Urinary bladder carcinoma with a neoplastic squamous component: a mapping study of 31 cases

A mapping study of cystectomy specimens in three cases of pure squamous cell carcinoma and 28 cases with transitional cell carcinoma with squamous differentiation is described, with an emphasis on the histogenesis of pure squamous cell carcinoma. Two of the three cases of pure squamous cell carcinoma had extensive benign keratinizing mucosa and an atypical squamous metaplastic mucosa contiguous with the tumour. These pure squamous cell carcinomas seemed to be derived from the squamous metaplasia. On the other hand, in all except one of the cases of transitional cell carcinoma with squamous differentiation, there was neither benign keratinizing nor atypical squamous metaplastic mucosa in the bladder. The quantitative amounts of both the transitional cell and squamous components differed from case to case in 28 cases with transitional cell carcinoma with squamous differentiation. Five of the 28 had a tumour composed predominantly of a squamous component with minute transitional cell components at the margin. In another two cases, transitional carcinoma in situ or satellite tumours of transitional cells were present adjacent to the main tumour which was composed of squamous cell carcinoma alone. We think these seven tumours originated as a result of extensive squamous differentiation in the transitional cell carcinomas. These features may indicate two forms of histogenesis of pure squamous cell carcinoma. The first is malignant transformation on the basis of squamous metaplasia of the bladder mucosa and the second is extensive squamous differentiation in a pre-existing transitional cell carcinoma.     

Expression of the epithelial L1 antigen as an immunohistochemical marker of squamous cell carcinoma of the lung

The distribution of epithelial L1 antigen was evaluated in 139 bronchogenic carcinomas which had been classified by a panel of pathologists according to the WHO recommendation of 1981. L1 was not found in three large cell and 13 small cell carcinomas, but it was expressed by tumour cells in 67 of 69 squamous cell carcinomas (97%), in three of four adenosquamous carcinomas (75%), and in three of 49 adenocarcinomas (6%). The staining for L1 antigen was more diffusely distributed in the positive adenocarcinomas than in the squamous cell carcinomas. Its expression in squamous cell carcinomas was typically confined to relatively small tumour cell groups and never included a complete specimen. Semi-quantitative estimation of the immunostaining showed no clear relationship to the degree of differentiation and scores for proliferation, but L1 expression was negatively related to nuclear aberration (P less than 0.025) and malignancy scores (P less than 0.002). The good agreement between morphological classification and expression of L1 makes this a valuable marker in the diagnosis of lung carcinomas.     

Molecular evidence for progression of nephrogenic metaplasia of the urinary bladder to clear cell adenocarcinoma

Nephrogenic metaplasia or nephrogenic adenoma of the urinary tract may present a diagnostic challenge in surgical pathology practice. Previous case reports suggest the possibility of nephrogenic metaplasia progressing to clear cell adenocarcinoma, but a malignant potential of nephrogenic metaplasia is generally not acknowledged. A case of a 70-year-old female patient with multiple recurrences of nephrogenic metaplasia of the urinary bladder and subsequent development of clear cell adenocarcinoma is described. Immunohistochemical studies help to differentiate the 2 entities. Results of molecular studies, particularly comparative genomic hybridization analysis, suggest clonal evolution of nephrogenic metaplasia to clear cell adenocarcinoma in this case.     

Carcinoma of the lung in Okinawa, Japan: With special reference to squamous cell carcinoma and squamous metaplasia

In Okinawa, a subtroplcal Island In southern Japan, squamous cell Carcinoma (SCC), especially the well-differentiated form, Is prevalent, while this form is relatively rare in both the mainland and other countries (e.g. United States of America). More patlents with SCC from Okinawa, moreover, were positive for human papillomavlrus (HPV) DNA by polymerase chain reaction (PCR) (79%), and harbored HPV types 6, 16 and 18, In combination. On the other hand, less than 30% of the mainland patlents were positive for HPV DNA by PCR. Those patients who were positive all harbored only one HPV type. Furthermore, in Okinawa, there were a signiflcant number of cases with adenosquamous carcinoma, and they too were positive for HPV DNA. The SCC and the adenocarcinoma cells adjacent to the SCC component In these cases were also positive for HPV DNA, and such adenocarcinoma cells were enlarged In size with relatively wide cytoplasm. The authors postulate that HPV infects adenocarcinoma cells and changes them to enlarged cells, followed by squamous metaplasla. In this report, HPV DNA was transfected to adenocarclnoma cells (cultured cell fines) and this showed that HPV causes squamous metaplasla. In addition, aberrant expression of p53 was demonstrated In a large number of the SCC cases In Okinawa. The enlarged adenocarclnoma cells adiacent to the SCC components In adenosquamous carcinomas also showed aberrant expression of p53.The recent advances In the studies of anti-oncogenes, p53, etc. and oncogenes are outlined. It Is to be noted that the molecular mechanisms of carcinogenesis in the lung have been studied In general, classifying lung tumors Into two groups, namely, small cell carcinoma (SCLC) and non-small cell carcinoma (NSCLC). However, because human lung cancer is represented by a wide variety of histological types, molecular genetic studies according to a more detailed histological subclasslflcatlon is needed.     

