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Presented by Dr. Andres Matoso and prepared by Dr. Harsimar Kaur
Adult male with bladder tumor
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1. Question
Adult male with bladder tumor.
Correct
Correct: C
Histology: Highly atypical tumor cells invading in single cells through the muscularis propria or detrusor muscle.
Discussion: Plasmacytoid urothelial carcinoma is considered an aggressive variant of urothelial carcinoma that includes signet ring cell carcinoma and carcinomas with poorly cohesive cells that invade similarly to lobular carcinoma of the breast. When tumor cells closely resemble plasma cells, immunostaining for CD138 could be a diagnostic pitfall as both, plasmacytoid variant of urothelial carcinoma and plasma cell neoplasia, are both positive. In the absence of a surface papillary component, the main differential diagnosis is with breast lobular carcinoma in a female and gastrointestinal signet ring cell carcinoma in both males and females. Both plasmacytoid urothelial carcinoma and lobular breast carcinomas are positive for GATA3 and negative for e-cadherin; but in contrast to breast carcinomas, urothelial carcinoma is commonly negative for ER. When the main differential diagnosis is with gastrointestinal signet ring cell carcinoma, it is important to remember that plasmacytoid urothelial carcinoma can be positive for CDX2 in approximately 15% of the cases and that CDX2 does not necessarily exclude a gastrointestinal origin, for which clinical/radiologic correlation is essential.
References
Perrino CM et al. Hum Pathol. 2019 Aug;90:27-36.Incorrect
Correct: C
Histology: Highly atypical tumor cells invading in single cells through the muscularis propria or detrusor muscle.
Discussion: Plasmacytoid urothelial carcinoma is considered an aggressive variant of urothelial carcinoma that includes signet ring cell carcinoma and carcinomas with poorly cohesive cells that invade similarly to lobular carcinoma of the breast. When tumor cells closely resemble plasma cells, immunostaining for CD138 could be a diagnostic pitfall as both, plasmacytoid variant of urothelial carcinoma and plasma cell neoplasia, are both positive. In the absence of a surface papillary component, the main differential diagnosis is with breast lobular carcinoma in a female and gastrointestinal signet ring cell carcinoma in both males and females. Both plasmacytoid urothelial carcinoma and lobular breast carcinomas are positive for GATA3 and negative for e-cadherin; but in contrast to breast carcinomas, urothelial carcinoma is commonly negative for ER. When the main differential diagnosis is with gastrointestinal signet ring cell carcinoma, it is important to remember that plasmacytoid urothelial carcinoma can be positive for CDX2 in approximately 15% of the cases and that CDX2 does not necessarily exclude a gastrointestinal origin, for which clinical/radiologic correlation is essential.
References
Perrino CM et al. Hum Pathol. 2019 Aug;90:27-36.
