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Presented by Jonathan Epstein, M.D. and prepared by Priya Banerjee, M.D.
Case 5: A 63 year old female two years ago underwent a transurethral resection of the bladder.
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1. Question
Week 380: Case 5
A 63 year old female two years ago underwent a transurethral resection of the bladder. At that time the patient was otherwise healthy, immunocompetent, and without any systemic disease.images/2_1_09 5A.jpg
images/2_1_09 5B.jpg
images/2_1_09 5C.jpg
images/2_1_09 5D.jpgCorrect
Answer: High grade papillary urothelial carcinoma with herpes infection
Histology: At low magnification much of this lesion shows the typical appearance of a non-invasive papillary urothelial carcinoma. The lesion is high grade based both on its architecture and cytology. Architecturally, the lesion shows a lack of polarity and in areas discohesive cells. At higher magnification the nuclei are
hyperchromatic with some cells resembling those seen with CIS. In other areas there is necrosis. The cells adjacent to the areas of necrosis are multinucleated with the typical features of herpes virus infection. Immunohostochemical stains performed at the outside institution were positive for herpes virus infection.Discussion: This case is unique. There is no relationship between herpes virus infection and urothelial carcinoma. One would expect that this patient would have been immunocompromised and that the herpes virus infection seen within the tumor was a manifestation of systemic herpes virus infection. However, this patient was otherwise healthy without any other manifestation of herpes virus infection. Furthermore, this patient has been followed for two years without a recurrence of urothelial carcinoma and also without any other illnesses relating to the herpes virus infection. The clinical significance of this finding is unknown although it was recommended that the patient undergo a gynecological exam for the evaluation of genital herpes virus infection. Just as there is no relationship between herpes virus infection and urothelial carcinoma, there is also no relationship between human papilloma virus infection and either urothelial carcinoma or even squamous cell carcinoma of the bladder.
Incorrect
Answer: High grade papillary urothelial carcinoma with herpes infection
Histology: At low magnification much of this lesion shows the typical appearance of a non-invasive papillary urothelial carcinoma. The lesion is high grade based both on its architecture and cytology. Architecturally, the lesion shows a lack of polarity and in areas discohesive cells. At higher magnification the nuclei are
hyperchromatic with some cells resembling those seen with CIS. In other areas there is necrosis. The cells adjacent to the areas of necrosis are multinucleated with the typical features of herpes virus infection. Immunohostochemical stains performed at the outside institution were positive for herpes virus infection.Discussion: This case is unique. There is no relationship between herpes virus infection and urothelial carcinoma. One would expect that this patient would have been immunocompromised and that the herpes virus infection seen within the tumor was a manifestation of systemic herpes virus infection. However, this patient was otherwise healthy without any other manifestation of herpes virus infection. Furthermore, this patient has been followed for two years without a recurrence of urothelial carcinoma and also without any other illnesses relating to the herpes virus infection. The clinical significance of this finding is unknown although it was recommended that the patient undergo a gynecological exam for the evaluation of genital herpes virus infection. Just as there is no relationship between herpes virus infection and urothelial carcinoma, there is also no relationship between human papilloma virus infection and either urothelial carcinoma or even squamous cell carcinoma of the bladder.
