Plasmacytoid Urothelial Carcinoma of the Bladder Metastatic to the Stomach: A Case Report

Abstract

Introduction. Plasmacytoid urothelial carcinoma (PUC) of the bladder is a rare histological variant of urothelial carcinoma that was recently identified. Available data on this histological variant is limited. Case Report. We report the case of a 75-year-old man with presumed history of high-grade urothelial cancer of the bladder, treated with transurethral resection and Bacille Calmette-Guérin (BCG) in 2004. Six years after treatment of the bladder cancer, the patient underwent gastrectomy for an undifferentiated carcinoma of the stomach. On followup, patient developed right ureterohydronephrosis and peritoneal carcinomatosis. Biopsy of the bladder during stent placement revealed a plasmacytoid urothelial carcinoma of the bladder. Rereadings revealed that the initial bladder and gastric malignancies were also plasmacytoid carcinoma, indicating that, the patient had since 2004, a PUC of the bladder that spread to the stomach and peritoneal cavity. Conclusion. Plasmacytoid urothelial carcinoma of the bladder is an aggressive variant of urothelial carcinoma. Based on our case and the literature review, this tumor can be misdiagnosed because of its rarity, leading to treatment delays. Both the urologist and the pathologist need to have a high index of suspicion for PUC whenever they encounter unusual clinical and/or pathological findings.

Plasmacytoid variant of urothelial carcinoma: Diagnostic challenges and role of immunohistochemistry

“…Prominent retraction artifact around each tumor cell may also be seen. [ 3 5 ] Retraction artifacts were seen in the present case too.…”

“…Plasmacytoid carcinoma of the urinary bladder or plasmacytoid urothelial carcinoma (PUC) is one such rare and only recently described a histological variant of transitional cell carcinoma. It is an aggressive variant and may be confused with plasmacytoma and lymphoma,[ 3 ] a high index of suspicion for both urologist and pathologist is essential to avoid a misdiagnosis. We report here an interesting case of plasmacytoid carcinoma of the urinary bladder in a 52-year-old male, which posed diagnostic difficulties on histopathology.…”

Plasmacytoid Urothelial Carcinoma of the Bladder: Case Report and Review of the Literature

“…Other symptoms include: urgency, urinary frequency increase, and low abdominal pain. 8 Metastasis often affects adjacent pelvic structures such as the bones, the peritoneum, the gastrointestinal tract, and the scrotum, 3,6,13,14 and even heart distant metastasis have been described. 15 Ricardo-Gonzalez et al evaluated 15 patients with PUC and found this tumor presenting with recurring extension to the peritoneum, often compromising serous surfaces.…”

“…15 Ricardo-Gonzalez et al evaluated 15 patients with PUC and found this tumor presenting with recurring extension to the peritoneum, often compromising serous surfaces. 16 One of the hypotheses for the aggressiveness of this tumor and its extension pattern is the loss of Ecadherin (a necessary protein for cell to cell adhesion), 6,17 which is absent in most PUCs and can help distinguish it from other types of UCs. 11 It is postulated that the absence of E-cadherin leads to loss of cellular differentiation, allowing the PUC cells to invade the surrounding tissues along the fascial planes and toward the lymph nodes.…”

“…3,4 Its first description was made by Sahin et al in 1991. 5,6 The incidence of PUC is higher in males (3:1), with a mean diagnosis age of 69 years old, and represents between 2.7 and 3% of all urothelial bladder cancers. 7,8 There have been less than 100 cases described in the literature; 6 therefore, the biology, prognosis and treatment of this pathology are still hard to establish.…”