Upper urinary tract inverted papillomas: Report of 10 cases

Luo, Jindan; Wang, Ping; Chen, Jun; Liu, Ben; Wang, Shuo; Shen, Bo-hua; Xie, Liping

doi:10.3892/ol.2012.706

Cited by 10 publications

(6 citation statements)

References 15 publications

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“…IUP of the upper urinary tract is a benign tumour with 68 cases described to date in the English literature. It usually manifests in middle-aged adults within the 6th or 7th decade of life, and males are more commonly affected than females [26].…”

Section: Discussionmentioning

confidence: 99%

“…Accurate preoperative diagnosis requires biopsy and visualisation through endoscopic examination. These procedures also provide therapeutic indications, thus avoiding unnecessary nephroureterectomy [26]. Due to the high likelihood of malignancy, preoperative biopsies were not carried out in our cases and patients underwent radical surgery.…”

Section: Discussionmentioning

confidence: 99%

“…Regarding treatment options, nephroureterectomy, local resection or partial ureterectomy with preservation of the kidney, and endoscopic surgery may be of use [65]. After excision, some authors recommend a followup protocol (endoscopy and radiographical studies) similar to that used in patients with low-grade urothelial carcinoma [26], while others do not advocate this rigorous and long-term follow-up due to the low risk of recurrence and favourable prognosis of IUP [66].…”

Section: Discussionmentioning

confidence: 99%

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Inverted urothelial papilloma of the upper urinary tract: description of two cases with systematic literature review

et al. 2020

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Background: Inverted urothelial papilloma (IUP) of the upper urinary tract is an uncommon benign tumour that occasionally presents as a polypoid mass causing urinary obstruction. Histologically, IUP is characterised by a proliferating urothelium arranged in cords and trabeculae, in continuity with overlying intact epithelium, and extending into the lamina propria in a non-invasive, endophytic manner. Cytological atypia is minimal or absent. Top differential diagnoses include urothelial carcinoma with inverted growth pattern and florid ureteritis cystica. Although urothelial carcinomas of the upper urinary tract with prominent inverted growth pattern commonly harbour microsatellite instability, the role of the mutator phenotype pathway in IUP development is still unclear. The aim of this study was to describe two additional cases of IUP of the upper urinary tract, along with an extensive literature review. Case presentation: We observed two polypoid tumours originating in the renal pelvis and the distal ureter, respectively. Both patients, a 76-year-old woman and a 56-year-old man, underwent surgery because of the increased likelihood of malignancy. Histology was consistent with IUP and patients are alive and asymptomatic after long-term follow-up (6 years for the renal pelvis lesion and 5 years for the ureter lesion). The tumours retained the expression of the mismatch-repair protein MLH1, MSH2, and PMS2 whereas loss of MSH6 was found in both cases. Conclusions: When completely resected, IUP does not require rigorous surveillance protocols, such as those for urothelial carcinoma and exophytic urothelial papilloma. It is therefore important for the surgical pathologist to be aware of this rare entity in order to ensure correct patient management.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Inverted urothelial papilloma of the upper urinary tract: description of two cases with systematic literature review

et al. 2020

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“…We speculate that these buds, to a small extent, mimic the phenotype of inverted papillomas, a rare human ureter disorder. In this disease, the ureteric urothelium extends cords of epithelial cells in away from the organ's lumen . In future, it may be informative to analyse expression of TGFβ axis molecules in these benign tumours.…”

Section: Discussionmentioning

confidence: 99%

Overactivity or blockade of transforming growth factor‐β each generate a specific ureter malformation

