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Bladder

Urothelial carcinoma-invasive

With trophoblastic differentiation


Reviewer: Nat Pernick, M.D., PathologyOutlines.com, Inc. (see Reviewers page)
Revised: 3 July 2011, last major update July 2011
Copyright: (c) 2003-2011, PathologyOutlines.com, Inc.

Definition
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● Urothelial carcinoma with hCG+ tumor cells

Epidemiology
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● 21-36% of urothelial carcinomas (Hum Pathol 1998;29:377)

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
● Usually no associated clinical symptoms

Case reports
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● 23 year old man (Int Urol Nephrol 2004;36:529)
● 36 year old woman with beta-hCG producing tumor (Actas Urol Esp 2009;33:209)

Micro description
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● 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 images
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Urothelial carcinoma with trophoblastic differentiation. Choriocarcinoma component with biphasic histology including syncytiotrophoblastic giant cells.


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)

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

Differential diagnosis
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Giant cell carcinoma: resembles giant cell tumors at other sites, hCG negative

End of Bladder > Urothelial carcinoma-invasive > With trophoblastic differentiation


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