Stanford School of Medicine

Surgical Pathology Criteria

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Plasmacytoid Urothelial (Transitional Cell) Carcinoma


  • Aggressive subtype of urothelial carcinoma with plasmacytoid features


Diagnostic Criteria

  • Simulates a hematolymphoid neoplasm
    • Discohesive invasive pattern
    • Eccentric nuclei
  • Prominent eosinophilic cytoplasm
    • Intracytoplasmic mucin positive lumens may be present
  • Frequently presents at high stage
  • Frequently exhibits peritoneal surface spread

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

Original posting/updates: 10/20/12

Supplemental studies


  • Keratin positive
  • CD138 positive
    • (CD138 stains many carcinomas)
  • MUM1 and kappa/lambda light chain negative
  • E cadherin negative
    • Conventional and micropapillary are positive
    • Signet ring carcinoma is negative also


  • Mucin stains may reveal intracytoplasmic lumens


Differential Diagnosis

  • The prinicpal differential diagnosis is plasmacytoma
    • Usually, awareness of this pattern is enough to permit a diagnosis but stains can be useful if necessary
    • P63 and strong keratin indicate carcinoma
      • Plasma cell processes may sometimes show weak keratin staining
    • Kappa/lambda in situ hybridization or IPOX will identify nearly all plasmacytomas
      • MUM1 preferentially stains plasmacytoma
      • CD138 is expressed on many carcinomas and is not useful

Grading / Staging


  • Plasmacytoid carcinoma is definitionally high grade


  • Node involvement and peritoneal surface spread are common
  • Although non-invasive papillary urothelial neoplasms are technically in situ, they are staged as Ta and are not referred to as carcinoma in situ
  • If possible, the extent of lamina propria / submucosa invasion should be reported
  • Muscularis mucosae is variable and its involvement does not affect staging
    • Generally loose strands of muscle
  • Muscularis propria involvement is significant and should be evaluated carefully
    • Dense, well defiined bundles of muscle
    • Depth of muscularis propria involvement cannot be assessed in transurethral specimens
    • Presence or absence of propria should be reported even if not involved
  • Lymphatic invasion should be confirmed by immunohistochemistry
    • Pseudovascular tissue retraction is common


  • Aggressive variant of urothelial carcinoma
    • Frequently presents with nodal metastases
    • Frequent peritoneal surface spread

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


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  • Ro JY, Shen SS, Lee HI, Hong EK, Lee YH, Cho NH, Jung SJ, Choi YJ, Ayala AG. Plasmacytoid transitional cell carcinoma of urinary bladder: a clinicopathologic study of 9 cases. Am J Surg Pathol. 2008 May;32(5):752-7.
  • Shah RB, Montgomery JS, Montie JE, Kunju LP. Variant (divergent) histologic differentiation in urothelial carcinoma is under-recognized in community practice: Impact of mandatory central pathology review at a large referral hospital. Urol Oncol. 2012 May 17. [Epub ahead of print]
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