Lopes

Roberts

Zeef

et al. 2019

The Journal of Pathology

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Transforming growth factor- (TGF) has been reported to be dysregulated in malformed ureters. There exists, however, little information on whether altered TGF levels actually perturb ureter development. We therefore hypothesised that TGF has functional effects on ureter morphogenesis. Tgfb1, Tgfb2 and Tgfb3 transcripts coding for TGF ligands, as well as Tgfbr1 and Tgfbr2 coding for TGF receptors, were detected by quantitative polymerase chain reaction in embryonic mouse ureters collected over a wide range of stages. As assessed by in situ hybridisation and immunohistochemistry, the two receptors were detected in embryonic urothelia. Next, TGF1 was added to serum-free cultures of embryonic day 15 mouse ureters. These organs contain immature smooth muscle and urothelial layers and their in vivo potential to grow and acquire peristaltic function can be replicated in serum-free organ culture. Such organs therefore constitute a suitable developmental stage with which to define roles of factors that affect ureter growth and functional differentiation. Exogenous TGF1 inhibited growth of the ureter tube and generated cocoon-like dysmorphogenesis. RNA sequencing suggested that altered levels of transcripts encoding certain fibroblast growth factors (FGFs) followed exposure to TGF. In serum-free organ culture exogenous FGF10 but not FGF18 abrogated certain dysmorphic effects mediated by exogenous TGF1. To assess whether an endogenous TGF axis functions in developing ureters, embryonic day 15 explants were exposed to TGF receptor chemical blockade; growth of the ureter was enhanced, and aberrant bud-like structures arose from the urothelial tube. The muscle layer was attenuated around these buds, and peristalsis was compromised. To determine whether TGF effects were limited to one stage, explants of mouse embryonic day 13 ureters, more primitive organs, were exposed to exogenous TGF1, again generating cocoon-like structures, and to TGF receptor blockade, again generating ectopic buds. As for the mouse studies, immunostaining of normal embryonic human ureters detected TGFRI and TGFRII in urothelia. Collectively, these observations reveal unsuspected regulatory roles for endogenous TGF in embryonic ureters, fine-tuning morphogenesis and functional differentiation. Our results also support the hypothesis that the TGF up-regulation reported in ureter malformations impacts on pathobiology. Further experiments are needed to unravel the intracellular signalling mechanisms involved in these dysmorphic responses.

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“…6 The less common inverted form of the tumor typically occurs in the urinary bladder. [7][8][9][10] Clinicopathologic features and recurrence rates of inverted noninvasive urothelial papillary tumors have been poorly characterized to date with few larger studies evaluating longterm outcomes. According to the recommendations of the literature, patients diagnosed with papillary lesions of > 80% inverted histology were enrolled in the current study, but ensures that the patient population evinced a highly inverted morphology.…”

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confidence: 99%

Clinicopathologic Features of Noninvasive Inverted Urothelial Papillary Tumor

Liu

Wei

Tang

2023

American Journal of Clinical Oncology

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Objectives: Clinicopathologic features and recurrence rates of inverted noninvasive urothelial papillary tumors have been poorly characterized to date with few larger studies evaluating long-term outcomes. The spectrum of histomorphology, clinical features, and prognosis of inverted lesions of the urinary bladder are retrospectively reviewed.Methods: Archived paraffin-embedded urothelial tumor samples from patients diagnosed with inverted urothelial papillary lesions between January 2005 and June 2020 were collated. A matched control population of patients with exophytic papillary lesions of the urothelium diagnosed during the same time period was randomly selected. The conventional clinicopathologic features of inverted urothelial papillary tumor were evaluated retrospectively and patient demographics, tumor characteristics, recurrence, and survival information were recorded.Results: Lower recurrence rates were observed for inverted papillary urothelial neoplasm of low malignant potential (IPUNLMP) relative to papillary urothelial neoplasms of low malignant potential and for lowgrade papillary urothelial carcinoma with an inverted growth pattern (LG-PUCI) relative to low-grade papillary urothelial carcinomas. No recurrence was found among the inverted urothelial papilloma cases. The 2-and 5-year disease-free survival rates were 100.0% and 85.2% for IPUNLMP patients; 94.4% and 80.4% for papillary urothelial neoplasms of low malignant potential; 89.5% and 82.0% for LG-PUCI; 73.7% and 54.6% for low-grade papillary urothelial carcinoma; 40.0% and 20.0% for high-grade papillary urothelial carcinoma with an inverted growth pattern patients and 26.7% and 26.7% for high-grade papillary urothelial carcinoma. Multivariate Cox regression analysis of IPUNLMP and LG-PUCI/high-grade papillary urothelial carcinoma with an inverted growth pattern indicated that tumor number (hazard ratio = 4.356; 95% CI: 1.145-16.570; P = 0.031) was a powerful prognostic factor for disease-free survival. Conclusion:Noninvasive, papillary urothelial lesions of the bladder tend to have lower recurrence and a better outcome if an inverted growth pattern is shown.

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Upper urinary tract inverted papillomas: Report of 10 cases

Cited by 10 publications

References 15 publications

Inverted urothelial papilloma of the upper urinary tract: description of two cases with systematic literature review

Inverted urothelial papilloma of the upper urinary tract: description of two cases with systematic literature review

Overactivity or blockade of transforming growth factor‐β each generate a specific ureter malformation

Clinicopathologic Features of Noninvasive Inverted Urothelial Papillary Tumor

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