Bladder, ureter & renal pelvis
Urothelial carcinoma - invasive
With trophoblastic differentiation
Author: Nat Pernick, M.D.
Topic Completed: 1 December 2014
Minor changes: 3 December 2020
Copyright: 2003-2019, PathologyOutlines.com, Inc.
PubMed Search: Trophoblastic differentiation [title]
Table of Contents
Definition / general | Epidemiology | Etiology | Clinical features | Case reports | Microscopic (histologic) description | Microscopic (histologic) description | Positive stains | Differential diagnosisCite this page: Pernick N. With trophoblastic differentiation. PathologyOutlines.com website. https://www.pathologyoutlines.com/topic/bladdertrophoblasticdiff.html. Accessed March 4th, 2021.
Definition / general
- Urothelial carcinoma with hCG+ tumor cells
Epidemiology
- 21-36% of urothelial carcinomas (Hum Pathol 1998;29:377)
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
- 23 year old man (Int Urol Nephrol 2004;36:529)
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
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
- 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
