Eble JN, Sauter G., Epstein JI, Sesterhenn IA - iarc

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Malignant fibrous histiocytoma J. Cheville Definition Malignant fibrous histiocytoma (MFH) is a malignant mesenchymal neoplasm occurring in the urinary bladder composed of fibroblasts and pleomorphic cells with a prominent storiform pattern. ICD-O code 8830/3 Synonym Undifferentiated high grade pleomorphic sarcoma. Epidemiology Malignant fibrous histiocytoma is one of the most frequent soft tissue sarcomas, and in some series, the second most frequent sarcoma of the urinary tract in adults {1410}. It is difficult to determine the incidence of urinary bladder malignant fibrous histiocytoma as it is likely that several tumours previously reported as malignant fibrous histiocytoma are sarcomatoid urothelial carcinoma. Malignant fibrous histiocytoma more frequently affects men, and is most common in patients in their 5th to 8th decade. Clinical features Patients present with haematuria. Macroscopy Similar to other sarcomas of the urinary bladder, most malignant fibrous histiocytomas are large but tumours as small as 1 cm have been reported. Histopathology All subtypes of malignant fibrous histiocytoma have been described involving the bladder including myxoid, inflammatory, storiform-fascicular, and pleomorphic {809,1410,1935}. Malignant fibrous histiocytoma must be separated from sarcomatoid urothelial carcinoma as well as reactive spindle cell proliferations of the bladder. The much more commonly encountered sarcomatoid urothelial carcinoma can be associated with a malignant epithelial component, and stains positively for the immunohistochemical markers of epithelial differentiation such as cytokeratin {1038,1555,2038}. In contrast, malignant fibrous histiocytoma is negative for cytokeratin, and can stain for alpha-1-antichymotrypsin, and CD68. Reactive spindle cell proliferations lack the cytologic atypia of malignant fibrous histiocytoma. A Prognosis The rarity of malignant fibrous histiocytoma makes it difficult to assess the biologic behaviour of these tumours. However, from the limited reports, malignant fibrous histiocytoma of the bladder appears aggressive with high local recurrence rates and metastases similar to malignant fibrous histiocytoma at other sites {809}. Treatment consists of resection, systemic chemotherapy and external beam radiation. The only patient with myxoid malignant fibrous histiocytoma of the bladder has been free to tumour following surgical resection, local radiation and systemic chemotherapy for 3 years {809}. B C Fig. 2.79 Malignant fibrous histiocytoma. A Pleomorphic type, showing its characteristic storiform growth pattern and histologically normal urothelium (right bottom). B Pleomorphic giant cells are a common finding in this high grade, pleomorphic type, malignant fibrous histiocytoma. C Some pleomorphic cells proliferating in this malignant fibrous histiocytoma were immunorreactive with Anti-Alpha-1-Antitrypsin antibody. D Virtually all proliferating cells in this case of malignant fibrous histiocytoma displayed immunorreactivity with anti-vimentin antibody. D Osteosarcoma / Malignant fibrous histiocytoma 143
Leiomyoma J. Cheville Definition A benign mesenchymal tumour occurring in the bladder wall showing smooth muscle differentiation. ICD-O code 8890/0 Epidemiology Leiomyoma of the urinary bladder is the most common benign mesenchymal neoplasm of the urinary bladder {908, 1255,1338}. Unlike sarcomas of the bladder, there is a predominance of females {908}. There is a wide age range from children to the elderly, but the vast majority of patients are middle-aged to older adults. Clinical features Patients present most frequently with obstructive or irritative voiding symptoms, and occasionally haematuria. Macroscopy Most leiomyomas are small with a mean A Fig. 2.80 A, B Lobulated giant leiomyoma. size less than 2 cm {1338}. Tumours up to 25 cm have been reported {908}. Grossly, the tumours are circumscribed, firm, and lack necrosis. Histopathology Histopathological features include well formed fascicles of smooth muscle. Leiomyoma of the bladder is circumscribed with low cellularity, lack of mitotic activity B and bland cytologic features {1639}. They are immunoreactive to smooth muscle actin and desmin. Prognosis Patients are treated by transurethral resection for small tumours, and open segmental resection for larger tumours. Surgical removal is curative in all cases. Other non-epithelial tumours J. Cheville Malignant mesenchymal neoplasms such as malignant peripheral nerve sheath tumour, liposarcoma, chondrosarcoma and Kaposi sarcoma can very rarely involve the bladder {1410}. The diagnosis of primary liposarcoma and malignant peripheral nerve sheath tumour of the bladder requires that bladder involvement by direct extension from another site be excluded. In the case of primary bladder osteosarcoma and chondrosarcoma, sarcomatoid carcinoma must be excluded. Solitary fibrous tumour of the bladder of the urinary bladder has recently been recognized {159,502,2808}. Solitary fibrous tumour of the bladder occurs in older patients who present with pain or haematuria. Two of the seven cases that have been reported were incidental findings {2808}. The tumour is typically a polypoid submucosal mass. Histopathologic features include spindle cells arranged haphazardly in a variably collagenous stroma. Dilated vessels reminiscent of haemangiopericytoma are present. Solitary fibrous tumour at other sites can act in an aggressive manner, but all solitary fibrous tumours of the bladder have had a benign course, although the number of cases is small, and follow-up has been short term in several cases. Fig. 2.81 Solitary fibrous tumour of urinary bladder. 144 Tumours of the urinary system
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World Health Organization Classific
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This volume was produced in collabo
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Contents 1 Tumours of the kidney 9
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CHAPTER 1 Tumours of the Kidney Can
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TNM classification of renal cell ca
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one quarter of kidney cancers in bo
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Familial renal cell carcinoma M.J.
