Clinical and pathological analysis of urothelial carcinoma with clear cell variant

Abstract

Objective To investigate the clinical and pathological features of urothelial carcinoma with clear cell variant. Methods The pathological and clinical data of 7 cases pathological diagnosed urothelial carcinoma with clear cell variant between March 2005 and May 2014 were retrospectively reviewed.There were 6 males and 1 female, aged 46–75 years (mean, 61 years). Clinical manifestations included gross hematuria in 5 cases, hematuria and backache in another 2 cases.The mean tumor size was 3.5 cm (ranged 2.0–6.0 cm). One case was multiple tumor and 6 cases were single tumor. Five cases were positive in urine cytology.All the 7 cases accepted surgical treatment, including radical nephroureterectomy in 2 cases, transurethral resection of bladder tumor plus pharmorubicin regular intravesicalinstillationin 1 case, and radical cystectomy in 4 patients. Results Pathological findings revealed that all the tumors were high-grade urothelial carcinoma with clear cell variant in different proportion.Among them, clear cell tumor was predominant in 1 case and focal in other 6 cases.Meanwhile, tumorsaccompanied by glandular differentiation were found in 2 cases, squamous differentiation was found in 1 case, and micropapillary variant was found in 1 case.Vascular tumor embolus was found in 4 cases.Pathological stage was pT2a (n=1), pT2b (n=3), and pT3a (n=3). Immunohistochemicalstaining revealed cytokeratin 7 (+ ), cytokeratin 20 (+ ), epithelial membrane antigen (+ )and prostate specific antigen (–). Six cases were followed up.The bladder preservation case was followed up for 8 months without recurrence.In 3 radical cystectomy cases, 1 died of cancer 25 months after surgery and another 2 case were followed up for 10 and 12 months after surgery without recurrence and metastasis.In 2 nephroureterectomy cases, 1 died of tumor metastasis 18 months after surgery and the other case was followed up for 6 months without recurrence or metastasis. Conclusions Urothelialcarcinoma with clear cell variant is a malignancy often with advanced stage and poor prognosis. Radical surgery is recommended for the treatment. Key words: Urinary bladder neoplasms; Urothelium; Pathology; Antineoplastic protocols