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      Case of inverted papillary urothelial carcinoma in the ureter

      case-report

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          Abstract

          Introduction

          Urothelial neoplasms with a varus growth pattern are rare, and few urologists have encountered inverted urothelial carcinoma of the ureter.

          Case presentation

          An 82‐year‐old man was referred to our hospital for investigation of gross hematuria. Magnetic resonance imaging revealed nodules measuring 1–2 mm in diameter in the left upper ureter with slight reduction in signal intensity on diffusion‐weighted imaging. Ureteroscopy showed a pedunculated smooth tumor that had the appearance of an inverted papilloma rather than the papillary shape typical of urothelial carcinoma. The tumor was biopsied and histopathological examination revealed a noninvasive, low‐grade urothelial carcinoma with inverted multiple layers. Laparoscopic radical nephroureterectomy was subsequently performed, and a pedunculated tumor measuring 20 mm in diameter was found in the left upper ureter. The histopathological diagnosis was inverted papillary urothelial carcinoma, low‐grade, pTa, pN0.

          Conclusion

          This report provides the first clinical description of inverted papillary urothelial carcinoma of the ureter.

          Related collections

          Most cited references14

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          The 2016 WHO Classification of Tumours of the Urinary System and Male Genital Organs-Part B: Prostate and Bladder Tumours.

          It has been 12 yr since the publication of the last World Health Organization (WHO) classification of tumours of the prostate and bladder. During this time, significant new knowledge has been generated about the pathology and genetics of these tumours. Intraductal carcinoma of the prostate is a newly recognized entity in the 2016 WHO classification. In most cases, it represents intraductal spread of aggressive prostatic carcinoma and should be separated from high-grade prostatic intraepithelial neoplasia. New acinar adenocarcinoma variants are microcystic adenocarcinoma and pleomorphic giant cell adenocarcinoma. Modifications to the Gleason grading system are incorporated into the 2016 WHO section on grading of prostate cancer, and it is recommended that the percentage of pattern 4 should be reported for Gleason score 7. The new WHO classification further recommends the recently developed prostate cancer grade grouping with five grade groups. For bladder cancer, the 2016 WHO classification continues to recommend the 1997 International Society of Urological Pathology grading classification. Newly described or better defined noninvasive urothelial lesions include urothelial dysplasia and urothelial proliferation of uncertain malignant potential, which is frequently identified in patients with a prior history of urothelial carcinoma. Invasive urothelial carcinoma with divergent differentiation refers to tumours with some percentage of "usual type" urothelial carcinoma combined with other morphologies. Pathologists should mention the percentage of divergent histologies in the pathology report.
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            The 2004 WHO classification of bladder tumors: a summary and commentary.

            The key points of the latest World Health Organization (WHO) classification of non-invasive urothelial tumors are the following: the description of the categories has been expanded to improve their recognition; a tumor with particularly good prognosis (papillary urothelial neoplasm of low malignant potential) no longer carries the label of 'cancer'; it avoids the use of ambiguous grading such as grade 1/2 or 2/3 (as done in the 1973 WHO classification); the group of noninvasive high-grade carcinoma is large enough to virtually contain all those tumors having biological properties similar to those seen in invasive urothelial carcinoma, and a similarly high level of genetic instability. This scheme is meant to replace the 1973 WHO classification, but the use of both the 1973 and the latest WHO classifications is recommended until the latter is sufficiently validated.
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              Update for the practicing pathologist: The International Consultation On Urologic Disease-European association of urology consultation on bladder cancer.

              The International Consultations on Urological Diseases are international consensus meetings, supported by the World Health Organization and the Union Internationale Contre le Cancer, which have occurred since 1981. Each consultation has the goal of convening experts to review data and provide evidence-based recommendations to improve practice. In 2012, the selected subject was bladder cancer, a disease which remains a major public health problem with little improvement in many years. The proceedings of the 2nd International Consultation on Bladder Cancer, which included a 'Pathology of Bladder Cancer Work Group,' have recently been published; herein, we provide a summary of developments and consensus relevant to the practicing pathologist. Although the published proceedings have tackled a comprehensive set of issues regarding the pathology of bladder cancer, this update summarizes the recommendations regarding selected issues for the practicing pathologist. These include guidelines for classification and grading of urothelial neoplasia, with particular emphasis on the approach to inverted lesions, the handling of incipient papillary lesions frequently seen during surveillance of bladder cancer patients, descriptions of newer variants, and terminology for urine cytology reporting.
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                Author and article information

                Contributors
                tnirei@t01.itscom.net
                Journal
                IJU Case Rep
                IJU Case Rep
                10.1002/(ISSN)2577-171X
                IJU5
                IJU Case Reports
                John Wiley and Sons Inc. (Hoboken )
                2577-171X
                02 December 2021
                March 2022
                : 5
                : 2 ( doiID: 10.1002/iju5.v5.2 )
                : 95-98
                Affiliations
                [ 1 ] Department of Urology Yokohama City University Hospital Yokohama Japan
                [ 2 ] Department of Pathology Yokohama City University Hospital Yokohama Japan
                Author notes
                [*] [* ] Correspondence: Takuma Nirei M.D., Department of Urology, Yokohama City University Hospital, 3‐9 Fukuura, Kanazawa‐ku, Yokohama, Kanagawa 236‐0004, Japan. Email: tnirei@ 123456t01.itscom.net

                Author information
                https://orcid.org/0000-0002-6731-9388
                Article
                IJU512403
                10.1002/iju5.12403
                8888011
                35252788
                7d50bb35-6a19-4866-87b9-ba9d1b74ae41
                © 2021 The Authors. IJU Case Reports published by John Wiley & Sons Australia, Ltd on behalf of Japanese Urological Association.

                This is an open access article under the terms of the http://creativecommons.org/licenses/by-nc-nd/4.0/ License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non‐commercial and no modifications or adaptations are made.

                History
                : 17 September 2021
                : 23 June 2021
                : 11 November 2021
                Page count
                Figures: 4, Tables: 0, Pages: 4, Words: 2148
                Categories
                Case Report
                Case Reports
                Custom metadata
                2.0
                March 2022
                Converter:WILEY_ML3GV2_TO_JATSPMC version:6.1.2 mode:remove_FC converted:01.03.2022

                inverted papilloma,ureteral neoplasms,ureteroscopy,urologic neoplasms,urothelial carcinoma

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