Plasmacytoid urothelial carcinoma of the urinary bladder
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50 Hellenic Journal of Surgery 2011; 83: 1
Plasmacytoid Urothelial Carcinoma of the Urinary Bladder Report of a Case A. Klimis, H. Karvounis Received 10/08/2010 Accepted 23/11/2010
Abstract A rare case of plasmacytoid urothelial carcinoma (PUC) was diagnosed in a 76-year-old man. Morphologic recognition and distinction from other plasmacytoid malignant neoplasms is crucial for its clinical management; immunohistochemical studies may be required for differential diagnosis. We present a case of PUC with clinico-pathological and immunohistochemical investigation and also review the literature.
was flat and indurated in appearance. On the basis of these findings, transurethral resection and deep tumour debulking was performed with removal of the underlying muscle layer. The histopathologic examination demonstrated a deeply invasive tumour extending widely into the bladder wall. The malignant cells were discohesive, oval-to-round with abundant eosinophilic cytoplasm, and eccentrically placed hyperchromatic nuclei (Fig.1). The tumour cells were all negative for mucicamine and Alcian Blue stains.
Key Words
Bladder neoplasms, Plasmacytoid, Urothelial carcinoma of bladder, Variant.
Introduction Plasmacytoid urothelial carcinoma was recently recognized by the World Health Organization (WHO) classification system as a rare variant of urothelial carcinoma [1] . Since the initial description of PUC in 1991 by Sahin et al [2] and Zukerberg et al [3], at least 30 cases have been reported [3-6]. The tumour is characterized by the presence of epithelial cells that resemble plasma cells and which compose 30% to 100% of the tumour.
Case Report A 67-year-old man presented with gross haematuria. His past medical history was unremarkable, except for smoking 15 cigarettes per day for 50 years. Urinalysis demonstrated R.B.C. 3+, with no protein or sugar content. Chest radiography was normal. Other laboratory tests were within normal limits. Cystoscopy revealed abnormal bladder mucosa including the trigone and the bladder neck. The lesion
- Department of Pathology, 3rd Hospital of Social Insurance Institute, Athens, Greece - Department of Pathology, Aretaieon Hospital, Athens University School of Medicine, Athens , Greece
Fig. 1 High magnification, showing invasive UC cells with plasmacytoid features mimicking plasmatocytoma (H-E Stain, original magnification x 200.) These areas, which composed 60% of the tumour, were associated with high-grade urothelial carcinoma. Immunohistochemistry, using the labeled streptavidin-biotin complex method, revealed that both plasmacytoid and conventional urothelial carcinoma components were positive for pan-cytokeratins, (AE1/AE3) , CK7, (Fig.2) and CK20, EMA, CEA, but negative for plasma cell/lymphocyte markers such as CD138 and LCA respectively (Fig.3). Melanocytic markers, including S-100 protein, HMB-45 and Melan-A, were negative. Also negative were neuroendocrine markers, such as Synaptophysin and Chromogranin. The mean Ki-67 labeling index was 25%. The immunohistochemical features of the ne
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