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Bladder

Urothelial carcinoma - invasive

Osteoclast rich undifferentiated carcinoma


Reviewer: Monika Roychowdhury, M.D., University of Minnesota Medical Center (see Reviewers page)
Revised: 24 April 2011, last major update April 2011
Copyright: (c) 2003-2011, PathologyOutlines.com, Inc.

Definition
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● Extremely rare variant of high-grade urothelial carcinoma with an aggressive behavior and poor outcome
● Composed of a mixture of undifferentiated mononuclear carcinoma cells and osteoclast-like reactive giant cells (Mod Pathol 2006;19:161)

Epidemiology
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● Mostly men in their 7th to 9th decade of life

Clinical
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● Usually gross hematuria, may present with flank pain, renal colic and dysuria

Case reports
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● 63 year old man with gross hematuria (Diagn Cytopathol 2010;38:364)
● 74 year old man (Cytojournal 2010;7:18)
● 76 year old man with tumor of distal ureter (Korean J Urol 2011;52:68)

Gross images
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Tumor of distal ureter

Micro description
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● Composed of a mixture of mononuclear malignant epithelial cells and multinucleated osteoclast-like reactive giant cells
● Mononuclear cells have abundant cytoplasm, round to oval vesicular nuclei, mild atypia and variable mitotic activity
● The giant cells are morphologically and immunohistochemically identical to osteoclasts and are regarded as being of histiocytic origin; are cytologically bland, may exhibit phagocytic activity but no mitotic activity; are generally evenly distributed among mononuclear cells but may condense around hemorrhagic foci

Micro mages
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Various H&E images

       

       
Various immunostains

Cytology images
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Various images

Stains
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● Mononuclear cells: cytokeratin+, EMA+, vimentin+, Ki67+, p53+
● Giant cells: CD68+, alpha-1 antitrypsin+, acid phosphatase+, vimentin+, CD51+, CD54+; cytokeratin-, EMA-, Ki67-, p53-

Differential diagnosis
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Giant cell carcinoma: obvious malignant bizarre giant cells, mitotic activity, invasion, positive staining for epithelial markers
Foreign-body type giant cell reaction: inflammatory infiltrate, no atypia, no invasion

End of Bladder > Urothelial carcinoma - invasive > Osteoclast rich undifferentiated carcinoma


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