RESUMO
OBJECTIVE: Ulceration is common in bladder tumors, but its prognostic role, although intuitive, is not established. We aim to explore the presence of gross ulceration and its relationship with other morphological and biological features classically associated with extravesical disease, in patients submitted to radical cystectomy. METHODS: Tumor size and morphology were noted on 101 cystectomy patients (2000-2010). Papillary, exophytic, and vegetant tumors were grouped as "papillary" and solid/nodular, ulcerated and infiltrative as "nonpapillary." Ulceration was noted grossly in every case as a binary parameter, regardless of morphology. Immunohistochemistry was performed for hypoxia (hypoxia-inducible factor-1α and vascular endothelial growth factor), and cell cycle proteins (pRb, p53, and cyclin D1). RESULTS: Mean age was 66.7 year, male:female ratio was 2:1, 20 patients received bacillus Calmette-Guerin and 10 neoadjuvant chemotherapy. Upstaging rate was 56.4%. Ulcerated lesions presented mostly as nonpapillary and nonorgan confined (nOC), whereas nonulcerated tumors were often papillary and organ confined (OC). Tumor size was smaller in nonpapillary tumors (P = 0.002), but did not associate with altered hypoxia or cell cycle expressions. pRb and cyclin D1 loss and p53 overexpression were more frequent in ulcerated and non-OC tumors as did the phenotype vascular endothelial growth factor-negative/hypoxia-inducible factor-1α-low (P<0.001). On a multivariate model, ulceration was an independent predictor of non-OC and extravesical disease. CONCLUSION: Patients with ulcerated tumors were often staged with extravesical disease, independent of other morphologic and biological features known to affect prognosis. Prospective studies are needed to confirm the predictive value of tumor ulceration at cystoscopy, which could improve patient stratification for neoadjuvant chemotherapy.
Assuntos
Carcinoma de Células de Transição/secundário , Cistectomia , Úlcera/etiologia , Neoplasias da Bexiga Urinária/patologia , Idoso , Antineoplásicos/uso terapêutico , Vacina BCG/uso terapêutico , Carcinoma de Células de Transição/química , Carcinoma de Células de Transição/complicações , Carcinoma de Células de Transição/terapia , Ciclo Celular , Hipóxia Celular , Terapia Combinada , Feminino , Humanos , Subunidade alfa do Fator 1 Induzível por Hipóxia/análise , Excisão de Linfonodo , Masculino , Pessoa de Meia-Idade , Terapia Neoadjuvante , Proteínas de Neoplasias/análise , Carga Tumoral , Úlcera/patologia , Neoplasias da Bexiga Urinária/química , Neoplasias da Bexiga Urinária/complicações , Neoplasias da Bexiga Urinária/terapia , Fator A de Crescimento do Endotélio Vascular/análiseAssuntos
Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Biomarcadores Tumorais/análise , Carcinoma de Células de Transição/química , Carcinoma de Células de Transição/tratamento farmacológico , Cistectomia , Fator Estimulador de Colônias de Granulócitos/uso terapêutico , Terapia Neoadjuvante/métodos , Substâncias Protetoras/uso terapêutico , Neoplasias da Bexiga Urinária/química , Neoplasias da Bexiga Urinária/tratamento farmacológico , Feminino , Humanos , MasculinoRESUMO
Basaloid squamous carcinoma (BSC) is an aggressive variant of squamous cell carcinoma (SCC) with a predilection for the upper aerodigestive tract. In the English literature, approximately 40 cases of BSC have been described in the oral cavity. BSC has frequently been confused with adenoid cystic carcinoma (ACC), basal cell adenocarcinoma, and undifferentiated SCC. The purpose of the investigation was to examine the histological features and immunohistochemical expression of differentiation-related substances, including cytokeratin (CK) subtypes, vimentin, S-100, chromogranin, laminin, and type IV collagen, for the characterization of biological features of these tumours. We studied three cases of BSC of the oral cavity, three cases of ACC, and one case of basal cell adenocarcinoma. Well-differentiated and undifferentiated SCCs were also studied for comparison. The BSCs showed many histopathologic similarities to cases previously reported. Among the CK subtypes analyzed, CK14 was the only subtype expressed by all basaloid cells of BSC. Potentially useful for the differential diagnosis was the finding of CKs 7 and 19 expression in the basaloid cells of ACC, and CKs 7 and 8 in basal cell adenocarcinoma. In BSCs, laminin and type IV collagen were found in the microcystic spaces between basaloid cells, but neither ACCs nor basal cell adenocarcinoma showed this feature. These data suggest that immunohistochemical findings are helpful in distinguishing BSC of the oral cavity from other histopathologically similar tumours.
