{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,11,11]],"date-time":"2025-11-11T15:53:20Z","timestamp":1762876400132,"version":"3.40.5"},"reference-count":28,"publisher":"PAGEPress Publications","issue":"3","license":[{"start":{"date-parts":[[2022,9,26]],"date-time":"2022-09-26T00:00:00Z","timestamp":1664150400000},"content-version":"unspecified","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Arch Ital Urol Androl"],"abstract":"<jats:p>Purpose: The aim of this study is to report our experience in managing bladder cancer in patients with variant pathology. Methods: Retrospective data collection for all patients managed by radical cystectomy over the last 3 years for a variant pathol-ogy was completed. We speci\ufb01cally included micropapillary and nested variants. Results: Ten patients were identi\ufb01ed, with eight having micropapillary carcinoma (MPC) and two having nested vari-ants. Nine patients were male. The median age was 75. The two patients with nested variant were 56 and 62 years old, respec-tively, whereas all patients with MPC were over the age of 70. Upon cystectomy of all micropapillary cases, three patients(37.5%) had positive lymph node invasion and the \ufb01nal patholo-gy was T2 (two patients), T3 (two patients), and T4 (four patients). Barring a grade III complication Clavien-Dindo classi-\ufb01cation due to wound dehiscence that necessitated secondary surgical closure, there were no speci\ufb01c perioperative complica-tions. Given the urethral invasion, cystourethrectomy was per-formed on the female patient. Within a median 13-month fol-low-up, three patients developed local recurrence, including two urethral and one new lateral pelvic mass. Conclusions: Considering the muscle invasive nature of micropapillary and nested bladder cancer, aggressive surgical management should not be postponed. Moreover, due to notable prevalence of concurrent and\/or recurrent urethral involvement, initial urethrectomy or early and frequent postoperative ure-throscopy should be provided. Patients with variant histology bladder cancer may bene\ufb01t from early radical cystectomy when compared to bladder sparing protocols and prostate sparing cystectomy treatment options.\u00a0<\/jats:p>","DOI":"10.4081\/aiua.2022.3.291","type":"journal-article","created":{"date-parts":[[2022,9,26]],"date-time":"2022-09-26T14:36:12Z","timestamp":1664202972000},"page":"291-294","source":"Crossref","is-referenced-by-count":4,"title":["Radical cystectomy for bladder urothelial carcinoma with aggressive variant histology"],"prefix":"10.4081","volume":"94","author":[{"given":"Vahid","family":"Mehrnoush","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Logan","family":"Brennan","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Asmaa","family":"Ismail","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ahmed","family":"Zakaria","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hazem","family":"Elmansy","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Walid","family":"Shahrour","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Owen","family":"Prowse","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1484-1332","authenticated-orcid":false,"given":"Ahmed","family":"Kotb","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"2549","published-online":{"date-parts":[[2022,9,26]]},"reference":[{"key":"59328","doi-asserted-by":"crossref","unstructured":"Chalasani V, Chin JL, Izawa JI. Histologic variants of urothelial bladder cancer and nonurothelial histology in bladder cancer. Can Urol Assoc J. 2009; 3(6 Suppl 4):193-198.","DOI":"10.5489\/cuaj.1195"},{"key":"59329","doi-asserted-by":"crossref","unstructured":"Humphrey PA, Moch H, Cubilla AL, et al. The 2016 WHO Classification of tumours of the urinary system and male genital organs-part B: prostate and bladder tumours. Eur Urol. 2016; 70:106-119.","DOI":"10.1016\/j.eururo.2016.02.028"},{"key":"59330","doi-asserted-by":"crossref","unstructured":"Burger M, Kamat AM, McConkey D. Does variant histology change management of non-muscle-invasive bladder cancer? Eur Urol Oncol. 