Whorled Urothelial Cell Carcinoma: A Neglected Variant

Area of Science:

• Uropathology
• Oncology
• Histopathology

Background:

• Urothelial cell carcinoma (UCC) is a common malignancy of the urinary tract.
• Histological variants of UCC can impact diagnosis and patient management.
• A distinct whorled growth pattern in UCC has not been well-characterized.

Purpose of the Study:

• To describe the clinicopathological and immunohistochemical features of urothelial cell papillary carcinoma with a whorled growth pattern.
• To determine if this histological variant represents a distinct low-grade tumor entity.

Main Methods:

• Histopathological examination of twelve UCC cases exhibiting a whorled growth pattern.
• Immunohistochemical analysis for p53, p27, Ki67, and GATA3 expression.
• Correlation of histological findings with clinical data, including staging and patient outcomes.

Main Results:

• All twelve cases displayed a characteristic whorled/curlicue histological pattern.
• The tumors were uniformly low-grade (cytological grade) and Ta staged.
• Immunophenotype revealed low p53, high p27, low Ki67, and high GATA3.
• No patient experienced tumor progression post-transurethral resection, though two had recurrences.

Conclusions:

• The whorled pattern is a distinctive histological feature of a specific urothelial cell papillary carcinoma variant.
• This variant is characterized by low-grade cytology, Ta stage, and a favorable prognosis.
• The defined immunophenotype supports its classification as a low-grade urothelial tumor.