Bladder, ureter & renal pelvis

Urothelial carcinoma - invasive

With trophoblastic differentiation

Topic Completed: 1 December 2014

Minor changes: 22 November 2021

Copyright: 2003-2021,, Inc.

PubMed Search: Trophoblastic differentiation [title]

Nat Pernick, M.D.
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Cite this page: Pernick N. With trophoblastic differentiation. website. Accessed December 4th, 2021.
Definition / general
  • Urothelial carcinoma with hCG+ tumor cells
  • 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
Microscopic (histologic) 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)
Microscopic (histologic) description

AFIP images
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Giant cells (arrows) are hCG+

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
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