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Presented by George Netto, MD and prepared by Marc Lewin, M.D.
Case 1: A 65 year old man presented with hematuria.
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1. Question
Week 287: Case 1
A 65 year old man presented with hematuria. On cystoscopy, a large ulcerated mass was found. A transurethral resection was performed.images/10-23-06case1a.jpg
images/10-23-06case1b.jpg
images/10-23-06case1c.jpgCorrect
Answer: Osteoclast rich undifferentiated carcinoma of urinary bladder
Histology: A striking morphologic feature of the tumor is the presence of multinucleated osteoclast like giant cells accompanying the neoplastic mononuclear ovoid to spindle cells. the undifferentiated ovoid monuclear cells focally acquire a plasmocytoid or signet ring like morphology.
In other portions, the neoplastic cells are separated by a myxoid extracellular matrix acquiring a chondroid appearance. Mitotic figures are common. Necrosis is focally present. The urothelial mucosa reveals focal pagetoid involvement by “flat” urothelial CIS.
Discussion: Osteoclast rich undifferentiated carcinoma is a rare aggressive variant of urinary bladder carcinoma. In the largest series reported to date by Baydar et al., four of five patients with available follow up were dead of disease within 15 months of establishing the diagnosis. In the same study, the osteoclastic/histicytic nature of the multinucleated cells was supported by their reactivity for CD68, LCA, CD51 and CD54. The osteoclasts are therefore considered part of the response mounted by the host toward the neoplastic mononuclear cells. Like the current case, a sarcomatoid component has been encountered in other examples of this lesion.
Reference(s):
– Baydar D, Amin MB, Epstein JI. Osteoclast-rich undifferentiated carcinomas of the urinary tract. Mod Pathol. 2006 Feb;19(2):161-71.Incorrect
Answer: Osteoclast rich undifferentiated carcinoma of urinary bladder
Histology: A striking morphologic feature of the tumor is the presence of multinucleated osteoclast like giant cells accompanying the neoplastic mononuclear ovoid to spindle cells. the undifferentiated ovoid monuclear cells focally acquire a plasmocytoid or signet ring like morphology.
In other portions, the neoplastic cells are separated by a myxoid extracellular matrix acquiring a chondroid appearance. Mitotic figures are common. Necrosis is focally present. The urothelial mucosa reveals focal pagetoid involvement by “flat” urothelial CIS.
Discussion: Osteoclast rich undifferentiated carcinoma is a rare aggressive variant of urinary bladder carcinoma. In the largest series reported to date by Baydar et al., four of five patients with available follow up were dead of disease within 15 months of establishing the diagnosis. In the same study, the osteoclastic/histicytic nature of the multinucleated cells was supported by their reactivity for CD68, LCA, CD51 and CD54. The osteoclasts are therefore considered part of the response mounted by the host toward the neoplastic mononuclear cells. Like the current case, a sarcomatoid component has been encountered in other examples of this lesion.
Reference(s):
– Baydar D, Amin MB, Epstein JI. Osteoclast-rich undifferentiated carcinomas of the urinary tract. Mod Pathol. 2006 Feb;19(2):161-71.
