Advances in Urology

Review Article

Nested Variant of Urothelial Carcinoma

Table 1

A list of some of the reported cases of nested variant of urothelial carcinoma and their outcome.


Patient	Reference	Age/sex	Pathologic stage	AJCC stage	Treatment	Status	Follow-up	Associated CUC (WHO/ISUP 1998)

1	Lin et al. [7]	90/F	pT1	1	Cystectomy	NED	30	No

2	Lin et al. [7]	73/F	pT3b	III	Cystectomy + chemotherapy	NED	5	No

3	Lin et al. [7]	65/M	pT2b	IV	Cystectomy + chemotherapy	AWM	16	Flat CIS

4	Lin et al. [7]	70/M	pT3b	III	Cystectomy + chemotherapy	AWM	15	Flat CIS

5	Lin et al. [7]	61/M	pT3b	IV	Cystectomy + chemotherapy	NED	19	Flat CIS

6	Lin et al. [7]	80/M	pT3b	III	Cystectomy	NED	27	Flat CIS

7	Lin et al. [7]	66/M	pT1	I	Cystectomy	NED	22	No

8	Lin et al. [7]	53/M	pT1	I	Cystectomy	NED	19	No

9	Lin et al. [7]	51/M	pT2	IV	Radiotherapy	DOD	3	No

10	Lin et al. [7]	59/M	pT2a	II	Cystectomy	NED	24	No

11	Lin et al. [7]	42/F	pT2a	II	Cystectomy	NED	20	No

12	Lin et al. [7]	75/M	pT2a	I	TUR	NED	12	Low-grade papillary UC

13	Wang et al. [11]	49/F	G3pT4M1		Partial cystectomy; en bloc resection of distal ileum, caecum; resection of transplanted pancreas; right salpingo-oophorectomy; repair of ileocolostomy anastomosis; chemotherapy	DOD	12 months	Plus conventional high-grade TCC

14	Tatsura et al. [12]	70/M	G3pT3b Nx M0	>III	Bladder adherent and cystectomy abandoned; open bladder total layer biopsy + bilateral ureterocutaneostomy; chemotherapy	Alive with disease	12 months	Small tumour atypical cells positive for cytokeratin

15	Terada [13]	80/F	pT1		TUR	Alive with no tumour	6 months	Atypical cells forming nests and tubules in lamina propria without surface urothelial involvement

16	Terada [13]	78/M	pT1		TUR	Alive with no tumour	15 months	Atypical cells forming nests and tubules in lamina propria without surface urothelial involvement

17	De Berardinis et al. [14]	70/M	pT2aN+		TUR twice + BCG for initial conventional G3pT1b tumour and cystectomy + lymphadenectomy + chemotherapy for nested variant was started	Alive 12 months after initial diagnosis of conventional urothelial carcinoma	12 months after initial diagnosis and exact duration of follow-up after cystectomy not stated but patient just started on chemotherapy after cystectomy

18, 19, 20, 21, 22, 23, 24	Cardillo et al. [15]	5 M 2 F 7 cases Age range 53–90 years		3 stage 1; 2 stage II; 1 stage III; 1 stage IV with metastasis	6 patients with stages I to III tumours underwent cystectomy; 1 patient with stage IV tumour had radiotherapy	Follow-up outcome data not provided	Follow-up outcome data not provided in paper

25	Dundar et al. [16]	78/M	pT4N1		Cystoprostatectomy and chemotherapy planned but not given at time of publication	Alive	Follow-up data not available at time of publication

26	Dundar et al. [16]	56/M	pT2 at least		TURBT he refused radical cystoprostatectomy	Alive but had 3 recurrences of nested variant urothelial carcinoma resected over 23 months	23 months

27	Badoual et al. [17]	Details not available	Details not available in English	Details not available	Details not available to author	Details not available	Details not available	Details not available

28	Badoual et al. [17]	Details not available	Details not available	Details not available	Details not available	Details not available	Details not available	Details not available

29	Krishnamoorthy et al. [18]	45 F	pT1		TUR	Alive	No follow-up paper soon after TUR

30	Ozdemir et al. [19]	65 M	pT2 at least		TUR biopsy Further details of treatment not mentioned in paper	Alive no data provided on follow-up case reported after biopsy	Data not available

31	Holmäng and Johansson 2001 [20]	10 patients	Details not available to author		Details not available to author	7 died of disease or treatment complications (4 months–40 months); 1 died of unrelated cause after 90 months; follow-up ≤1 year for the remaining 2

32	Ooi et al. [21]	74/M		Bladder tumour with ureteric involvement	TUR + bilateral local resection of ureter and chemotherapy	Alive with tumour (partial response)	12 months

