Browsing by Author "Fonseca, Jorge"

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    Dysplasia and carcinoma in situ of the urinary bladder
    (2015-02) Lopez-Beltran, Antonio; Marques, Rita C.; Montironi, Rodolfo; Reymundo, Carlos; Fonseca, Jorge; Cheng, Liang; Department of Pathology and Laboratory Medicine, IU School of Medicine
    Urothelial dysplasia (low-grade intraurothelial neoplasia) is recognized as a premalignant urothelial lesion in the 2004 World Health Organization (WHO) classification system. Although clarification of the diagnostic criteria of urothelial dysplasia has improved in recent years, there is still a lack of interobserver reproducibility. Active clinical follow-up is mandatory in patients with a diagnosis of urothelial dysplasia since it constitutes a marker of urothelial instability, and disease progression, in up to 19% of cases. The differential diagnosis of urothelial dysplasia is with other flat urothelial lesions with atypia, including flat urothelial hyperplasia, reactive urothelial atypia, urothelial atypia of unknown significance, and urothelial carcinoma in situ (high-grade intraurothelial neoplasia). In most cases, especially when small amounts of tissue are available, morphologic features alone may not be sufficient for diagnosis. Immunohistochemistry can be of help in selected cases, and a panel of cytokeratin 20, p53, and CD44 may help in the diagnosis. The use of HER2, p16, and Racemase remains as an option pending validation. Herein, we present the pathologic features and clinical significance of urothelial dysplasia and carcinoma in situ with emphasis on differential diagnosis from common flat lesions with atypia.
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    Predicting biochemical recurrence after radical prostatectomy: the role of prognostic grade group and index tumor nodule
    (Elsevier, 2019-11) Vau, Nuno; Henriques, Vanessa; Cheng, Liang; Blanca, Ana; Fonseca, Jorge; Montironi, Rodolfo; Cimadamore, Alessia; Lopez-Beltran, Antonio; Pathology and Laboratory Medicine, School of Medicine
    The aim of the current study was to test whether the grade group assessed in the index tumor nodule predicts biochemical recurrence after surgery. The study cohort series included 144 consecutive patients treated by laparoscopic radical prostatectomy. The following parameters were evaluated in each case: type of radical prostatectomy (with/without lymphadenectomy), pT and pN status, histologic type of prostate carcinoma (acinar versus mixed histology), surgical margin resection status, perineural invasion, lymphovascular invasion, biochemical recurrence status, presence of tertiary Gleason 5 pattern, and grade group that was assessed both in overall prostate cancer and in index (dominant) tumor nodule. Twenty patients (13.9%) experienced postoperative biochemical recurrence at a mean follow-up time of 12.2 months. The univariate survival analysis selected type of radical prostatectomy, histological subtype, lymphovascular invasion, American Joint Committee on Cancer pT and pN classification, tertiary Gleason 5 pattern, preoperative serum prostate specific antigen level, and the grade group assessed in both the overall prostate and index tumor nodule as significant for biochemical recurrence-free survival. Type of radical prostatectomy (P = .020), histological subtype (P = .002), lymphovascular invasion (P = .023), tertiary Gleason pattern 5 (P = .016), and grade group classification in index tumor nodule (P ≤ .0001) were selected as independent predictors of biochemical recurrence-free survival. In conclusion, our results validate grade group in the index tumor nodule as an independent predictor of biochemical recurrence-free survival, thus emphasizing the value of reporting grade group in index tumor nodule. The main limitation of our study is the relatively low number of cases in the current series, suggesting the need of large confirmatory studies.
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    Rare entities in urinary bladder pathology
    (2015-02) Lopez-Beltran, Antonio; Marques, Rita C.; Montironi, Rodolfo; Reymundo, Carlos; Fonseca, Jorge; Cheng, Liang; Department of Pathology and Laboratory Medicine, IU School of Medicine
    Bladder carcinoma with variant histology is a subject of recent interest, with data suggesting more aggressive behavior when compared with conventional urothelial carcinoma. The timely identification and recognition of these histological variants should avoid their misinterpretation as benign lesions. We emphasize the need to recognize these peculiar morphologic features since some of them may require a different/specific therapeutic approach. Other rare entities such as bladder polyps and myofibroblastic proliferations tend to occur at a younger age and represent specific problems in the differential diagnosis. We describe the salient clinicopathologic features of representative rare entities arising in the urinary bladder.