Overview of Histopathologic Features in 191 Radical Cystectomy Specimens with Urothelial Carcinoma

Yıl 2007, Cilt: 14 Sayı: 2, 75 - 80, 01.04.2007

Ayşegül Sarı Murat Ermete Aylin Çallı Cengiz Girgin

Öz

Aim: All cases of urethelial carcinoma of the bladder undergoing radical cystectomy between 1997 January and 2005 December were retriewed from the files of İzmir Ataturk Training Hospital, Pathology department and reviewed. The aim of this study was to evaluate the histopathological features (such as tumor size, presence of carcinoma in-situ, infiltration of vesicula seminalis and prostatic gland, vascular invasion, perineural invasion, and lymph node status) of these 191 radical cystectomy specimens and to detect if there was a relation between these parameters. Material and Method: The tumours were staged according the TNM staging system and graded according to grading schema proposed by World Heath Organization. The relationship between pathologic stage and grade was analysed by Spearman correlation test. Mann Whitney U tests were used to determine the relation between stage and other parameters. Grade 1 and grade 2 tumors were gathered as one group and chi-square tests were performed to determine the relation between grade and other parameters. The relationship of the other parameters with each other were analysed by chi-square tests. Results: The male/ female ratio was 13/178, and the mean age was 61,3. The pathologic stages of the cases was as follows: 15% (n=29) pTa; 12% (n=23) pT1; 26,7% (n=51) pT2; 26,2% (n= 50) pT3; 19,9% (n=38) pT4. The grades of the tumors were as follows: 3% (n=6) grade I; 12% (n=23) grade II; 84,8 % (n=162) grade III. Lymphovascular invasion was seen in 33% (n=63) of patients and perineural invasion in 8% (n=15). Lymph node metastases was observed in 29,4% (n=35) of the 119 lymph nodes extracted cases. Cases with lymphovascular invasion, perineural invasion, vesicula seminalis infiltration or lymph node metastases were composed of muscle invasive and grade III tumors. Among 178 male patients, prostatic infiltration and vesicula seminalis infiltration was present in 13% (n=23) and %9,6 (n=17) of the cases respectively. Incidental adenocarcinoma of prostat was detected in 9% (n=16) of the specimens. Conclusions: There was a statistically significant relationship between tumoral pathologic stage and grade. High pathologic stage or grade III tumors had statistically significant correlation with the presence of lymphovascular invasion and lymph node metastases. Presence of lymphovascular invasion was found to be a risk factor for the lymph node metastases. All the tumors which showed vesicula seminalis infiltration were grade III and these tumors were statistically associated with the presence of lymphovascular invasion. Key words: Bladder carcinomas, Cystectomy, Urothelial carcinoma

Anahtar Kelimeler

Bladder carcinomas, Cystectomy, Urothelial carcinoma

Ürotelyal Karsinomlu 191 Olgunun Radikal Sistektomi Materyalinde Histopatolojik İnceleme

