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Presented by Dr. Andres Matoso and prepared by Dr. Katherine Fomchenko.
This case is a middle-aged female with a bladder mass.
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1. Question
This case is a middle-aged female with a bladder mass.
Correct
Answer: B. Squamous Cell Carcinoma
Histology: The lesion is composed of an invasive neoplasm composed of sheets and nests of cells with pleomorphic nuclei invading into the detrusor muscle. Nuclei have prominent, sometimes multiple nucleoli with focal nuclear molding and a high nuclear to cytoplasmic ratio. There is also prominent lymphovascular invasion and focal necrosis. Of note, there are areas of benign urothelium overlying the invasive carcinoma.
Discussion: This lesion is a metastatic HPV-related squamous cell carcinoma from the cervix involving the bladder. Most primary squamous cell carcinomas of the bladder occur in the context of squamous metaplasia from a process causing chronic irritation, such as schistosomiasis. Primary squamous cell carcinoma is rare and more difficult to treat than urothelial carcinoma, as it is typically resistant to chemotherapy. Urothelial carcinoma can exhibit squamous features, which may be associated with a more aggressive and treatment resistant course. The basaloid appearance of the tumor, along with its location undermining benign urothelium, are suggestive of a carcinoma from another site that is involving the bladder as a metastasis or direct extension. In women, HPV-related basaloid squamous cell carcinoma is most commonly an extension from the gynecologic tract.
Dotson A, May A, Davaro F, Raza SJ, Siddiqui S, Hamilton Z. Squamous cell carcinoma of the bladder: poor response to neoadjuvant chemotherapy. Int J Clin Oncol. 2019 Jun;24(6):706-711. doi: 10.1007/s10147-019-01409-x. Epub 2019 Feb 1. PMID: 30707342.
Clark PE. Urothelial carcinoma with squamous differentiation: response to chemotherapy and radiation. Urol Oncol. 2015 Oct;33(10):434-6. doi: 10.1016/j.urolonc.2015.06.019. Epub 2015 Aug 14. PMID: 26278365.
Incorrect
Answer: B. Squamous Cell Carcinoma
Histology: The lesion is composed of an invasive neoplasm composed of sheets and nests of cells with pleomorphic nuclei invading into the detrusor muscle. Nuclei have prominent, sometimes multiple nucleoli with focal nuclear molding and a high nuclear to cytoplasmic ratio. There is also prominent lymphovascular invasion and focal necrosis. Of note, there are areas of benign urothelium overlying the invasive carcinoma.
Discussion: This lesion is a metastatic HPV-related squamous cell carcinoma from the cervix involving the bladder. Most primary squamous cell carcinomas of the bladder occur in the context of squamous metaplasia from a process causing chronic irritation, such as schistosomiasis. Primary squamous cell carcinoma is rare and more difficult to treat than urothelial carcinoma, as it is typically resistant to chemotherapy. Urothelial carcinoma can exhibit squamous features, which may be associated with a more aggressive and treatment resistant course. The basaloid appearance of the tumor, along with its location undermining benign urothelium, are suggestive of a carcinoma from another site that is involving the bladder as a metastasis or direct extension. In women, HPV-related basaloid squamous cell carcinoma is most commonly an extension from the gynecologic tract.
Dotson A, May A, Davaro F, Raza SJ, Siddiqui S, Hamilton Z. Squamous cell carcinoma of the bladder: poor response to neoadjuvant chemotherapy. Int J Clin Oncol. 2019 Jun;24(6):706-711. doi: 10.1007/s10147-019-01409-x. Epub 2019 Feb 1. PMID: 30707342.
Clark PE. Urothelial carcinoma with squamous differentiation: response to chemotherapy and radiation. Urol Oncol. 2015 Oct;33(10):434-6. doi: 10.1016/j.urolonc.2015.06.019. Epub 2015 Aug 14. PMID: 26278365.
