ESWL) and in 41 cases (after introduction of ESWL). The latter was significantly decreased (78 of 288 or 32.4% versus 59 of 1588 or 3.7%). The success rate were 75.3% (58/77) before introduction of ESWL and 90.2% (37/41) after introduction of ESWL. The latter success rate was significantly increased. The causes of diagnostic intervention were upper tract bleeding in 2 cases, ureteral filling defect or delayed visualization at intravenous urography in 8 cases. The diagnostic results showed 1 case of ureteral transitional cell carcinoma, 1 case of ureteral stones, 1 case of urethral stricture, 3 cases of ureteral stones, 1 case of chronic ureteral inflammation and 3 cases of normal findings. Success rate was 90%. The frequency of diagnostic intervention increased from 1.3% for the 78 procedures done before introduction of ESWL to 15.3% for the 59 procedures done after introduction of ESWL. The minor complications (managed conservatively or with temporary stent drainage) occurred: flank pain in 35 cases (25.5%), gross hematuria in 10 cases (7.3%), high fever of over 38 degrees C in 5 cases (3.7%), ureteral perforations in 3 cases (2.2%) and urethral mucosal avulsion in 2 cases (1.5%). There were no major complications (all requiring an open surgery). In conclusion, after the introduction of ESWL the frequency of ureteroscpoic stone extraction decreased (p<0.05) and the frequency of diagnostic intervention increased (p<0.05). In the hands of experienced urologists the success rate of ureteroscopy increased.
Carcinoma, Transitional Cell ; Catheters ; Constriction, Pathologic ; Diagnosis ; Fever ; Flank Pain ; Foreign Bodies ; Hand ; Hematuria ; Hemorrhage ; Inflammation ; Pathology ; Retrospective Studies ; Stents ; Ureter ; Ureteroscopy* ; Urethral Stricture ; Urinary Tract ; Urography