Primary squamous metaplasia of the breast

A case of primary or idiopathic squamous metapiasia of the breast occurring in a 45-year-old woman is presented. Immunohistochemical studies suggested that the metapiasia had arisen in ductular eplthellum. No evidence of neopiasia was identiffied.     

The histological and immunohistochemical evidence of squamous metaplasia from the myoepithelial cells in the breast

Squamous metaplasia in the breast is well documented. However, the putative cell of origin for the squamous epithelium is not clear. This paper describes a case of fibroadenoma of the breast with myoepithelial hyperplasia and squamous metaplasia. The histological finding of transition between myoepithelial cells and squamous cells and the immunohistochemical expressions of actin and S-100 in the metaplastic squamous cells support the myoepithelial origin of squamous epithelium in the breast.     

Double squamous cell carcinomas, verrucous type and poorly differentiated type, of the urinary bladder unassociated with bilharzial infection

A case of a 66-year-old Japanese woman with two synchronous urinary biadder tumors, namely verrucous carcinoma and poorly differentiated squmamous cell carcinoma, is described. Both tumors were accompanled by widespread squamous metaplasia in the background and unassociated with bilharzial infection. The poorly differentiated squamous cell carcinoma, having a satellite tumor in Its proximlty, was large and in an advanced stage. The verrucous carcinoma was small with minimal invasion to the muscuiaris propria. The boundary between both tumors was well defined, suggesting colliding growth appearance. Immunoexpression of cytokeratins of verrucous carcinoma was simllar to that of squamous metaplasia, and significant differences between verrucous carcinoma and poorly differentiated squamous cell carcinoma were demonstrated in thair immunoexpression of cytokeratins.     

The prognostic significance of morphometry in T1 bladder tumours

Only 3% of patients with T1 bladder tumours die of bladder carcinoma within 5 years (Williams, Hammonds & Saunders 1977), therefore these patients are initially treated conservatively. There would however be benefits from being able to predict which patients should be treated more aggressively. Morphometry was applied to quantitate characteristic microscopical features of the removed T1 tumours in 16 patients who had survived for five years and in seven patients dead from the tumour, in order to evaluate the prognostic value of this method. The measurements of nuclear and cytoplasmic areas were made on routine H & E sections with a graphic tablet (ASM, Leitz). Statistical analysis of the obtained data revealed that there were significant differences between the two groups. It indicated that morphometric parameters of T1 bladder tumours can have prognostic as well as therapeutic significance which will be further tested in a prospective study.     

Argentaffin cells, intestinal metaplasia and antral metaplasia in carcinoma of the gall bladder

The occurrence of argentaffin cells, intestinal metaplasia, and antral metaplasia has been studied in 20 gall bladders with carcinomas, in a papilloma, and in 20 specimens of cholelithiasis. Argentaffin cells were present in six carcinomas, but in only one specimen were they present in large numbers. Only one adenocarcinoma contained occasional argyrophil cells and no argentaffin or argyrophil cells were seen in the papilloma. Five of the 20 specimens of cholelithiasis contained occasional argentaffin cells. Intestinal and antral metaplasia were found in four carcinomas, in the papilloma, and in seven of the 20 specimens of cholelithiasis. It is suggested that metaplastic changes may play a role in the pathogenesis of carcinoma of the gall bladder.     

