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Case of the Week #219

6 October 2011 Case of the Week #219

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Case of the Week #219

Clinical History:

A 76 year old man with an unknown clinical history had an irregular process on the posterior bladder wall, which was biopsied.

Micro images:

       

       

What is your diagnosis?































Diagnosis:

High grade urothelial carcinoma - plasmacytoid and lymphoma-like variant

Discussion:

Immunostains were performed:

           
Left to right: EMA, CD20, CD38, CD138

The tumor consisted of a dyscohesive pattern of urothelial tumor cells resembling plasma cells, due to abundant glassy eosinophilic cytoplasm and eccentric nuclei. No binucleated forms were present. In some areas, the tumor resembled a low grade lymphoma. Obvious areas of high grade urothelial carcinoma were also present in other sections.

Plasmacytoid variant of urothelial carcinoma is part of the WHO/ISUP classification of tumors of the urinary tract. These tumors are rare, and tend to present at advanced stage with a poor prognosis (Int J Cancer 2011;129:346). Tumors are strongly positive for epithelial markers (cytokeration, EMA) and GATA-3 (Hum Pathol 2011;42:1149), and are usually negative for CD38 and light chains, markers for plasma cells. There often is immunoreactivity for CD138 (Hum Pathol 2009;40:1023, Am J Surg Pathol 2009;33:417).

Differential diagnosis includes chronic cystitis and plasmacytoma, particularly a problem in limited biopsies.

Treatment consists of surgery plus chemotherapy (Int J Clin Oncol 2011 Jul 7 [Epub ahead of print]).

Nat Pernick, M.D., President
PathologyOutlines.com, Inc.
30100 Telegraph Road, Suite 408
Bingham Farms, Michigan (USA) 48025
Telephone: 248/646-0325
Email: NatPernick@Hotmail.com
Alternate email: NatPernick@gmail.com