Recurrent papillary urothelial neoplasm of low malignant potential. Subtle architectural disorder detected by quantitative analysis in DAXX-immunostained tissue sections

Paolo Castellini, Maria A. Montironi, Antonio Zizzi, Marina Scarpelli, Roberta Mazzucchelli, Antonio Lopez-Beltran, Liang Cheng, Nicola Paone, Rodolfo Montironi

Research output: Contribution to journalArticle

4 Scopus citations

Abstract

The aim of the study was to identify subtle changes in the so-called architectural predominant order in nonrecurrent and recurrent papillary urothelial neoplasm of low malignant potential (PUNLMP). Quantitative analysis was performed with a software package written in LabVIEW (National Instruments, Austin, TX) in DAXX-immunostained tissue sections. Twelve cases of PUNLMP with papillary fronds sectioned lengthwise through the core were investigated and subdivided as follows: 7 nonrecurrent and 5 recurrent PUNLMP cases. Six cases of normal urothelium (NU) were included. When an epithelial thickness threshold is set at 108 μm (ie, 400 pixels), there is a complete separation between NU and PUNLMP; however, nonrecurrent and recurrent cases fall in the same range of thickness. In setting a nuclear elongation factor threshold at 2.1, there are differences between the 2 PUNLMP groups, recurrent PUNLMP and NU cases, showing a somewhat similar proportion of elongated nuclei. The nuclear orientation separates nonrecurrent from recurrent PUNLMP groups; however, NU cases do not appear as a separate group from the 2 PUNLMP groups. In combining epithelial thickness, nuclear elongation, and orientation in a multivariate analysis, the 2 PUNLMP groups appear separate between them and from NU. NU is less thickened than the 2 PUNLMP groups and shows a combination of elongated and less elongated nuclei. Elongated nuclei are more numerous in nonrecurrent PUNLMP, whereas the nuclei in recurrent PUNLMP are less elongated and less polarized than in the other group. Such finding can be used routinely to identify those PUNLMP patients who will have recurrence.

Original languageEnglish (US)
Pages (from-to)745-752
Number of pages8
JournalHuman pathology
Volume45
Issue number4
DOIs
StatePublished - Apr 2014

Keywords

  • Chromatin remodeler DAXX
  • Nuclear elongation
  • Nuclear inclination angle
  • Nuclear polarization
  • Papillary urothelial neoplasm of low malignant potential
  • PUNLMP
  • Recurrence

ASJC Scopus subject areas

  • Pathology and Forensic Medicine

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