PTU - Polskie Towarzystwo Urologiczne
list of articles:

Usefulness of histological homogeneity estimation of muscle-invasive urinary bladder cancer in an individual prognosis: a mapping study
Article published in Urologia Polska 2006/59/3.


Wojciech Jóźwicki 1, Jan Domaniewski 1, Zdzisław Skok 1, Zbigniew Wolski 2, Ewa Domanowska 1, Grażyna Jóźwicka 1
1 Katedra i Zakład Patomorfologii Klinicznej Collegium Medicum im. L. Rydygiera w Bydgoszczy, Uniwersytetu Mikołaja Kopernika w Toruniu
2 Katedra i Klinika Urologii Collegium Medicum im. L. Rydygiera w Bydgoszczy, Uniwersytetu Mikołaja Kopernika w Toruniu


bladder cancer, cystectomy, conventional differentiation, nonconventional differentiation, tumor biology, tumor biological stability, prognosis


Objectives. To examine the histological homogeneity of the muscle invasive urothelial cell carcinoma of the bladder, with conventional and nonconventional (eg, squamous, glandular, or variants) differentiation, to asses its influence on prognosis.
Material and methods. With organ mapping we, investigated 38 cystectomy specimens. Each entire bladder was cut into 88 slices according to an identical topographic scheme. From all the bladder slices, only 1231 slices that included tumor were chosen for histological study. We examined the diagnostic significance, extension and number of histological differentiation types.
Results. The extension of nonconventional differentiation, with any proportion of histological type, had an unfavourable impact on survival time. The number of nonconventional differentiation types increases in the presence of a sarcomatoid, an undifferentiated, a nested or a micropapillary pattern. The increased number of differentiation types had an unfavourable influence on survival time. Patients with a more than 80% classic urothelial cell carcinoma pattern had a favourable prognosis, which increases further with increasing percentage of this differentiation type.
Conclusions. Muscle-invasive urinary bladder cancers are not a homogenous group of tumors. Our results suggest that a precise assessment of the extension and number of histological differentiation types may be an individual prognostic factor. Conventional differentiation with at least 80% extension seems to be prognostically favourable. Nonconventional differentiation, especially with greater extension and a greater number of types, could imply a worse prognosis.


  1. 1. Hasui Y, Osada Y, Kitada S et al: Significance of invasion to the muscularis mucosae on the progression of superficial bladder cancer. Urology 1994, 43, 782-786.
  2. 2. Younes M, Sussman J, True LD: The usefulness of the level of the muscularis mucosae in the staging of invasive transitional cell carcinoma of the urinary bladder. Cancer 1990, 66, 543-548,
  3. 3. Cheng L, Weaver AL, Neumann RM et al: Substaging of T1 bladder carcinoma based on the depth of invasion as measured by micrometer: a new proposal. Cancer 1999, 86, 1035-1043.
  4. 4. Stein JP, Grossfeld GD, Ginsberg DA et al: Prognostic markers in bladder cancer: a contemporary review of the literature. J Urol 1998, 160, 645-659.
  5. 5. Colquhoun AJ, Jones GD, Moneef MA et al: Improving and predicting radiosensitivity in muscle invasive bladder cancer. J Urol 2003, 169, 1983-1992.
  6. 6. Michaelson MD, Shipley WU, Heney NM et al: Selective bladder preservation for muscle-invasive transitional cell carcinoma of the urinary bladder. Br J Cancer 2004, 90, 578-581.
  7. 7. Tiguert R, Lessard A, So A et al: Prognostic markers in muscle invasive bladder cancer. World J Urol 2002, 20, 190-195.
  8. 8. Eble JN, Sauter G, Epstein JI et al: WHO histological classification of tumours of the urinary tract, in Pathology and Genetics of Tumours of the Urinary System and Male Genital Organs. Lyon, IARC Press, 2004.
  9. 9. Lopez-Beltran A, Pacelli A, Rothenberg HJ et al: Carcinosarcoma and sarcomatoid carcinoma of the bladder: clinicopathological study of 41 cases. J Urol 1998, 159, 1497-1503.
  10. 10. Holmang S, Johansson SL: The nested variant of transitional cell carcinoma – a rare neoplasm with poor prognosis. Scand J Urol Nephrol 2002, 35, 102-105.
  11. 11. Johansson SL, Borghede G, Holmang S: Micropapillary bladder carcinoma: a clinicopathological study of 20 cases. J Urol 1999, 161, 1798-1802.
  12. 12. Lopez JI, Elorriaga K, Imaz I et al: Micropapillary transitional cell carcinoma of the urinary bladder. Histopathology 1999, 34, 561-562.
  13. 13. Maranchie JK, Bouyounes BT, Zhang PL et al: Clinical and pathological characteristics of micropapillary transitional cell carcinoma: a highly aggressive variant. J Urol 2000, 163, 748-751.
  14. 14. Tamboli P, Amin MB, Moshin SK et al: Plasmocytoid variant of non-papillary urothelial carcinoma. Mod Pathol 2000, 13, 116A.
  15. 15. Lopez-Beltran A, Martin J, Garcia J et al: Squamous and glandular differentiation in urothelial bladder carcinomas: histopathology, histochemistry and immunohistochemical expression of carcinoembryonic antigen. Histol Histopathol 1988, 3, 63-68.
  16. 16. Gronau S, Menz CK, Melzner I et al: Immunohistomorphologic and molecular cytogenetic analysis of a carcinosarcoma of the urinary bladder. Virchows Arch 2002, 440, 436-440.
  17. 17. Koss LG: Mapping of the urinary bladder: its impact on the concepts of bladder cancer. Hum Pathol 1979, 10, 533-548.
  18. 18. Talbert ML, Young RH: Carcinomas of the urinary bladder with deceptively benign-appearing foci: a report of three cases. Am J Surg Pathol 1989, 13, 374-381.
  19. 19. Jimenez RE, Gheiler E, Oskanian P et al: Grading the invasive component of urothelial carcinoma of the bladder and its relationship with progression-free survival. Am J Surg Pathol 2000, 24, 980-987.


Wojciech Jóźwicki
Katedra i Zakład Patomorfologii Klinicznej Collegium Medicum
ul. M. Skłodowskiej-Curie 9
85-094 Bydgoszcz
tel. (052) 585 42 05