2021; 4:510-514.","DOI":"10.1016\/j.euo.2019.06.012"},{"key":"59331","doi-asserted-by":"crossref","unstructured":"Shapur NK, Katz R, Pode D, et al. Is radical cystectomy manda-tory in every patient with variant histology of bladder cancer. Rare Tumors. 2011; 3:e22.","DOI":"10.4081\/rt.2011.e22"},{"key":"59332","doi-asserted-by":"crossref","unstructured":"Barata PC, Rini BI. Treatment of renal cell carcinoma: Current sta-tus and future directions. CA Cancer J Clin. 2017; 67:507-524.","DOI":"10.3322\/caac.21411"},{"key":"59333","doi-asserted-by":"crossref","unstructured":"Sefik E, Celik S, Basmaci I, et al. Effect of variant histology pres-ence and squamous differentiation on oncological results and patient's survival after radical cystectomy. Arch Ital Urol Androl. 2018; 90:172-175.","DOI":"10.4081\/aiua.2018.3.172"},{"key":"59334","doi-asserted-by":"crossref","unstructured":"Pereira JN, Reis JD, Braga I, et al. Variant histologies of urothelial carcinoma: Does it change the survival outcomes in patients managed with radical cystectomy? Arch Ital Urol Androl. 2022; 94:138-143.","DOI":"10.4081\/aiua.2022.2.138"},{"key":"59335","doi-asserted-by":"crossref","unstructured":"Black AJ, Black PC. Variant histology in bladder cancer: diagnos-tic and clinical implications. Transl Cancer Res. 2020; 9:6565-6575.","DOI":"10.21037\/tcr-20-2169"},{"key":"59336","doi-asserted-by":"crossref","unstructured":"Vetterlein MW, Wankowicz SAM, Seisen T, et al. Neoadjuvant chemotherapy prior to radical cystectomy for muscle-invasive blad-der cancer with variant histology. Cancer. 2017; 123:4346-4355.","DOI":"10.1002\/cncr.30907"},{"key":"59337","doi-asserted-by":"crossref","unstructured":"Choi W, Porten S, Kim S, et al. Identification of distinct basal and luminal subtypes of muscle-invasive bladder cancer with different sen-sitivities to frontline chemotherapy. Cancer Cell. 2014; 25:152-165.","DOI":"10.1016\/j.ccr.2014.01.009"},{"key":"59338","doi-asserted-by":"crossref","unstructured":"Horwich A, Babjuk M, Bellmunt J, et al. EAU\u2013ESMO consensus statements on the management of advanced and variant bladder can-cer\u2014an international collaborative multi-stakeholder effort: under the auspices of the EAU and ESMO Guidelines Committees. Ann Oncol. 2019; 30:1697-1727.","DOI":"10.1093\/annonc\/mdz296"},{"key":"59339","doi-asserted-by":"crossref","unstructured":"Comp\u00e9rat E, Roupret M, Yaxley J, et al. Micropapillary urothe-lial carcinoma of the urinary bladder: a clinicopathological analysis of 72 cases. Pathology. 2010; 42:650-654.","DOI":"10.3109\/00313025.2010.522173"},{"key":"59340","doi-asserted-by":"crossref","unstructured":"Ramos P, Pereira P, Dinis P, Pacheco-Figueiredo L. Bladder can-cer variant histologies: epidemiology, diagnosis, treatment and prog-nosis. In Ed F. Ziglioli Modern approach to diagnosis and treatment of bladder cancer. IntechOpen 2021.","DOI":"10.5772\/intechopen.98246"},{"key":"59341","doi-asserted-by":"crossref","unstructured":"Berg S, D\u2019Andrea D, Vetterlein MW, et al. Impact of adjuvant chemotherapy in patients with adverse features and variant histology at radical cystectomy for muscle-invasive carcinoma of the bladder: Does histologic subtype matter? Cancer. 2019; 125:1449-1458.","DOI":"10.1002\/cncr.31952"},{"key":"59342","doi-asserted-by":"crossref","unstructured":"Lobo N, Shariat SF, Guo CC, et al. What is the significance of variant histology in urothelial carcinoma? Eur Urol Focus. 2020; 6:653-663.","DOI":"10.1016\/j.euf.2019.09.003"},{"key":"59343","doi-asserted-by":"crossref","unstructured":"Sui W, Matulay JT, James MB, et al. Micropapillary bladder can-cer: insights from the National Cancer Database. Bladder Cancer. 