Stanford School of Medicine

Surgical Pathology Criteria

 use browser back button to return

Small Cell Carcinoma of the Bladder


  • Carcinoma of the bladder composed of uniform cells with scant cytoplasm and neuroendocrine features

Diagnostic Criteria

  • Appearance is identical to that of small cell carcinoma of the lung
    • Scant cytoplasm, very high nucleus/cytoplasm ratio
    • Finely granular, stippled chromatin
    • Nucleoli small to absent
    • Nuclear molding
    • Very high mitotic rate
    • Immunohistochemical demonstration of neuroendocrine differentiation not required
      • Many are positive for synaptophysin
  • Frequently mixed with other types of carcinoma
    • Any component of small cell carcinoma determines behavior
  • Large cell neuroendocrine carcinoma is exceedingly rare in the bladder

Robert V Rouse MD
Department of Pathology
Stanford University School of Medicine
Stanford CA 94305-5342

Original posting/updates: 10/28/12

Supplemental studies


  • Most but not all are positive for synaptophysin and neuron specific enolase
    • Few are chromogranin positive
  • Most negative for p63 and high molecular weight keratin
  • Many are TTF1 positive

Differential Diagnosis

  • Metastasis from lung primary must be ruled out clinically
    • Both are frequently TTF1 positive and usually p63 negative

Grading / Staging


  • High grade by definition


  • Same as urothelial carcinoma


  • Poor prognosis

Classification / Lists

Flat Lesions of the Urinary Bladder

Papillary Lesions of the Urinary Bladder

Subtypes of High Grade Urothelial Carcinoma

Inverted Lesions of the Urinary Bladder

Glandular Lesions of the Urinary Bladder


  • Murphy WM, Grignon DJ, Perlman EJ. Tumors of the Kidney, Bladder and Related Urinary Structures, Atlas of Tumor Pathology, AFIP Fourth Series, Fascicle 1, 2004
  • Eble JN, Sauter G, Epstein JI, Sesterhenn IA eds. World Health Organization Classification of Tumors. Pathology and genetics of tumors of the Urinary System and Male Genital Organs. IARC Press: Lyon 2004.
  • Rogers CG, Palapattu GS, Shariat SF, Karakiewicz PI, Bastian PJ, Lotan Y, Gupta A, Vazina A, Gilad A, Sagalowsky AI, Lerner SP, Schoenberg MP. Clinical outcomes following radical cystectomy for primary nontransitional cell carcinoma of the bladder compared to transitional cell carcinoma of the bladder. J Urol. 2006 Jun;175(6):2048-53
  • Black PC, Brown GA, Dinney CP. The impact of variant histology on the outcome of bladder cancer treated with curative intent. Urol Oncol. 2009 Jan-Feb;27(1):3-7.
  • Abol-Enein H, Kava BR, Carmack AJ. Nonurothelial cancer of the bladder. Urology. 2007 Jan;69(1 Suppl):93-104.
  • Lopez-Beltran A, Cheng L. Histologic variants of urothelial carcinoma: differential diagnosis and clinical implications. Hum Pathol. 2006 Nov;37(11):1371-88
  • Shanks JH, Iczkowski KA. Divergent differentiation in urothelial carcinoma and other bladder cancer subtypes with selected mimics. Histopathology. 2009
  • Printed from Surgical Pathology Criteria:
    © 2010  Stanford University School of Medicine