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Histologic variants of infiltrating urothelial
carcinoma.
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| Article Type: | Letter to the editor |
| Subject: |
Immunohistochemistry
(Analysis) Adenocarcinoma (Diagnosis) Adenocarcinoma (Genetic aspects) Bladder cancer (Genetic aspects) Bladder cancer (Diagnosis) |
| Author: | Vardar, Enver |
| Pub Date: | 10/01/2008 |
| Publication: | Name: Archives of Pathology & Laboratory Medicine Publisher: College of American Pathologists Audience: Academic; Professional Format: Magazine/Journal Subject: Health Copyright: COPYRIGHT 2008 College of American Pathologists ISSN: 1543-2165 |
| Issue: | Date: Oct, 2008 Source Volume: 132 Source Issue: 10 |
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| Accession Number: | 230246823 |
| Full Text: |
To the Editor.--Because of the presence of a difficult case
requiring a differential diagnosis among primary adenocarcinoma of the
bladder, metastatic adenocarcinoma to the bladder, and primary
urothelial carcinoma showing glandular differentiation, I've
conducted a literature survey on bladder tumors. I found and read an original article, titled "Histologic Variants of Infiltrating Urothelial Carcinoma" by Zhai et al, (1) which had the sentence "Although urothelial carcinoma with glandular differentiation will show positive staining for CK7 and negative staining for villin, CDX2, and CK20, metastatic adenocarcinoma of the colon is CK7 negative and shows positive staining for villin, CDX2, and CK20, (10)" on page 1245. To my understanding, as a nonnative speaker of English, that means that, in urothelial carcinoma with glandular differentiation, CK20 staining is negative, as is villin and CDX2. Again, according to the same sentence, CK7 is negative, and villin, CDX2, and CK20 are positive in metastatic adenocarcinoma of the colon. While working on the case, I read another article, "Urothelial Carcinoma of the Urinary Bladder With a Component of Acinar/Tubular Type Differentiation Simulating Prostatic Adenocarcinoma," by Huang et al. (2) In this case report, it stated "Immunohistochemical studies revealed the acinar/tubular component of the tumor to be negative for prostate-specific antigen and prostatic acid phosphatase, but positive for cytokeratin 7, cytokeratin 20, high molecular weight cytokeratin (34pE12), and thrombomodulin, consistent with origin from the bladder rather than the prostate" in the abstract on page 769. Because of the presence of conflicting results related to immunohistochemical CK20 staining in urothelial carcinoma showing glandular differentiation, I reviewed the article used as a reference (reference 10) in the original article mentioned above: "Colonic Adenocarcinoma Metastatic to the Urinary Tract Versus Primary Tumors of the Urinary Tract With Glandular Differentiation: A Report of 7 Cases and Investigation Using a Limited Immunohistochemical Panel" by Tamboli et al. (3) In the conclusions section of the abstract, it states "We conclude that (1) villin is expressed in primary enteric-type adenocarcinoma of the urinary tract; (2) in difficult cases, urothelial carcinoma with glandular differentiation can be distinguished from colonic adenocarcinoma because the former is CK-7 positive, CK-20 positive, and villin negative, whereas the latter is CK-20 positive, villin positive, and CK-7 negative"; finally, I realized that urothelial carcinoma with glandular differentiation is CK20 positive. The information related to immunohistochemical CK20 staining was not given correctly in the Zhai et al (1) article. Also, the results related to the immunohistochemical CDX2 staining pattern, given in the same sentence, were not present in the original article cited as reference 10. Neither the staining pattern for CK20 nor the term CDX2 are used in the referenced article. I think that the CDX2 staining results should not have been present in the sentence by Zhai et al. (1) (1.) Zhai QJ, Black J, Ayala AG, Ro JY. Histologic variants of infiltrating urothelial carcinoma. Arch Pathol Lab Med. 2007;131:1244-1256. (2.) Huang Q, Chu PG, Lau SK, Weiss LM. Urothelial carcinoma of the urinary bladder with a component of acinar/tubular type differentiation simulating prostatic adenocarcinoma. Hum Pathol. 2004;35:769-773. (3.) Tamboli P, Mohsin SK, Hailemariam S, Amin MB. Colonic adenocarcinoma metastatic to the urinary tract versus primary tumors of the urinary tract with glandular differentiation: a report of 7 cases and investigation using a limited immunohistochemical panel. Arch Pathol Lab Med. 2002;126:1057-1063. The author has no relevant financial interest in the products or companies described in this article. Enver Vardar,MD SB Izmir Training Teaching Hospital Izmir, 35040, Turkey In Reply.--Thank you very much for your comments regarding our recent article.1 We agree that the following statement from our article, "Although urothelial carcinoma with glandular differentiation will show positive staining for CK7 and negative staining for villin, CDX2, and CK20, metastatic adenocarcinoma of the colon is CK7 negative and shows positive staining for villin, CDX2, and CK20, (10)" was incorrectly transcribed and should read as follows: "Urothelial carcinoma with glandular differentiation usually shows positive staining for CK7 and CK20 but negative staining for villin. In contrast, metastatic adenocarcinoma of the colon is CK7 negative and shows positive staining for villin and CK20." In our experience, CDX2 is negative in the relatively few cases of glandular variant urothelial carcinoma that we have stained but is positive in colonic adenocarcinoma. We agree that it is better not to mention CDX2 staining in this sentence not only because it is not pertinent to the referenced article but also because our experience with CDX2 in glandular variant urothelial carcinoma is limited and not confirmed in a larger series of cases. (2) Again, we appreciate your thoughtful review of our article and hope that our reply will clarify any confusion regarding this issue. (1.) Zhai QJ, Black J, Ayala AG, Ro JY. Histologic variants of infiltrating urothelial carcinoma. Arch Pathol Lab Med. 2007;131:1244-1256. (2.) Tamboli P, Mohsin SK, Hailemariam S, Amin MB. Colonic adenocarcinoma metastatic to the urinary tract versus primary tumors of the urinary tract with glandular differentiation: a report of 7 cases and investigation using a limited immunohistochemical panel. Arch Pathol Lab Med. 2002;126:1057-1063. The authors have no relevant financial interest in the products or companies described in this article. Qihui J. Zhai,MD Jennifer O. Black,MD Alberto G. Ayala,MD Jae Y. Ro, MD, PhD Weill Medical College of Cornell University at The Methodist Hospital Houston, TX 77030 |
| Gale Copyright: | Copyright 2008 Gale, Cengage Learning. All rights reserved. |
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