Öz

Amaç: Bu çalışmada 1997 Ocak -2005 Aralık yılları arasında İzmir Atatürk Eğitim ve Araştırma Hastanesi, Patoloji bölümünde ürotelyal karsinom tanısı alan 191 adet radikal sistektomi materyalinin histopatolojik özelliklerini (tümör boyutu, karsinoma insitu varlığı, vesiküla seminalis tutulumu, prostat tutulumu, lenfovasküler ve sinir invazyonu ile lenf nodu metastaz varlığı) değerlendirilerek, bu parametrelerin birbirleri ile ilişkisini araştırmak amaçlandı. Gereç ve Yöntem: Tümör evresi ve derece arasındaki ilişki spearman korelasyon analizi ile, evre ve diğer değişkenler arasındaki ilişki ise Mann-Whitney U testi ile değerlendirildi. Derece ile diğer parametreler arasındaki ilişki incelenirken derece 1 ve derece 2 tümörler bir grup altında birleştirilerek ki kare testi uygulandı. Diğer kategorik veri setlerinin karşılaştırılmasında ise ki-kare testi kullanıldı. Evrelemede TNM sınıflaması, Ürotelyal karsinomun derecelendirilmesinde ise Dünya Sağlık Örgütünün (WHO) sınıflaması kullanıldı. Bulgular: Yüzdoksanbir olgunun ( 13 kadın; 178 erkek) ortalama yaşı 61,3 idi. Olguların evrelere göre dağılımı: %15 (n=29) pT1; %12 (n=23) pT1; %26,7 (n=51) pT2; %26,2 (n= 50) pT3; %19,9 (n=38) pT4 şeklinde, derecelere göre dağılımı ise: %3 (n=6) derece I; % 12 (n=23) derece II; % 84,8 (n=162) derece III şeklinde idi. Olguların %33'ünde (n=63) lenfovasküler invazyon, %8'inde (n=15) ise sinir invazyonu vardı. Lenf nodu disseksiyonu uygulanmış 119 olgunun % 29,4'ünde (n=35) metastaz mevcuttu. Lenfovasküler invazyon, sinir invazyonu, vesikulo seminalis infiltrasyonu veya lenf nodu metastazı bulunan olguların tamamını kas invaziv ve derece III tümörler oluşturmaktaydı. Yüzyetmişsekis erkek olgunun % 13'ünde (n=23) prostat tutulumu, %9,6'sında (n=17) vesikula seminalis tutulumu gözlendi. Prostat insidental karsinomu ise 16 (%9) olguda izlendi. Sonuç : Tümör patolojik evresi ve derecesi arasında istatistiksel olarak anlamlı ilişki saptandı. İleri patolojik evreye sahip tümörler yanısıra derece III tümörlerde lenfovasküler invazyon ve lenf nodu metastazı bulunma olasılığının istatistiksel olarak arttığı izlendi. Lenfovasküler invazyonun lenf nodu metastazı için risk oluşturduğu gözlemlendi. Vesikulo seminalis infiltrasyonu olan tümörlerin hepsi derece III olup, bu olgularda lenfovasküler invazyon bulunma olasılığı istatistiksel olarak anlamlı derecede yüksek bulundu. Anahtar kelimeler: Mesane karsinomları, Sistektomi, Ürotelyal karsinom