Assuntos
Carcinoma de Células Escamosas/patologia , Carcinoma de Células de Transição/patologia , Neoplasias Bucais/patologia , Adenocarcinoma/química , Adenocarcinoma/diagnóstico , Adenocarcinoma/patologia , Carcinoma Adenoide Cístico/química , Carcinoma Adenoide Cístico/patologia , Carcinoma de Células Escamosas/química , Carcinoma de Células de Transição/química , Diagnóstico Diferencial , Humanos , Imuno-Histoquímica , Queratinas/análise , Neoplasias Bucais/químicaRESUMO
BACKGROUND: Transitional cell carcinoma of the cervix (TCCC) is a rare neoplasm of recent description. The cytologic characteristics of the tumor have not been published to date. Six cases of TCCC are described, including their clinical, histologic, cytologic and immunohistochemical features. CASES: All cases presented at an advanced clinical stage; two recurred, and one metastasized. Five cases showed a papillary exophytic pattern, and one case showed an "inverted" endophytic pattern similar to that of transitional cell carcinoma of the urothelium (TCCU). The cytokeratin profile was similar to that of squamous cell carcinoma of the cervix (SCCC), positive for CK 7 and negative for CK 20. The cervical smears showed a background that was necrotic or hemorrhagic. The cells with transitional features formed cohesive groups in a multilayered fashion and had an oval or spindle shape with tapered ends. The nuclei were hyperchromatic, with coarse and medium-sized granules that frequently displayed a wrinkled membrane, nuclear grooves and rare pseudoinclusions. The nucleoli were small or absent. Others cells with cytologic characteristics of SCCC were seen in all cases. CONCLUSION: TCCC is a rare neoplasm that probably represents a subgroup of SCCC. The most frequent histologic pattern is papillary-exophytic, but it can be inverted-endophytic. In cervical smears there are cells with characteristics of regular SCCC and others resembling those of TCCU. A larger number of cases is needed to define the evolution and clinical outcome.
Assuntos
Carcinoma de Células de Transição/patologia , Neoplasias do Colo do Útero/patologia , Adulto , Idoso , Biomarcadores Tumorais/análise , Carcinoma de Células Escamosas/química , Carcinoma de Células Escamosas/diagnóstico , Carcinoma de Células de Transição/química , Carcinoma de Células de Transição/diagnóstico , Nucléolo Celular/patologia , Núcleo Celular/patologia , Diagnóstico Diferencial , Feminino , Humanos , Imuno-Histoquímica , Queratinas/análise , Queratinas/imunologia , Pessoa de Meia-Idade , Estudos Retrospectivos , Neoplasias do Colo do Útero/química , Neoplasias do Colo do Útero/diagnósticoRESUMO
A case of basaloid squamous carcinoma that involves the posterior buccal mucosa is described. The major histopathologic feature is a carcinoma with a basaloid pattern in association with squamous differentiation. The basaloid cells exhibit large and vesicular nuclei and eosinophilic clear or vacuolated cytoplasm. Cells are distributed in cords, trabeculae, or lobules that occasionally show glandular arrangement. The majority of the tumor cells are positive for keratin and a large group of cells distributed in glandular arrangement are positive also for vimentin.
Assuntos
Carcinoma de Células Escamosas/patologia , Carcinoma de Células de Transição/patologia , Neoplasias Bucais/patologia , Adulto , Carcinoma de Células Escamosas/química , Carcinoma de Células de Transição/química , Humanos , Queratinas/análise , Masculino , Mucosa Bucal/patologia , Neoplasias Bucais/química , Vimentina/análiseRESUMO
Transitional cell carcinoma (TCC) of the bladder is a neoplasm with variability in its clinical behavior. Although there are several studies correlating stage and ABO isoantigen expression with invasiveness, there is no single predictor factor to assess the potential invasiveness, especially in the low grade, non-invasive TCC. In the present study we evaluated the correlation of histological grade plus stage and the expression of beta human chorionic gonadotropin (beta-hCG), in 100 cases of TCC, with the clinical behavior. These features were correlated with tumor progression in patients with at least two years of follow up. We observed more aggressiveness in G4 group (high grade and invasive) (93% had tumor progression) when compared to G1 group (low grade and superficial) (11% had tumor progression). However in 25.5% of the TCC cases (groups G2: low grade and invasive and G3: high grade and superficial) the clinical behavior was intermediate, showing some limitation in using grading and staging only, as a predictive factor. There was an expression of beta-hCG in 21.4% of the cases in up to 25% of the tumor cells without any trophoblastic morphology. These beta-hCG producing TCC had a strong correlation with aggressiveness: 39.1% and 12.8% of the TCC expressed beta-hCG with and without tumor progression, respectively.