An unusual presentation of a mixed epithelial and stromal tumor in an elderly male.

Mixed epithelial and stromal tumors (MESTs) of the kidney are rare renal neoplasms characterized by mixed cystic and solid components. These tumors are typically present in middle-aged women as a flank mass, or as a cause of flank pain or hematuria. We outline the case of an older male who presented with an enlarging abdominal mass causing symptoms that suggested a partial small bowel obstruction. Management of the patient and a brief review are discussed.

Utility of p63 and high molecular weight cytokeratin in the distinction between urothelial carcinoma with prostatic stromal invasion and urothelial carcinoma with colonisation of prostatic ducts and acini.

AIMS: To evaluate the utility of p63 and high molecular weight cytokeratin in the distinction between urothelial carcinoma with prostatic stromal invasion and urothelial carcinoma with colonisation of prostatic ducts and acini which may be challenging on H&E, especially for general pathologists who may occasionally encounter these cases. METHODS: A search of surgical pathology and consultation files was made for cystoprostatectomy specimens with confirmed urothelial carcinoma with prostatic stromal invasion. Intensity for both p63 and high molecular weight cytokeratin within the tumour cells were scored as negative/weak or strong. RESULTS: A total of 34 cases were identified, 23 (68%) of which had associated foci of urothelial carcinoma with colonisation of prostatic ducts and acini. Mean patient age was 68.5 years (range 44-88 years). In all cases, basal cells of benign prostatic glands showed strong staining for both p63 and high molecular weight cytokeratin. Seventeen of 34 cases (50%) of urothelial carcinoma showed no or weak expression of high molecular weight cytokeratin in the tumour cells. The other 17 cases (50%) of urothelial carcinoma showed strong expression of high molecular weight cytokeratin in the tumour cells. Fourteen of 34 cases (41%) showed negative or weak expression of p63 in tumour cells. Twenty of 34 cases (59%) showed strong expression of p63 in tumour cells. In the 14 of 34 cases (41%) and 17 of 34 cases (50%) which showed negative/weak expression of p63 and high molecular weight cytokeratin, respectively, in the tumour cells, the positive staining of the basal cells by p63 and high molecular weight cytokeratin in the benign prostatic glands and acini or those colonised by urothelial carcinoma, aided in the distinction from urothelial carcinoma with prostatic stromal invasion. In the remaining 20 of 34 cases (59%) and 17 of 34 cases (50%) in which the tumour cells showed strong expression of p63 and high molecular weight cytokeratin, respectively, larger malignant tumour cells and smaller benign basal cells of the prostatic glands and acini were highlighted with these markers, and were easily distinguishable. CONCLUSION: Our study suggests that p63 and high molecular weight cytokeratin may be utilised in the distinction between urothelial carcinoma with prostatic stromal invasion and urothelial carcinoma with colonisation of prostatic ducts and acini.

Urothelial carcinoma of the bladder with transmural and direct prostatic stromal invasion: does extent of stromal invasion significantly impact patient outcome?

Urothelial carcinoma of the bladder with prostatic stromal invasion is included in stage pT4a of the new 2010 American Joint Committee on Cancer/Tumor-Node-Metastasis classification. Despite being a strong indicator of poor prognosis, there have been few large studies investigating the impact of extent of prostatic stromal invasion on patient outcome. A search of the surgical pathology and expert consultation files at our institution was made for cystoprostatectomy specimens diagnosed as urothelial carcinoma with prostatic stromal invasion from 2002 to 2009. Cases were further stratified as follows: group 1--focal prostatic stromal invasion and group 2--extensive prostatic stromal invasion. Only patients who had surgery as monotherapy and those with available follow-up information were selected for this study. Thirty-five cases of urothelial carcinoma with prostatic stromal invasion and follow-up information were identified. Mean patient age was 70 years (range, 44-88 years). Of these 35 patients, 15 (43%) had focal prostatic stromal invasion and 20 (57%) had extensive prostatic stromal invasion. Angiolymphatic invasion was identified in 93% of group 1 cases and 79% of group 2 cases. Positive margins were identified in 50% of group 1 cases and 45% of group 2 cases. Incidence of nodal metastasis was 64% for group 1 and 60% for group 2. Four (27%) of 15 cases in group 1 and 6 (30%) of 20 cases in group 2 had various histologic variants identified. In group 1, there were 2 cases of urothelial carcinoma with micropapillary features and urothelial carcinoma with focal squamous differentiation. In group 2, there were 3 cases of urothelial carcinoma with focal squamous differentiation, 2 cases of urothelial carcinoma with focal sarcomatoid differentiation, and 1 case of urothelial carcinoma with focal micropapillary features. One- and 3-year overall survival for group 1 was 53% and 27%, respectively. One- and 3-year overall survival for group 2 was 47% and 12%, respectively. Mean survival was 17.4 and 16.3 months for groups 1 and 2, respectively. Overall survival curves did not show a statistically significant difference between the 2 groups from initial diagnosis (P = .889) and radical cystoprostatectomy (P = .369). Our study suggests that extent of prostatic stromal invasion by urothelial carcinoma of the bladder as an independent factor does not impact overall patient survival. Other well-known prognostic factors including positive margin status, presence of aggressive histologic variants of urothelial carcinoma, angiolymphatic invasion, and distant metastasis likely play more critical roles in predicting outcome in male patients who have urothelial carcinoma with prostatic stromal invasion.