방광에 생긴 미세유두변이 요로상피세포암종의 임상 및 병리학적 분석 = Clinicopathologic Analysis of the Micropapillary Variant of Urothelial Carcinoma in Urinary

다국어 초록 (Multilingual Abstract)

Background : Micropapillary urothelial carcinoma of urinary bladder is a rare and aggressive
subtype of urothelial carcinoma (UC). Methods & Results : Seven UCs with a micropapillary
component (MPC) were identified by reviewing 135 cystectomy specimens of UC (5.2% in
incidence). MPC was associated with conventional UC in 6 cases and the plasmacytoid variant
of UC in 1 case. Lymph node metastasis, that characteristically contained MPC was present
in 60% (3 out of 5 cases of regional lymph node dissection). Three patients with extensive
MPC showed laminar propria invasion (pT1; 33%) and perivesical fat invasion (pT3; 67%).
Two out of 3 patients with extensive MPC showed distant metastasis into the colon after cystectomy.
The colonic lesions showed exclusively micropapillary differentiation. Four patients
with focal or moderate MPC (pT2, 25%; pT3, 75%) were alive without disease at the time of
writing this article. All 3 cases with extensive MPC had surface and/or invasive MPC on the
prior TURB specimen. Immunohistochemically, the tumor cells were positive for cytokeratin 7,
cytokeratin 20, EMA and E-cadherin and tissue retraction spaces that simulate lymphatic spaces
were negative for CD34 in all 7 cases. Conclusions : This study suggests that the micropapillary
growth pattern in UC is a manifestation of aggressive behavior and UC with MPC must
be included as part of the differential diagnosis when dealing with a metastatic lesion with a
micropaillary structure.

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