Coexistence of primary squamous cell carcinoma of thyroid with classic papillary thyroid carcinoma

Primary squamous cell carcinoma of the thyroid gland is very rare and its histogenesis is poorly defined so far. Although there have been some cases of squamous cell carcinoma with variant types of papillary thyroid carcinoma (PTC), the present case is the first primary squamous cell carcinoma with classic PTC to be reported. A 43‐year‐old woman presented with a 20 year history of neck mass. Neck ultrasound indicated a 6 × 4 × 3 cm large mass. The patient underwent total thyroidectomy. Histopathology indicated a well‐differentiated squamous cell carcinoma and squamous metaplasia in conjunction with classic PTC. On immunohistochemistry cytokeratin 7 was positive in papillary carcinoma and squamous metaplasia, thyroglobulin was positive only in papillary carcinoma, and p63 was positive in squamous metaplasia and squamous cell carcinoma. Postoperatively, the patient received 59.4 Gy adjuvant radiotherapy, hormonal therapy and radioactive iodine therapy. At 8 months after surgery the patient remained disease free.     

Recommendations for the reporting of urinary bladder specimens containing bladder neoplasms Association of Directors of Anatomic and Surgical Pathology

The Association of Directors of Anatomic and Surgical Pathology have developed recommendatlons for the surgical pathology repotting of common malignant tumors. The recommendations for carcinomas of the urinary bladder are reported herein.     

膀胱移行细胞癌中血型抗原Lewis A和Lewis X表达

目的　探讨血型抗原LewisA和LewisX在膀胱移行细胞癌中的表达及其诊断应用价值。方法　采用免疫组织化学EnVision方法 ,测定血型抗原LewisA和LewisX在 83例膀胱移行细胞癌和 6 8例非肿瘤性移行上皮黏膜中的表达 ,并收集10例膀胱癌及 10例正常人的尿脱落细胞标本进行LewisX免疫染色。结果　LewisA和LewisX在膀胱癌中的表达阳性率分别为 81 9% (6 8/ 83)和 83 1% (6 9/ 83) ,非肿瘤黏膜中的表达阳性率分别为 5 2 9% (36 / 6 8)和 11 8% (8/ 6 8)。LewisA和LewisX的表达强度与膀胱癌的病理分级和临床分期无关 (P >0 0 5 ) ,但膀胱癌的LewisA和LewisX表达强度高于非肿瘤黏膜 (P <0 0 5 )。 2 0例尿脱落细胞标本中 ,8例膀胱癌LewisX表达阳性 ,正常人组全部阴性。结论　LewisA和LewisX可成为诊断膀胱移行细胞癌的参考指标 ,特别是LewisX ,有助于低级别移行细胞癌的诊断     

血清SCCA水平及盆腔淋巴结HPV 16/18感染状况与宫颈鳞癌患者预后的关系

 摘要：目的 探讨术前血清SCCA水平、盆腔淋巴结HPV16/18感染状况与宫颈鳞癌患者预后的关系。方法 ELISA法检测血清SCCA水平,实时荧光定量PCR法检测盆腔淋巴结HPV16 /18感染,分析二者与宫颈鳞癌患者三年生存率的关系。结果 血清SCCA水平与盆腔淋巴结HPV16/18感染相关 (P<0.05)。35例宫颈鳞癌患者中位随访36个月（12～41月）,死亡4例,3年总体生存率为85.0%。血清SCCA阴性者和阳性者的3年生存率分别为100%和69.2%;盆腔淋巴结HPV16/18阴性者和阳性者的3年生存率分别为96.4%和57.1%;血清SCCA及盆腔淋巴结HPV16/18阴性患者的3年生存率明显优于阳性者（P<0.05）。淋巴结转移、血清SCCA和淋巴结HPV16/18与宫颈鳞癌患者的预后相关。结论 血清SCCA水平及盆腔淋巴结HPV 16/18感染状况与宫颈鳞癌患者预后相关,可作为宫颈鳞癌预后判断指标。     

Evaluation of endothelial markers in detecting blood and lymphatic channel invasion in pT1 transitional carcinoma of bladder

In a study of 40 patients with high-grade (G2 and G3) transitional cell carcinoma of bladder invading the lamina propria--stage pT1, retraction artifact was often misdiagnosed as vascular/lymphatic tumour invasion. Vascular/lymphatic infiltration was diagnosed in five cases based on haematoxylin and eosin stained sections, but confirmed in only two of these using immunohistochemical techniques to demonstrate endothelial markers. Of the latter, these preparations demonstrating von-Willebrand factor and binding the monoclonal antibody QBEND/10 were technically superior to those in which Ulex europaeus agglutinin 1 was used. It is unlikely that the demonstration of vascular/lymphatic infiltration, a rare feature, will prove of value in defining prognostic groups for treatment.     

