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.

authors

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

keywords

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

summary

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.

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