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Table 1.02 Genotype - phenotype cor
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A B Fig. 1.11 A Multiple cutaneous
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A B Fig. 1.14 Birt-Hogg-Dubé syndr
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Clear cell renal cell carcinoma D.J
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Fig. 1.20 Clear cell renal cell car
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Papillary renal cell carcinoma B. D
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A B Fig. 1.29 Papillary renal cell
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Fig. 1.33 Chromophobe RCC with sarc
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Carcinoma of the collecting ducts o
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Renal medullary carcinoma C.J. Davi
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Renal carcinomas associated with Xp
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Renal cell carcinoma associated wit
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Papillary adenoma of the kidney J.N
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of this tumour. Microscopic extensi
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A B Fig. 1.59 Metanephric adenoma.
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esults in intratumoral aneurysms. O
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peritumoural fibrous pseudocapsule.
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increases in prevalence to approxim
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Nephrogenic rests and nephroblastom
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Cystic partially differentiated nep
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A B Fig. 1.80 Clear cell sarcoma of
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A B Fig. 1.85 Rhabdoid tumour of th
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transcription factor is fused to th
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Leiomyosarcoma S.M. Bonsib Definiti
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Angiomyolipoma G. Martignoni M.B. A
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melanocytic and smooth muscle marke
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Multinucleated and enlarged ganglio
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Haemangioma P. Tamboli Definition H
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Fig. 1.107 Juxtaglomerular cell tum
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Intrarenal schwannoma I. Alvarado-C
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Mixed epithelial and stromal tumour
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Synovial sarcoma of the kidney J.Y.
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Renal carcinoid tumour L.R. Bégin
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Primitive neuroectodermal tumour (E
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Paraganglioma / Phaeochromocytoma P
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Leukaemia A. Orazi Interstitial inf
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WHO histological classification of
Page 89 and 90: TNM classification of carcinomas of
Page 91 and 92: The risk of bladder cancer goes dow
Page 93 and 94: Tumour spread and staging Urinary b
Page 95 and 96: feature in such patients undergoing
Page 97 and 98: A Fig. 2.12 Infiltrative urothelial
Page 99 and 100: A Fig. 2.15 A Infiltrating urotheli
Page 101 and 102: A B Fig. 2.19 A Infiltrative urothe
Page 103 and 104: Fig. 2.23 Infiltrative urothelial c
Page 105 and 106: ing systems have been proposed on t
Page 107 and 108: Non-invasive urothelial tumours G.
Page 109 and 110: chronically inflamed urothelium and
Page 111 and 112: Inverted papilloma G. Sauter Defini
Page 113 and 114: muscle invasive disease, but there
Page 115 and 116: Fig. 2.42 Non-invasive urothelial n
Page 117 and 118: A Fig. 2.45 Non-invasive urothelial
Page 119 and 120: for DBCCR1 silencing {984,2476}. Th
Page 121 and 122: Squamous cell carcinoma D.J. Grigno
Page 123 and 124: Fig. 2.51 Squamous cell carcinoma.
Page 125 and 126: Adenocarcinoma A.G. Ayala P. Tambol
Page 127 and 128: A B Fig. 2.61 A Adenocarcinoma in s
Page 129 and 130: A B Fig. 2.65 Intramural urachal ca
Page 131 and 132: Müllerian origin is postulated for
Page 133 and 134: A Fig. 2.69 Small cell carcinoma. A
Page 135 and 136: Carcinoid L. Cheng Definition Carci
Page 137 and 138: Leiomyosarcoma J. Cheville Definiti
Page 139: Osteosarcoma L. Guillou Definition
Page 143 and 144: Haemangioma L. Cheng Definition Hae
Page 145 and 146: Metastatic tumours and secondary ex
Page 147 and 148: Tumours of the renal pelvis and ure
Page 149 and 150: nodular, ulcerative or infiltrative
Page 151 and 152: Tumours of the urethra F. Hofstädt
Page 153 and 154: usually show enteric, colloid or si
Page 155 and 156: CHAPTER 3X Tumours of of the the Pr
Page 157 and 158: TNM classification of carcinomas of
Page 159 and 160: contrast, mortality among migrants
Page 161 and 162: Fig. 3.06 Transrectal ultrasound of
Page 163 and 164: PSA-related diagnostic strategies.