Mucin histochemistry and lectin binding sites in intestinal metaplasia of the urinary bladder

We report a case of intestinal metaplasia of the bladder urothelium associated with dysplastic foci and a transitional cell carcinoma. A mixture of sialomucins, O -acetylated sialomucins and sulphomucins was found in the goblet cells. Neuraminidase resistant binding of the lectin peanut agglutinin was demonstrated in the brush border of columnar cells in intestinal metaplasia and diffusely in columnar cells in dysplastic foci. The histochemical findings are compared with those described in normal, dysplastic and neoplastic colonic mucosa.     

Transitional cell carcinomas of the ovary and bladder are immunophenotypically different

AIMS: Transitional cell carcinoma (TCC) of the ovary is a subtype of ovarian cancer whose main characteristic is its histological resemblance to TCC of the bladder. Thrombomodulin (TM), a surface glycoprotein commonly expressed in normal and neoplastic urothelium, has been proven to be a good marker for TCC of the bladder. To better define the phenotype of TCC of the ovary, we investigated TM, cytokeratin 20 and carcinoembryonic antigen (CEA) expression in 15 TCCs of the ovary and compared their phenotype with that of 20 TCCs of the bladder, and 20 serous and 10 endometrioid carcinomas of the ovary. METHODS AND RESULTS: Immunostaining was performed on formalin-fixed, paraffin-embedded tissue sections using the avidin-biotin-peroxidase complex method. All 20 TCCs of the bladder stained for TM and cytokeratin 20, and 13 stained for CEA. None of the TCCs of the ovary reacted for TM or cytokeratin 20, and only two expressed CEA. All of the serous and endometrioid carcinomas were negative for TM and cytokeratin 20. CEA positivity was observed in two of the serous carcinomas, but in none of the endometrioid carcinomas. CONCLUSION: The immunophenotype of TCC of the ovary is similar to that of other surface carcinomas of the ovary, but differs from that of TCC of the bladder. Since immunohistochemical procedures are often used in the diagnosis and classification of both primary and metastatic tumours, it is important to be aware of these differences in immunophenotype.     

A study of vesical adenocarcinoma, intestinal metaplasia and related lesions using mucin histochemistry

Biopsy and autopsy material from the urinary bladder was studied using PAS and PAS-D techniques to identify glycogen and neutral mucins, the alcian blue/high iron diamine method to distinguish sialo- and sulphamucins and the PB/KOH/PAS technique to localize O-acylated sialomucins. All of 10 examples of normal urothelium and both of two cases of transitional carcinoma in situ contained glycogen, but no mucin. Other lesions displayed one of two patterns of mucin production: the extracellular mucin seen focally in 17 cases of cystitis cystica consisted of sialo- and/or neutral mucins only, a pattern also displayed by mucins produced in 10 of 13 examples of transitional cell carcinomas and by three of nine tumours purely or in part adenocarcinomas. The intracellular mucins expressed in five of the 17 cases of cystitis glandularis and in all of eight cases of frank intestinal metaplasia with goblet cells displayed a colonic phenotype, with production of O-acylated sialomucins. A similar profile was expressed by six adenocarcinomas and this included tumours likely to be of vesical and also of urachal origin. It is concluded that identification of O-acylated mucins cannot distinguish between primary bladder tumours and metastases from a colonic primary, or between carcinomas of vesical and urachal origin.     

Inappropriate mucin production in gall bladder metaplasia and neoplasia–an immunohistological study

This study demonstrates the presence of three antigens in glandular metaplasia occurring in patients with cholecystitis and cholelithiasis: specifically carcinoembryonic antigen (CEA), large intestinal mucin antigen (LIMA) and small intestinal mucin antigen (SIMA). These antigens could not be detected in normal gall bladder mucosa or in squamous metaplasia of the gall bladder. The occurrence of the three intestine-associated antigens in three carcinomas was irregular. In one mucinous carcinoma, only SIMA could be demonstrated. In one adenocarcinoma, SIMA was present in small areas of mucinous change, whilst CEA was present in the nonmucinous malignant tissue. In a mixed mucinous and non-mucinous adenocarcinoma with widespread dissemination, the three antigens were present both in the primary tumour and the metastases. These observations suggest that all forms of glandular metaplasia of the gall bladder are intestinal in nature and at least a proportion of gall bladder carcinomas are of an intestinal type. Finally they provide further immunological evidence that glandular metaplasia of the gall bladder should be considered a pre-malignant condition.