2016; 2:415-423.","DOI":"10.3233\/BLC-160066"},{"key":"59344","doi-asserted-by":"crossref","unstructured":"Black PC, Brown GA, Dinney CPN. The impact of variant his-tology on the outcome of bladder cancer treated with curative intent. Urol Oncol. 2009; 27:3-7.","DOI":"10.1016\/j.urolonc.2007.07.010"},{"key":"59345","doi-asserted-by":"crossref","unstructured":"Chua KLM, Kusumawidjaja G, Murgic J, Chua MLK. Adjuvant treatment following radical cystectomy for muscle-invasive urothelial carcinoma and variant histologies: Is there a role for radiotherapy?ESMO open. 2016; 1:e000123.","DOI":"10.1136\/esmoopen-2016-000123"},{"key":"59346","doi-asserted-by":"crossref","unstructured":"Honma I, Masumori N, Sato E, et al. Local recurrence after rad-ical cystectomy for invasive bladder cancer: an analysis of predictive factors. Urology. 2004; 64:744-748.","DOI":"10.1016\/j.urology.2004.05.003"},{"key":"59347","doi-asserted-by":"crossref","unstructured":"Zaghloul MS, Awwad HK, Akoush HH, et al. Postoperative radiotherapy of carcinoma in bilharzial bladder: improved disease free survival through improving local control. Int J Radiat Oncol Biol Phys. 1992; 23:511-517.","DOI":"10.1016\/0360-3016(92)90005-3"},{"key":"59348","doi-asserted-by":"crossref","unstructured":"Lewis GD, Haque W, Verma V, et al. The role of adjuvant radia-tion therapy in locally advanced bladder cancer. Bladder Cancer. 2018; 4:205-213.","DOI":"10.3233\/BLC-180163"},{"key":"59349","doi-asserted-by":"crossref","unstructured":"Willis DL, Fernandez MI, Dickstein RJ, et al. Clinical outcomes of cT1 micropapillary bladder cancer. J Urol. 2015; 193:1129-1134.","DOI":"10.1016\/j.juro.2014.09.092"},{"key":"59350","doi-asserted-by":"crossref","unstructured":"Venyo AK. Nested variant of urothelial carcinoma. Adv Urol. 2014; 2014:192720.","DOI":"10.1155\/2014\/192720"},{"key":"59351","doi-asserted-by":"crossref","unstructured":"Warrick JI. Clinical significance of histologic variants of bladder cancer. J Natl Compr Canc Netw. 2017; 15:1268-1274.","DOI":"10.6004\/jnccn.2017.7027"},{"key":"59352","doi-asserted-by":"crossref","unstructured":"Aron M. Variant histology in bladder cancer-current understand-ing of pathologic subtypes. Curr Urol Rep. 2019; 20:80.","DOI":"10.1007\/s11934-019-0949-6"},{"key":"59353","doi-asserted-by":"crossref","unstructured":"Lopez-Beltran A, Henriques V, Montironi R, et al. Variants and new entities of bladder cancer. Histopathology. 2019; 74:77-96.","DOI":"10.1111\/his.13752"},{"key":"59354","doi-asserted-by":"crossref","unstructured":"Beltran AL, Cheng L, Montironi R, et al. Clinicopathological characteristics and outcome of nested carcinoma of the urinary blad-der. Virchows Arch. 2014; 465:199-205.","DOI":"10.1007\/s00428-014-1601-y"},{"key":"59355","doi-asserted-by":"crossref","unstructured":"Linder BJ, Frank I, Cheville JC, et al. Outcomes following radical cystectomy for nested variant of urothelial carcinoma: a matched cohort analysis. J Urol. 2013; 189:1670-1675.","DOI":"10.1016\/j.juro.2012.11.006"}],"container-title":["Archivio Italiano di Urologia e Andrologia"],"original-title":[],"link":[{"URL":"https:\/\/www.pagepressjournals.org\/index.php\/aiua\/article\/download\/aiua.2022.3.291\/10341","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/www.pagepressjournals.org\/index.php\/aiua\/article\/download\/aiua.2022.3.291\/10341","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2022,9,26]],"date-time":"2022-09-26T14:36:47Z","timestamp":1664203007000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.pagepressjournals.org\/index.php\/aiua\/article\/view\/aiua.2022.3.291"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,9,26]]},"references-count":28,"journal-issue":{"issue":"3","published-online":{"date-parts":[[2022,9,26]]}},"URL":"https:\/\/doi.org\/10.4081\/aiua.2022.3.291","relation":{},"ISSN":["2282-4197","1124-3562"],"issn-type":[{"type":"electronic","value":"2282-4197"},{"type":"print","value":"1124-3562"}],"subject":[],"published":{"date-parts":[[2022,9,26]]}}}