Page 165 and 166: A B C Fig. 3.10 A,B Section of pros
Page 167 and 168: pale-clear, similar to benign gland
Page 169 and 170: A B Fig. 3.20 A, B Adenocarcinoma w
Page 171 and 172: prostate adenocarcinomas exhibit AR
Page 173 and 174: A Fig. 3.27 A, B Foamy gland adenoc
Page 175 and 176: A B Fig. 3.32 A Sarcomatoid carcino
Page 177 and 178: A B Fig. 3.37 A Gleason score 1+1=2
Page 179 and 180: A B Fig. 3.43 A Prostate cancer Gle
Page 181 and 182: Fig. 3.48 Heat map-nature. From S.M
Page 183 and 184: Fig. 3.51 Prostate cancer. Major su
Page 185 and 186: many stage T1b cancers. Stage T2 Mo
Page 187 and 188: Fig. 3.58 Patterns of seminal vesic
Page 189 and 190: Prostatic intraepithelial neoplasia
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A B Fig. 3.63 A Micropapillary high
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A B Fig. 3.68 A Ductal carcinoma in
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Ductal adenocarcinoma X.J. Yang L.
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Papillary pattern can be seen in bo
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A B Fig. 3.74 A Inflammation withou
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Squamous neoplasms T.H. Van der Kwa
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Neuroendocrine tumours P.A. di Sant
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Mesenchymal tumours J. Cheville F.
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Fig. 3.89 Sarcoma of the prostate.
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Miscellaneous tumours P.H. Tan L. C
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A Fig. 3.96 A Adenocarcinoma of the
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Introduction F.K. Mostofi I.A. Sest
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wartime birth cohorts illustrate th
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Similar tumours as those of group 1
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crucial for the development of this
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A B Fig. 4.09 Spermatocytic seminom
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A B Fig. 4.14 Intratubular germ cel
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A B Fig. 4.19 Seminoma. A Typical s
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Fig. 4.24 Seminoma. Vascular invasi
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Fig. 4.28 Spermatocytic seminoma wi
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A B Fig. 4.33 Embryonal carcinoma.
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A B Fig. 4.38 Yolk sac tumour. A En
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have cytoplasmic lacunae that conta
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A Fig. 4.46 Teratoma. A Longitudina
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A B Fig. 4.51 A Cut surface of derm
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Fig. 4.54 Mixed germ cell tumour. L
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Sex cord / gonadal stromal tumours
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A B C Fig. 4.67 Malignant Leydig ce
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A Fig. 4.73 A Sertoli cell tumour.
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ICD-O codes Granulosa cell tumour 8
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ICD-O code 8592/1 Clinical features
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A B Fig. 4.83 Germ cell-sex cord/go
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A Fig. 4.85 A, B Brenner tumour of
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typical grade III follicular morpho
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testicular parenchyma and tumour te
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A B the surgical scar and adjacent
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Immunoprofile Ordóñez and associa
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often have a grey-white cut surface
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Fig. 4.111 Angiomyofibroblastoma-li
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A B Fig. 4.119 Embryonal rhabdomyos
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Table 4.05 Secondary tumours of the
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A Fig. 5.04 A, B Squamous cell carc
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deformed by an exophytic mass. In s
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A B C Fig. 5.12 A Warty (condylomat
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A Fig. 5.20 Bowenoid papulosis. A,
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three had been circumcized by 9 yea
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Mesenchymal tumours J.F. Fetsch M.
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Fig. 5.31 Neurofibroma of the penis
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oectodermal tumour/Ewing sarcoma [p
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Secondary tumours of the penis C.J.
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Dr John N. EBLE* Dept. of Pathology
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Dr Ricardo PANIAGUA Department of C
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Source of charts and photographs 1.
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References 1. Anon. (1955). Case re
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115. Ariel I, Sughayer M, Fellig Y,
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246. Birt AR, Hogg GR, Dube WJ (197
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374. Cardone G, Malventi M, Roffi M
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502. Corti B, Carella R, Gabusi E,
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633. Donhuijsen K, Schmidt U, Richt
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768. Fischer J, Palmedo G, von Knob
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900. Goedert JJ, Cote TR, Virgo P,
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1028. Hartmann A, Dietmaier W, Hofs
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1424. Ladanyi M, Lui MY, Antonescu
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1548. Lopez-Beltran A, Croghan GA,
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1681. McLaughlin JK, Silverman DT,
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1945. Ohori M, Wheeler TM, Kattan M
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2070. Phillips G, Kumari-Subaiya S,
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2199. Riou G, Barrois M, Prost S, T
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2327. Schmidt L, Junker K, Weirich
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2450. Smith G, Elton RA, Beynon LL,
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2572. Tamboli P, Mohsin SK, Hailema
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2693. van Echten J, Timmer A, van d
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2816. Wick MR, Berg LC, Hertz MI (1
Page 347 and 348:
2937. Zhuang Z, Park WS, Pack S, Sc
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CCNB, 226 CCND1, 105, 108 CCND2, 22
Page 351 and 352:
J Juvenile type granulosa cell tumo
Page 353 and 354:
Promoter methylation, 21 Prostate s
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Eble JN, Sauter G., Epstein JI, Sesterhenn IA - iarc

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