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Plasmacytoid Urothelial (Transitional Cell) Carcinoma

Definition

  • Aggressive subtype of urothelial carcinoma with plasmacytoid features

Note

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

Immunohistology

  • 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

Histochemistry

  • 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

Grading

  • Plasmacytoid carcinoma is definitionally high grade

Staging

  • 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

Clinical

  • 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

Bibliography

  • 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.
  • Ricardo-Gonzalez RR, Nguyen M, Gokden N, Sangoi AR, Presti JC Jr, McKenney JK. Plasmacytoid carcinoma of the bladder: a urothelial carcinoma variant with a predilection for intraperitoneal spread. J Urol. 2012 Mar;187(3):852-5.
  • Lim MG, Adsay NV, Grignon DJ, Osunkoya AO. E-cadherin expression in plasmacytoid, signet ring cell and micropapillary variants of urothelial carcinoma: comparison with usual-type high-grade urothelial carcinoma. Mod Pathol. 2011 Feb;24(2):241-7.
  • Fritsche HM, Burger M, Denzinger S, Legal W, Goebell PJ, Hartmann A. Plasmacytoid urothelial carcinoma of the bladder: histological and clinical features of 5 cases. J Urol. 2008 Nov;180(5):1923-7..
  • Nigwekar P, Tamboli P, Amin MB, Osunkoya AO, Ben-Dor D, Amin MB. Plasmacytoid urothelial carcinoma: detailed analysis of morphology with clinicopathologic correlation in 17 cases. Am J Surg Pathol. 2009 Mar;33(3):417-24.
  • Lopez-Beltran A, Requena MJ, Montironi R, Blanca A, Cheng L. Plasmacytoid urothelial carcinoma of the bladder. Hum Pathol. 2009 Jul;40(7):1023-8.
  • Raspollini MR, Sardi I, Giunti L, Di Lollo S, Baroni G, Stomaci N, Menghetti I, Franchi A. Plasmacytoid urothelial carcinoma of the urinary bladder: clinicopathologic, immunohistochemical, ultrastructural, and molecular analysis of a case series. Hum Pathol. 2011 Aug;42(8):1149-58.
  • 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]
  • Shanks JH, Iczkowski KA. Divergent differentiation in urothelial carcinoma and other bladder cancer subtypes with selected mimics. Histopathology. 2009
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