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Presented by Dr. Jonathan Epstein and prepared by Dr. Tricia Cottrell
Clinical history: A 65 year old man underwent a TUR of the bladder following an episode of hematuria.
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1. Question
A 65 year old man underwent a TUR of the bladder following an episode of hematuria.
Correct
Answer: D
Discussion: Infiltrating bladder tumors with this morphology have been variably described as all of the above choices. The unifying feature is the presence of loosely cohesive cells which lose ecadherin and infiltrate widely in the bladder in a linitis plastic fashion. Some of these tumors resemble infiltrating lobular carcinoma of the breast without plasmacytoid, rhabdoid, or signet ring cytoplasmic features. In a woman it can be hard to rule out spread from a breast carcinoma. GATA3 is not helpful as it is positive in both breast and urothelial carcinomas. GCDFP may help in this differential. In both genders, one also has to put a caveat in the report that a gastrointestinal primary should be excluded. In the current case, the presence of overlying CIS is diagnostic of a primary urothelial carcinoma. The presence of micropapillary features in CIS has no prognostic significance, as opposed to micropapillary features in infiltrating urothelial carcinoma where it adversely affects prognosis.
Incorrect
Answer: D
Discussion: Infiltrating bladder tumors with this morphology have been variably described as all of the above choices. The unifying feature is the presence of loosely cohesive cells which lose ecadherin and infiltrate widely in the bladder in a linitis plastic fashion. Some of these tumors resemble infiltrating lobular carcinoma of the breast without plasmacytoid, rhabdoid, or signet ring cytoplasmic features. In a woman it can be hard to rule out spread from a breast carcinoma. GATA3 is not helpful as it is positive in both breast and urothelial carcinomas. GCDFP may help in this differential. In both genders, one also has to put a caveat in the report that a gastrointestinal primary should be excluded. In the current case, the presence of overlying CIS is diagnostic of a primary urothelial carcinoma. The presence of micropapillary features in CIS has no prognostic significance, as opposed to micropapillary features in infiltrating urothelial carcinoma where it adversely affects prognosis.
