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Bladder

Urothelial carcinoma-invasive

Plasmacytoid carcinoma


Reviewers: Monika Roychowdhury, University of Minnesota Medical Center; Rugvedita Parakh, Cedars-Sinai Medical Center (see Reviewers page)
Revised: 6 October 2011, last major update May 2011
Copyright: (c) 2003-2011, PathologyOutlines.com, Inc.

Definition
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● Urothelial carcinoma in which tumor cells have features of plasma cells, due to abundant glassy eosinophilic cytoplasm, eccentric nuclei and indistinct nucleoli
● Included in the WHO classification since 2004

Clinical features
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● Rare
● Tends to present at advanced stage with poor prognosis
● Diagnosed at advanced pathological stage (64% pT3, 23% pT4), showing metastases in 60% (Int J Cancer 2010 Sep 28 [Epub ahead of print])
● May spread in abdominal cavity more commonly than other variants

Case reports
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● 57 year old man with metastatic disease (Cases J 2009 Apr 28;2:6647)
● 76 year old man (Case of Week #219)

Micro description
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● Urothelial tumor cells resemble plasma cells, due to abundant glassy eosinophilic cytoplasm and eccentric nuclei
● Discohesive single cell pattern resembling lobular breast carcinoma or diffuse type of gastric cancer
● Myxoid or loose edematous stroma
● Retraction spaces around tumor cells
● Classic urothelial carcinoma usually also present

Micro images
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Various images


CK7


Keratin+


Keratin+ nodal metastasis


Fig A: Diffuse infiltration
Fig B: Malignant cells with eosinophilic cytoplasm and eccentric nuclei
Fig C: Resembling signet-ring cells
Fig D: AE1/AE3 positive (strong)


Cytology description
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● Scattered discohesive cells with a plasmacytoid appearance, characterized by abundant cytoplasm, eccentric nuclei and inconspicuous nucleoli (Diagn Cytopathol 2009;37:359)

Positive stains
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● Cytokeratin (strong)
● May be CD138+ (Hum Pathol 2009;40:1023, Am J Surg Pathol 2009;33:417)

Negative stains
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● Plasma cell and lymphocyte markers, gamma globulin, light chains
● Membranous E-cadherin (usually)

Molecular
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● Highly aneuploid and polysomic
● Deletion on chromosome 9p21 is common
● p53 mutation in 29%

Differential diagnosis
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Plasmacytoma: often associated with myeloma, no usual type urothelial carcinoma, tumor cells have plasmacytic features, are keratin-
Metastatic lobular breast carcinoma: ER/PR positive, GCDFP 15 or mammoglobin positive, always E-cadherin negative, no usual type urothelial carcinoma

Additional references
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J Urol 2008;180:1923

End of Bladder > Urothelial carcinoma-invasive > Plasmacytoid


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