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Presented by George Netto, M.D. & Alcides Chaux, M.D. and prepared by Amy Duffield, M.D., Ph.D.
Case 2: A 65 year old male presented with hematuria.
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Question 1 of 1
1. Question
Week 340: Case 2
A 65 year old male presented with hematuria. A large ulcerated mass was found during cystoscopy. Transurethral resection was performed./images/2A 2_18_08.jpg
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Answer: Small cell carcinoma
Histology: none provided
Discussion: Primary small cell carcinoma (SCCa) of the urinary bladder is a relatively rare but highly aggressive tumor. Coexistence with an in situ (flat CIS) or invasive urothelial carcinoma is common. Currently, combinations of surgical resection, chemotherapy (Platinum based), and radiation therapy are utilized as treatment options with only limited success. The recent observation of c-kit and epidermal growth factor receptor (EGFR) expression in more than 25% of urinary bladder small cell carcinomas may offer new potential for future targeted therapy.
Like their lung counterparts, bladder SCCa are comprised of sheets and cords of small sized cells separated by delicate fibrovascular stroma. The cells contain uniformly small, round-to-oval, overlapping nuclei with evenly distributed chromatin lacking prominent nucleoli. Cytoplasm is usually sparse. Mitotic figures and apoptotic bodies are usually abundant. When needed, immunohistochemical stains can help establish epithelial (Cytokeratins) and neuroendocrine differentiation (synaptophysin, chromogranin and CD56). Up to 40 % of primary bladder SCCa are positive for TTF1, limiting the utility of the latter marker in differentiating a primary lesion from a metastasis from a lung primary. The differential diagnosis of SCCa may also include malignant lymphoma (CD45 positive) and PNET. The latter usually lacks cytokeratin positivity and is positive for CD99.
Reference(s):
– Wang X, et al. Small cell carcinoma of the urinary bladder–histogenesis, genetics, diagnosis, biomarkers, treatment, and prognosis. Appl Immunohistochem Mol Morphol. 2007;15(1):8-18.
– Paul Sved, et al. Small cell carcinoma of the bladder. BJU International 2004: 94 (1):12-17.Incorrect
Answer: Small cell carcinoma
Histology: none provided
Discussion: Primary small cell carcinoma (SCCa) of the urinary bladder is a relatively rare but highly aggressive tumor. Coexistence with an in situ (flat CIS) or invasive urothelial carcinoma is common. Currently, combinations of surgical resection, chemotherapy (Platinum based), and radiation therapy are utilized as treatment options with only limited success. The recent observation of c-kit and epidermal growth factor receptor (EGFR) expression in more than 25% of urinary bladder small cell carcinomas may offer new potential for future targeted therapy.
Like their lung counterparts, bladder SCCa are comprised of sheets and cords of small sized cells separated by delicate fibrovascular stroma. The cells contain uniformly small, round-to-oval, overlapping nuclei with evenly distributed chromatin lacking prominent nucleoli. Cytoplasm is usually sparse. Mitotic figures and apoptotic bodies are usually abundant. When needed, immunohistochemical stains can help establish epithelial (Cytokeratins) and neuroendocrine differentiation (synaptophysin, chromogranin and CD56). Up to 40 % of primary bladder SCCa are positive for TTF1, limiting the utility of the latter marker in differentiating a primary lesion from a metastasis from a lung primary. The differential diagnosis of SCCa may also include malignant lymphoma (CD45 positive) and PNET. The latter usually lacks cytokeratin positivity and is positive for CD99.
Reference(s):
– Wang X, et al. Small cell carcinoma of the urinary bladder–histogenesis, genetics, diagnosis, biomarkers, treatment, and prognosis. Appl Immunohistochem Mol Morphol. 2007;15(1):8-18.
– Paul Sved, et al. Small cell carcinoma of the bladder. BJU International 2004: 94 (1):12-17.
