Nested and Large Nested Subtypes of Urothelial Carcinoma of the Upper Urinary Tract: A Multi-institutional Study

Aron, Manju; Chandrashekar, Darshan S.; Canete-Portillo, Soﬁa; Brimo, Fadi; Williamson, Sean R.; Osunkoya, Adeboye O.; Raspollini, Maria Rosaria; Kunju, Lakshmi P.; Varambally, Sooryanarayana; Mackinnon, Alexander C.; Harada, Shuko; Netto, George J.

doi:10.1016/j.modpat.2023.100333

Modern Pathology

2023

DOI: 10.1016/j.modpat.2023.100333

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Nested and Large Nested Subtypes of Urothelial Carcinoma of the Upper Urinary Tract: A Multi-institutional Study

Manju Aron,

Darshan S. Chandrashekar,

Soﬁa Canete-Portillo

et al.

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2024

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Cited by 3 publications

References 42 publications

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Metastatic upper tract urothelial carcinoma with nest‐like features presenting as malignant pleural effusion

Arienzo,

Valenti,

Ricci

et al. 2024

Diagnostic Cytopathology

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Metastatic urothelial carcinoma is a rare cause of pleural effusions. We report a case of urothelial carcinoma of the upper urinary tract in an oldest‐old male patient, a smoker, with situs inversus totalis, that presented uniquely with malignant pleural effusion at presentation without evidence of a primary tumor on imaging. Cytological smears of the massive left pleural effusion revealed epithelioid neoplastic cells arranged in short cords, small‐to‐large clusters, and raspberry‐like morules, mimicking mesothelioma; cell block preparations highlighted the presence of tubules and nest‐like structures. The tumor cells showed a high nuclear‐to‐cytoplasmic ratio, nuclear grooves, and mitotic figures. Cytomorphologic features coupled with the immunophenotype of neoplastic cells (p63, GATA3, and uroplakin II positive) allowed the diagnosis of metastatic urothelial carcinoma and a possible nested subtype. These findings were supported by a total body computed tomography (CT) showing no evidence of a mass in the bladder or elsewhere in the urinary tract but a concentric parietal thickening of the proximal left ureter, suggesting malignancy. To our knowledge, a malignant effusion as a primary manifestation of urothelial carcinoma with nest‐like features originating in the upper urinary tract has never been described previously. Our case focuses on the value of cell block in the working‐up of neoplastic effusions by revealing the architectural pattern of an uncommon malignancy and the correlation between cytopathology and imaging gross findings to reach an accurate diagnosis.

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Metastatic upper tract urothelial carcinoma with nest‐like features presenting as malignant pleural effusion

Arienzo,

Valenti,

Ricci

et al. 2024

Diagnostic Cytopathology

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Updates on Urothelial Carcinoma of the Upper Urinary Tract with a Focus on Molecular Findings

Eva,

Johannes,

Shahrokh

et al. 2024

Surgical Pathology Clinics

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Clinical and Pathological Features of the Nested Subtype of Urothelial Carcinoma With Lymph Node Metastasis as the Initial Presentation: A Case Report

Li,

Zhang,

et al. 2024

Clin Med�Insights�Pathol

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The nested subtype of urothelial carcinoma (NS-UC), a rare and aggressive bladder cancer, mimics benign bladder lesions but behaves like high-grade urothelial carcinomas. The author reported a rare case of NS-UC, initially presenting with inguinal lymph node metastasis. The tumor cells of NS-UC exhibit minimal cellular atypia, forming small nests, while the tumor cells of lymph node metastatic carcinoma show greater cellular atypia with diverse structures. Immunohistochemistry is helpful in determining the origin of lymph node metastatic carcinoma. NS-UC often presents morphologically similar to benign lesions, which should be given sufficient attention.

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Nested and Large Nested Subtypes of Urothelial Carcinoma of the Upper Urinary Tract: A Multi-institutional Study

Cited by 3 publications

References 42 publications

Metastatic upper tract urothelial carcinoma with nest‐like features presenting as malignant pleural effusion

Metastatic upper tract urothelial carcinoma with nest‐like features presenting as malignant pleural effusion

Updates on Urothelial Carcinoma of the Upper Urinary Tract with a Focus on Molecular Findings

Clinical and Pathological Features of the Nested Subtype of Urothelial Carcinoma With Lymph Node Metastasis as the Initial Presentation: A Case Report

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