Anahtar Kelimeler

Mesane karsinomları, Sistektomi, Ürotelyal karsinom

Kaynakça

• Zlotta AR, Schulman CC. Biological markers in superficial bladder tumors and their prognostic significance. Urol Clin North Am. 2000 Feb;27(1):179-89, xi-xii.
• Urologic Pathology, in Murphy WM, ed. 2nd ed. Philadelphia: WB Saunders Company; 1997, 64-115.
• Rosai and Ackerman's Surgical Pathology, in Rosai J ed. Volume 1. 9th ed. Philadelphia, Mosby; 2004, 1317-59.
• Manunta A, Vincendeau S, Kiriakou G, Lobel B, Guille F. Non-transitional cell bladder carcinomas. BJU Int. 2005 Mar;95(4):497-502.
• Stein JP, Grossfeld GD, Ginsberg DA, Esrig D, Freeman JA, Figueroa AJ, et al. Prognostic markers in bladder cancer: a contemporary review of the literature. J Urol. 1998 Sep;160(3 Pt 1):645-59.
• Lipponen PK, Eskelinen MJ, Kiviranta J, Pesonen E. Prognosis of transitional cell bladder cancer: a multivariate prognostic score for improved prediction. J Urol. 1991 Dec;146(6):1535-40.
• Kwak C, Ku JH, Park JY, Lee E, Lee SE, Lee C. Initial tumor stage and grade as a predictive factor for recurrence in patients with stage T1 grade 3 bladder cancer. J Urol. 2004 Jan;171(1):149-52.
• Chaudhary R, Bromley M, Clarke NW, Betts CD, Barnard RJ, Ryder WD, et al. Prognostic relevance of micro-vessel density in cancer of the urinary bladder. Anticancer Res. 1999 Jul-Aug;19(4C):3479-84.
• Wittekind C GF, Hutter PVR, Klimpfinger M, Sobin LH. TNM Atlas, Illustrated Guide to the TNM/pTNM classification of Malignant Tumors. Berlin Hiedelberg: Springer-Verlag , 2004.
• Mostofi FK SL, Torloni H. :Histologic typing of urinary bladder tumors , International Histological Classification of Tumors; World Health Organization , Geneva, 1973.
• Lapham RL, Grignon D, Ro JY. Pathologic prognostic parameters in bladder urothelial biopsy, transurethral resection, and cystectomy specimens. Semin Diagn Pathol. 1997 May;14(2):109-22.
• Dahm P PD. The role of cystectomy in the management of superficial bladder cancer. Urol Integr Invest. 2001;6(2):134-8.
• Reuter EV, Melamed RM. The Urothelial Tract: Renal Pelvis, Ureter, Urinary Bladder and Urethra, in Sternberg SS, ed. Diagnostic Surgical Pathology. Volume 2. 3rd ed. Philadelphia: Lipincott Williams & Walkins; 1999:1853-91.
• Abel PD. Prognostic indices in transitional cell carcinoma of the bladder. Br J Urol. 1988 Aug;62(2):103-9.
• Jimenez RE, Keane TE, Hardy HT, Amin MB. pT1 urothelial carcinoma of the bladder: criteria for diagnosis, pitfalls, and clinical implications. Adv Anat Pathol. 2000 Jan;7(1):13-25.
• Amin MB, Young RH. Intraepithelial lesions of the urinary bladder with a discussion of the histogenesis of urothelial neoplasia. Semin Diagn Pathol. 1997 May;14(2):84- 97.
• Murphy W, Beckwith BJ, Farrow G. Tumors of the kidney, bladder and related urinary structures, in Rosai J ed. Atlas of Tumor Pathology, Third series, fasicle 11. Armed Forces Institute of Pathology, Washington DC, 1994; 193-297.
• Daneshmand S, Stein JP, Lesser T, Quek ML, Nichols PW, Miranda G, et al. Prognosis of seminal vesicle involvement by transitional cell carcinoma of the bladder. J Urol. 2004 Jul;172(1):81-4.
• Volkmer BG, Kufer R, Maier S, Bartsch G, Jr., Bach D, Hautmann R, et al. Outcome in patients with seminal vesicle invasion after radical cystectomy. J Urol. 2003 Apr;169(4):1299-302.
• Hızlı F Aİ, Başay S, Benzer E, Uygur CM. Mesane kanseri nedeniyle radikal sistoprostatektomi yapılan hastalarda rastlantısal prostat kanser oranı. Türk Üroloji Dergisi. 2005;31(4):490-4.
• Romero RF DCG, Junior AA, Meneses de HA, Fernandes CR, Perez D.CM. Coexistence of Prostate neoplasia in patients undergoing radical cystoprostatectomy due to vesical neoplasia. International Braz J Urol. 2004;30(4):269-301.
• Moutzouris G, Barbatis C, Plastiras D, Mertziotis N, Katsifotis C, Presvelos V, et al. Incidence and histological findings of unsuspected prostatic adenocarcinoma in radical cystoprostatectomy for transitional cell carcinoma of the bladder. Scand J Urol Nephrol. 1999 Feb;33(1):27-30.
• Chun TY. Coincidence of bladder and prostate cancer. J Urol. 1997 Jan;157(1):65-7.
• Winfield HN, Reddy PK, Lange PH. Coexisting adenocarcinoma of prostate in patients undergoing cystoprostatectomy for bladder cancer. Urology. 1987 Aug;30(2):100-1.
• Abbas F, Hochberg D, Civantos F, Soloway M. Incidental prostatic adenocarcinoma in patients undergoing radical cystoprostatectomy for bladder cancer. Eur Urol. 1996;30(3):322-6.
• Montie JE, Wood DP, Jr., Pontes JE, Boyett JM, Levin HS. Adenocarcinoma of the prostate in cystoprostatectomy specimens removed for bladder cancer. Cancer. 1989 Jan 15;63(2):381-5.
• Lopez JI, Angulo JC. The prognostic significance of vascular invasion in stage T1 bladder cancer. Histopathology. 1995 Jul;27(1):27-33.
• Cheng L, Neumann RM, Scherer BG, Weaver AL, Leibovich BC, Nehra A, et al. Tumor size predicts the survival of patients with pathologic stage T2 bladder carcinoma: a critical evaluation of the depth of muscle invasion. Cancer. 1999 Jun 15;85(12):2638-47.
• Leissner J, Koeppen C, Wolf HK. Prognostic significance of vascular and perineural invasion in urothelial bladder cancer treated with radical cystectomy. J Urol. 2003 Mar;169(3):955-60.
• Soto EA, Friedell GH, Tiltman AJ. Bladder cancer as seen in giant histologic sections. Cancer. 1977 Feb;39(2):447-55.
• Nangia AK, Konety BR, Wachtel S, Dhir R, Becich MJ, Bahnson RR. Perineural invasion in transitional cell carcinoma and the effect on prognosis following radical cystectomy. Urology. 1997 Jun;49(6):968-72.