nested variant of urothelial carcinoma

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 ?
Outcomes following radical cystectomy for nested variant of urothelial carcinoma: a matched cohort analysis.
(v) Nested variant of urothelial carcinoma of the bladder may resemble nephrogenic adenoma of the bladder but characteristically in nested variant of urothelial carcinoma there is cystic degeneration of nests and not a single layer and there is marked atypia [7].
(xi) Nested variant of urothelial carcinoma (Figures 4(c) to 4(f)) exhibits distinctive patterns in the superficial and deep portions of the tumour.
Nested variant of urothelial carcinoma. A rare histological variant [in Spanish].
Large nested variant of urothelial carcinoma: 23 cases mimicking von brunn nests and inverted growth pattern of noninvasive papillary urothelial carcinoma.
The nested variant of urothelial carcinoma is another important type of divergent differentiation for surgical pathologists to recognize because, despite its relatively bland cytologic features, its presence in invasive tumors is often associated with high-stage disease.
Florid von Brunn nests mimicking urothelial carcinoma: a morphologic and immunohistochemical comparison to the nested variant of urothelial carcinoma. Am J Surg Pathol 2003;27:1243-52http://dx.doi.org/10.1097/00000478-200309000-00008.
(4) The wormlike pattern of invasion seen in LGEESS is similar to that of infiltration seen in the large, nested variant of urothelial carcinoma. Distinguishing features between these entities in the bladder that favor large, nested variants of urothelial carcinoma include a desmoplastic response (typically not seen in ESS), cells with more abundant cytoplasm and distinct cell borders, and an in situ lesion, when present.
The most clinically significant differential diagnoses for pseudocarcinomatous hyperplasia include invasive high-grade urothelial carcinoma and the nested variant of urothelial carcinoma. This is highlighted by the fact that in the study of Kryvenko and Epstein, (2) up to 20% of their consultation cases came with a contributing diagnosis of neoplasia or carcinoma by the referring pathologist.
However, florid von Brunn nests, the nested variant of urothelial carcinoma, and urothelial carcinoma involving von Brunn nests can mimic adenocarcinoma.
However, keeping in mind a few of their histologic characteristics can help in proper identification and distinction from the nested variant of urothelial carcinoma, which is a high-grade carcinoma with a deceptively bland cytologic appearance.
Nephrogenic adenoma with focal solid and/or tubular pattern, especially with irregular borders and involving deep lamina propria/superficial muscularis propria, (10) may mimic certain urothelial carcinomas with deceptively bland features, such as the nested variant of urothelial carcinoma, urothelial carcinoma with small tubules, and microcystic urothelial carcinoma.
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