Guo Charles C, Tamboli Pheroze, Czerniak Bogdan
Department of Pathology, University of Texas M. D. Anderson Cancer Center, Houston, TX 77030-4009, USA.
Arch Pathol Lab Med. 2009 Jan;133(1):62-6. doi: 10.5858/133.1.62.
Micropapillary urothelial carcinoma (MPUC) is a rare variant of urothelial carcinoma. Most studies of MPUC have focused on the urinary bladder, but MPUC of the upper urinary tract remains to be investigated.
To investigate the pathologic features and clinical significance of MPUC in the upper urinary tract.
We searched the pathology files at our institution and identified 11 cases of MPUC of the upper urinary tract. The histology slides were reviewed, and the clinical information was obtained by review of medical charts.
The average age of the patients was 64.2 years (range, 22-76 years). The tumors were located in the renal pelvis (n = 5), ureter (n = 4), and ureteropelvic junction (n = 2). In all cases, MPUC accounted for an average of 45% (range, 10%-80%) of the tumor and was associated with conventional urothelial carcinoma. Lymphovascular invasion was present in all cases, and metastasis to lymph node was present in 4 of 5 patients whose lymph nodes were dissected. Two patients presented with pT2 disease, and both were alive without evidence of disease at 85 and 119 months after surgery. The other 9 patients presented with pT3 or pT4 disease: 4 of them died of disease at an average of 18 months; 4 surviving patients developed distant metastases; and 1 surviving patient with limited follow-up (6 months) showed no evidence of disease.
Micropapillary urothelial carcinoma of the upper urinary tract often presents at an advanced stage with lymphovascular invasion and distant metastasis. The presence of MPUC, even focal, indicates a poor clinical course.
微乳头型尿路上皮癌（MPUC）是尿路上皮癌的一种罕见变体。大多数关于MPUC的研究都集中在膀胱，但上尿路MPUC仍有待研究。
探讨上尿路MPUC的病理特征及临床意义。
我们检索了本机构的病理档案，确定了11例上尿路MPUC病例。回顾了组织学切片，并通过查阅病历获取了临床信息。
患者的平均年龄为64.2岁（范围22 - 76岁）。肿瘤位于肾盂（n = 5）、输尿管（n = 4）和输尿管肾盂连接处（n = 2）。在所有病例中，MPUC平均占肿瘤的45%（范围10% - 80%），并与传统尿路上皮癌相关。所有病例均存在淋巴管侵犯，在5例接受淋巴结清扫的患者中，有4例发生淋巴结转移。2例患者表现为pT2期疾病，术后85个月和119个月时均存活且无疾病证据。其他9例患者表现为pT3或pT4期疾病：其中4例平均18个月死于疾病；4例存活患者发生远处转移；1例存活患者随访时间有限（6个月），无疾病证据。
上尿路微乳头型尿路上皮癌常表现为晚期，伴有淋巴管侵犯和远处转移。MPUC的存在，即使是局灶性的，也预示着临床病程不佳。
