Bladder
Urothelial carcinoma-invasive
With trophoblastic differentiation

Author: Nat Pernick, M.D. (see Authors page)

Revised: 25 July 2016, last major update December 2014

Copyright: (c) 2003-2016, PathologyOutlines.com, Inc.

PubMed Search: Trophoblastic differentiation [title]
Definition / General
  • Urothelial carcinoma with hCG+ tumor cells
Epidemiology
Etiology
  • Considered a variant of urothelial carcinoma, not a germ cell tumor
Clinical Features
  • Associated with aggressive clinical course (Harefuah 1998;134:260)
  • hCG is present in serum of 10-30% of bladder cancer patients, including 50% with disseminated disease
  • Usually no associated clinical symptoms
Case Reports
Micro Description
  • Patterns include focal syncytiotrophoblasts, focal areas resembling choriocarcinoma, pure choriocarcinoma and urothelial carcinomas with non-giant cells that are hCG+
  • Associated with high grade urothelial carcinoma (Cancer 1989;63:2497)
  • Usually syncytiotrophoblastic cells (multinucleated giant cells) that are hCG+
  • Recommended to report the presence of elements with trophoblastic morphology with an some estimate of their quantity (Arch Pathol Lab Med 2007;131:1244)
Micro Description

Images hosted on Pathout server:
Missing Image

Giant cells (arrows) are hCG+
Note that many hcG+ cells are not multinucleated and cannot be distinguished from other anaplastic
cells without hCG staining (AFIP image courtesy of Dr. Jonathan I. Epstein, Baltimore, Maryland)



Images hosted on other servers:

Figure 3

Positive Stains
  • Giant cells and occasionally other cells are hCG+
  • Occasionally human placental lactogen, pregnancy specific beta-1 glycoprotein and placental alkaline phosphatase
Differential Diagnosis
  • Giant cell carcinoma: resembles giant cell tumors at other sites, hCG negative