Thomas Seisen1, Eva Compérat, Priscilla Léon, Morgan Roupret. 1. aAcademic Department of Urology, La Pitié-Salpétrière, Assistance-Publique Hôpitaux de Paris; Faculté de Médecine Pierre et Marie Curie, Université Paris 6 bUniversity of Paris cAcademic Department of Pathology, La Pitié-Salpêtrière Hospital, Assistance Publique-Hôpitaux de Paris, Faculté de Médecine Université Paris 6, Paris, France.
Abstract
PURPOSE OF REVIEW: The scoring system used after transurethral resection of the bladder (TURB) to guide clinical decision-making regarding nonmuscle invasive bladder cancer (NMIBC) largely assumes that NMIBCs are pure urothelial carcinomas and does not take into account the role of variant histology. This review outlines pathological and clinical characteristics of major histological variants to determine their potential impact in therapeutic strategies for the management of NMIBC. RECENT FINDINGS: Assessing the presence of histological variants in NMIBCs after TURB currently remains challenging because of limited tissue sample sizes. However, the presence of these variants often indicates poor prognosis with increased risk for recurrence and progression. Among them, only the following histological variants are indications for Bacillus Calmette-Guerin intravesical instillations: squamous or glandular differentiations and deceptively benign or lymphoepithelioma-like carcinomas. However, patients diagnosed with any other variants should be promptly considered for early radical cystectomy, and only those with small cell carcinoma might benefit from neoadjuvant chemotherapy with a neuroendocrine-specific regimen. SUMMARY: Based on the available literature (e.g., small case studies and retrospective studies), the existence of histological variants after TURB appears to massively impact NMIBC outcomes.
PURPOSE OF REVIEW: The scoring system used after transurethral resection of the bladder (TURB) to guide clinical decision-making regarding nonmuscle invasive bladder cancer (NMIBC) largely assumes that NMIBCs are pure urothelial carcinomas and does not take into account the role of variant histology. This review outlines pathological and clinical characteristics of major histological variants to determine their potential impact in therapeutic strategies for the management of NMIBC. RECENT FINDINGS: Assessing the presence of histological variants in NMIBCs after TURB currently remains challenging because of limited tissue sample sizes. However, the presence of these variants often indicates poor prognosis with increased risk for recurrence and progression. Among them, only the following histological variants are indications for Bacillus Calmette-Guerin intravesical instillations: squamous or glandular differentiations and deceptively benign or lymphoepithelioma-like carcinomas. However, patients diagnosed with any other variants should be promptly considered for early radical cystectomy, and only those with small cell carcinoma might benefit from neoadjuvant chemotherapy with a neuroendocrine-specific regimen. SUMMARY: Based on the available literature (e.g., small case studies and retrospective studies), the existence of histological variants after TURB appears to massively impact NMIBC outcomes.
Authors: Marco Moschini; David D'Andrea; Stephan Korn; Yasin Irmak; Francesco Soria; Eva Compérat; Shahrokh F Shariat Journal: Nat Rev Urol Date: 2017-09-12 Impact factor: 14.432
Authors: Guglielmo Mantica; Stefano Tappero; Stefano Parodi; Nataniele Piol; Bruno Spina; Rafaela Malinaric; Federica Balzarini; Marco Borghesi; André Van Der Merwe; Nazareno Suardi; Carlo Terrone Journal: Cent European J Urol Date: 2021-09-09