title: Recurrent papillary urothelial neoplasm of low malignant potential. Subtle architectural disorder detected by quantitative analysis in DAXX-immunostained tissue sections.
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.
authors.affiliation: Department of Industrial Engineering and Mathematical Sciences (DIISM), Polytechnic University of the Marche Region, Ancona 60020, Italy.
authors.forename: Paolo
authors.initials: P
authors.lastname: Castellini
authors.affiliation: Department of Industrial Engineering and Mathematical Sciences (DIISM), Polytechnic University of the Marche Region, Ancona 60020, Italy.
authors.forename: Maria A
authors.initials: MA
authors.lastname: Montironi
authors.affiliation: Section of Pathological Anatomy, School of Medicine, Polytechnic University of the Marche Region, United Hospitals, Ancona 60020, Italy.
authors.forename: Antonio
authors.initials: A
authors.lastname: Zizzi
authors.affiliation: Section of Pathological Anatomy, School of Medicine, Polytechnic University of the Marche Region, United Hospitals, Ancona 60020, Italy.
authors.forename: Marina
authors.initials: M
authors.lastname: Scarpelli
authors.affiliation: Section of Pathological Anatomy, School of Medicine, Polytechnic University of the Marche Region, United Hospitals, Ancona 60020, Italy.
authors.forename: Roberta
authors.initials: R
authors.lastname: Mazzucchelli
authors.affiliation: Department of Surgery, Cordoba University Medical School, Cordoba E14004, Spain.
authors.forename: Antonio
authors.initials: A
authors.lastname: Lopez-Beltran
authors.affiliation: Department of Pathology and Laboratory Medicine, Indiana University School of Medicine, Indianapolis, IN 46202.
authors.forename: Liang
authors.initials: L
authors.lastname: Cheng
authors.affiliation: Department of Industrial Engineering and Mathematical Sciences (DIISM), Polytechnic University of the Marche Region, Ancona 60020, Italy.
authors.forename: Nicola
authors.initials: N
authors.lastname: Paone
authors.affiliation: Department of Industrial Engineering and Mathematical Sciences (DIISM), Polytechnic University of the Marche Region, Ancona 60020, Italy. Electronic address: r.montironi@univpm.it.
authors.forename: Rodolfo
authors.initials: R
authors.lastname: Montironi
mesh_terms: D002291:Carcinoma, Papillary / Q000473:pathology*; D006801:Humans; D007090:Image Interpretation, Computer-Assisted / Q000379:methods*; D007150:Immunohistochemistry; D009364:Neoplasm Recurrence, Local / Q000473:pathology*; D001749:Urinary Bladder Neoplasms / Q000473:pathology*
keywords: Chromatin remodeler DAXX; Nuclear elongation; Nuclear inclination angle; Nuclear polarization; PUNLMP; Papillary urothelial neoplasm of low malignant potential; Recurrence