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Bladder
Urothelial carcinoma-invasive
With trophoblastic differentiation
Author: Nat Pernick, M.D. (see Authors page)
Revised: 12 June 2010, last major update June 2010
Copyright: (c) 2002-2010, PathologyOutlines.com, Inc.
Definition
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● Urothelial carcinoma with hCG+ tumor cells
Terminology
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Epidemiology
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● 21-36% of urothelial carcinomas (Hum Pathol 1998;29:377)
Sites
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Etiology
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● Considered a variant of urothelial carcinoma, not a germ cell tumor
Clinical features
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● 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; can be used as a marker of disease recurrence
● Usually no associated clinical symptoms
Prognostic factors
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Case reports
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● 23 year old man (Int Urol Nephrol 2004;36:529)
Treatment
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Clinical images
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Gross description (Macroscopy)
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Gross images
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Micro description (Histopathology)
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● Patterns include focal syncytiotrophoblasts, (multinucleated hCG+ cells), focal areas resembling choriocarcinoma, pure choriocarcinoma and urothelial carcinoma with non-giant cells that are hCG+
● Associated with high grade urothelial carcinoma (Cancer 1989;63:2497)
● Recommended to report the presence of trophoblastic cells and to estimate their frequency (Arch Pathol Lab Med 2007;131:1244)
Micro images
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Figure 3
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
Cytology description
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Cytology images
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Positive stains
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● Giant cells and occasionally other cells are hCG+
● Occasionally human placental lactogen, pregnancy specific beta-1 glycoprotein and placental alkaline phosphatase
Negative stains
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Electron microscopy descriptions
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Electron microscopy images
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Molecular / cytogenetics description
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Molecular / cytogenetics images
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Differential Diagnosis
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● Giant cell carcinoma: resembles giant cell tumors at other sites, hCG negative
Additional references
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End of Bladder > Urothelial carcinoma-invasive > With trophoblastic differentiation
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