33–86	Linder et al. [22]	52 patients Mean age 69.5 years Range 62–74	36 (69%) with pT3-T4 10 (19%) with nodal invasion		All had radical cystectomy 8 had additional perioperative (15%) chemotherapy	Analysis in the comparison of patients with nested variant matched with a cohort of conventional urothelial carcinoma showed no significant differences in the 10-year local recurrence free survival (83% versus 80%, ) or 10-year cancer specific survival (41% versus 46%, )	Median follow-up 10.8 months Range 9.3–11.3

87	Tripodi et al. [23]	49/F	Renal pelvis pT1		Nephrectomy and upper ureterectomy	Alive	No long-term follow-up at time of publication

88	Cerda et al. [24]	53/M	pT3b pN1		TUR and radical cystoprostatectomy, radiotherapy, and chemotherapy	Died due to advanced metastatic disease	12 months

89	Cerda et al. [24]	83/F	pT2		TUR (surgical procedure not done due to advanced age)	Died of disease	3 years (36 months)

90	Yildiz et al. [25]	60/M	T2 at least (muscle invasion)		TUR further details in Turkish language	Not found in data

91	Pusztaszeri et al. [26]		Renal pelvis and ureter		Details not available to author	Details not available to author	Details not available to author

92	Lau [27]		Renal pelvis	Locally advanced	Details not available to author	Details not available to author	Details not available to author

93	Stern [1]	45/M	Details not available to author	Details not available to author	TUR	Alive tumour recurred 18 months later	18 months

94, 95, 96	Talbert and Young [3]	3 men Aged 53–73 years	Details not available to author		Details not available to author	Details not available to author

97, 98, 99, 100	Murphy and Deana [4]	4 cases	Details not available to author	Details not available to author	Details not available to author	Tumours persisted/recurred	Details not available to author

101–130	Wasco et al. [8]	30 cases Aged 41–83 years Average 63 Male-female 2.3 : 1	All but 1 invasive tumours (9% pT1; pT2-3a; 65% pT3b; 17% pT4)		All had cystectomy and 15 had cystectomy and chemotherapy	3 (10%) died of disease; 16 (55%) alive with persistent or recurrent disease; 10 (34%) alive without disease Response to chemotherapy observed in 2 (13%) of 15 patients	Follow-up in 29 patients (97%) with median 12 months (range 1–31 months)	Focal atypia in 90% and focal high-grade cytological atypia at tumour base in 40%

131–134	Young and Oliva [9]	4 patients Age range 70–85 years	Details not available to author		Details not available to author	Details not available to author		1 or more specimens were misinterpreted as benign

135–150	Drew et al. [10]	16 cases with marked male predominance	Details not available to author		Details not available to author	3 with no disease	Average follow-up 16.6 months	A few cells in every case with cytological atypia

151 and 152	Xiao et al. [28]	69/M 70/M	pT4 N1 pT2/3 + perineural and vascular invasion + Gleason 3 + 3 adenoca of prostate		Radical cystoprostatectomy and chemotherapy Radical cystoprostatectomy	Developed bone and soft tissue metastases in 4 months	4 months Lost to follow-up at 2 months	Focal urothelial CIS and multiple foci of urothelial atypia Focus of urothelial CIS

153	Huang et al. [29]	83/M	G3pT2-3		Cystoprostatectomy	Alive no long-term follow-up data available to author

154–164	Volmar et al. [30]	11 patients	5 pT2-3 N0 1 pT2-3 M1; 1 pT4 stage of remaining not available to author			Details not available to author	Details not available

165–174	Holmäng and Johansson [20]	10 patients	Details not available		Locoregional therapy	7 died of disease or treatment complications 4–40 months after diagnosis; 1 died of unrelated cause after 90 months; Follow-up ≤1 year for the remaining 2

175–177	Liedberg et al. [31]	3 patients		Advanced muscle-invasive 2 with lymph node involvement	Final outcome not available

178–200	Cox and Epstein [32]	23 cases Mean age 63.7 years; Range 39–89; 86% male	20 T2-T3 2 pT1 1a pT1b		18 had TURBT 2 nephroureterectomy 3 radical cystectomy	3 of 17 patients developed metastasis 2 lung 1 unknown with 2 of the 3 dead of disease; 1 patient died of disease with no known details	Follow-up for 17 patients Mean 43 months Range 5 months to 9 years

Abbreviations: M: male; F: female; NED: alive with no evidence of disease; AWM: alive with metastasis; DOD: dead of disease; CIS: carcinoma in situ; CUC: conventional urothelial carcinoma; TUR: transurethral resection of tumour; and Lin et al.: Lin O, Cardillo M, Dalbagni G, Linkov I, Hutchinson B, and Reuter V E. Nested variant of urothelial carcinoma: a clinicopathologic and immunohistochemical study of 12 cases. Modern Pathology 2003; 16(12): 1289-1298.