nested variant of urothelial carcinoma

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nested variant of urothelial carcinoma

A rare (less than 0.3% of invasive bladder tumours), deceptively bland yet clinically aggressive urothelial carcinoma, which affects older people, especially males.
 
Clinical findings
Haematuria (usually macroscopic), dysuria, frequency, nocturia. Despite NVUCs’ low-grade histology, they are bad actors which, given the typical delay in diagnosis, contributes to their more advanced local stage compared to conventional high-grade urothelial carcinoma.

Management
The optimal treatment for NVUCs is uncertain given its rarity—radical resection is recommended; chemo- and radiotherapy are completely ineffective.
 
Prognosis
Most patients die within 3 years.
References in periodicals archive ?
Nested urothelial carcinoma represents one of the more subtle patterns of invasive urothelial carcinoma.
Nested urothelial carcinoma. Cytologically bland tumor cells infiltrate as a disordered arrangement of crowded urothelial nests (hematoxylin-eosin, original magnification X40).
The nests of nested urothelial carcinoma are closely packed, with irregular borders, in contrast to VBNs, which are closely packed at the centre of the focus and may be scattered at the peripheral sides.
Nested urothelial carcinoma is a specific variant of invasive urothelial carcinoma in which the invasive urothelial nests are deceptively cytologically bland and mimic von Brunn nests (5); despite their bland cytologic features, nested urothelial carcinomas can often be deeply invasive.
Pathologists must be cognizant of this entity, as these urothelial nests can be quite extensive and can mimic an invasive urothelial carcinoma or a nested urothelial carcinoma. Unfortunately, as there are no immunostains or secondary studies that can help distinguish between pseudocarcinomatous hyperplasia and urothelial carcinoma, one must rely on distinguishing morphologic features.
Also useful is the presence of edematous inflammatory stroma in NA, in contrast to the desmoplastic/myxoid stroma commonly seen in nested urothelial carcinoma. The tubules of NA are lined by a single layer of cuboidal, columnar, or hobnail cells in contrast to the nests of urothelial calls in nested variant of urothelial carcinoma and the attenuated urothelial cells lining the tubules in the nested variant as well as urothelial carcinoma with small tubules.