What Is the Significance of Variant Histology in Urothelial Carcinoma?

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dc.contributor.authorLobo, Niyati
dc.contributor.authorShariat, Shahrokh
dc.contributor.authorGuo, Charles
dc.contributor.authorFernández, Mario
dc.contributor.authorKassouf, Wassim
dc.contributor.authorChoudhury, Ananya
dc.contributor.authorGao, Jianjun
dc.contributor.authorWilliams, Stephen
dc.contributor.authorGalsky, Matthew
dc.contributor.authorTaylor, John
dc.contributor.authorRoupret, Morgan
dc.contributor.authorKamat, Ashish
dc.date.accessioned2020-09-11T14:27:45Z
dc.date.available2020-09-11T14:27:45Z
dc.date.issued2020-07
dc.description.abstractContext: Urothelial carcinoma can exhibit a wide range of variant morphologies. Many variants present diagnostic challenges and carry clinical implications that inform prognosis and treatment decisions. Objective: To provide an overview of the diagnostic, therapeutic, and prognostic significance of histological variants of urothelial carcinoma. Evidence acquisition: A PubMed/MEDLINE-based literature search was conducted using the key terms "urothelial carcinoma", "variant histology", "nested", "micropapillary", "microcystic", "sarcomatoid", "squamous differentiation", "glandular differentiation", "clear cell", "plasmacytoid", "lymphoepithelioma-like carcinoma", "squamous cell carcinoma", "small cell carcinoma", "adenocarcinoma", "radiotherapy", "neoadjuvant chemotherapy", and "adjuvant chemotherapy". Evidence synthesis: The incidence of variant histology is increasing due to improved recognition. Nonetheless, diagnosis can pose challenges due to sampling limitations and interobserver variability. Although associated with advanced disease at presentation, survival outcomes for most variants do not differ significantly compared with pure urothelial carcinoma of the same stage. Controversy exists regarding optimal management due to the low quality of available evidence. For most cases, radical cystectomy with pelvic lymph node dissection (with neoadjuvant chemotherapy when appropriate) represents the standard of care. Small cell carcinoma and lymphoepithelioma-like carcinoma appear to be particularly chemosensitive. Conclusions: Accurate identification of variant histological subtypes is an important part of risk stratification, as these variants exhibit aggressive biological behaviour. Variant histology tumours are associated with advanced disease at presentation, which must be considered when counselling patients regarding survival outcomes. Optimal management remains to be defined but in most cases; neoadjuvant chemotherapy and radical cystectomy with pelvic lymph node dissection remains the mainstay of treatment.es
dc.identifier.citationLobo N, Shariat SF, Guo CC, et al. What Is the Significance of Variant Histology in Urothelial Carcinoma?. Eur Urol Focus. 2020;6(4):653-663. doi:10.1016/j.euf.2019.09.003es
dc.identifier.urihttps://doi.org/10.1016/j.euf.2019.09.003es
dc.identifier.urihttp://hdl.handle.net/11447/3423
dc.language.isoenes
dc.publisherEuropean Association of Urology by Elsevier B.Ves
dc.subjectAdenocarcinomaes
dc.subjectBladder canceres
dc.subjectClear cell urothelial carcinomaes
dc.subjectLymphoepithelioma-like carcinomaes
dc.subjectMicrocystic urothelial carcinomaes
dc.subjectMicropapillary urothelial carcinomaes
dc.subjectNested urothelial carcinomaes
dc.subjectPlasmacytoid urothelial carcinomaes
dc.subjectSarcomatoid urothelial carcinomaes
dc.subjectSmall cell carcinomaes
dc.subjectSquamous cell carcinomaes
dc.subjectVariant histologyes
dc.titleWhat Is the Significance of Variant Histology in Urothelial Carcinoma?es
dc.typeArticlees

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