Progressive plasmacytoid variant bladder cancer with retroperitoneal dissemination: An autopsy case report

Abstract

Introduction Plasmacytoid urothelial carcinoma is a rare and aggressive variant of bladder cancer. Case presentation A 75‐year‐old woman presented with plasmacytoid urothelial carcinoma with retroperitoneal dissemination was treated with chemotherapy. After an unsuccessful first‐line chemotherapy with gemcitabine and cisplatin, we assessed circulating tumor cells; one such cell was found to be positive for programmed death‐ligand 1. The patient received second‐line chemotherapy with pembrolizumab. However, the tumor extended to the retroperitoneal organs, and the patient eventually died. Autopsy revealed a widespread diffuse scirrhous infiltration of the carcinoma into the retroperitoneum. However, distant metastasis was not observed. Conclusion The evaluation of circulating tumor cells and autopsy revealed a disease state of progressive plasmacytoid urothelial carcinoma treated with pembrolizumab.

Poor Outcome due to the Plasmacytoid Variant of Urothelial Carcinoma

“…However, mucosal induration and a thickened bladder wall without masses unlike UC in situ lesions are also shown, which can lead to diagnostic pitfalls [3]. According to the report, cystoscopy revealed that bladder capacity was extremely decreased, and the whole bladder mucosa was irregular and thick at advanced PUC [9]. Otherwise, no masses were seen even after cystoscopic examination, and PUC was diagnosed after mucosal resection was performed [3].…”

Pathological complete response of plasmacytoid variant bladder cancer to pembrolizumab following genomic analysis

“…In this case, we continued administration of pembrolizumab even after we confirmed pathological CR. A feature of pembrolizumab is a durable response, and a recent 5‐year follow‐up analysis of phase 3 KEYNOTE‐045 trial revealed a median duration of response of more than 2 years for patients with locally advanced or metastatic UC that progressed during or after platinum‐based chemotherapy 7 . Another possibility was to discontinue pembrolizumab treatment after confirmation of the pCR at cystectomy, but considering the aggressive nature of the disease and the benefit of continued activation of CD8 + T cells, we decided to continue treatment with pembrolizumab.…”

Outcomes of poorly differentiated and plasmacytoid variant bladder urothelial carcinoma

“…Nonetheless, some cases have reported responsiveness to typical chemotherapeutic agents 19 . Usually, platinum‐based chemotherapy is given with regimes such as methotrexate, vinblastine, doxorubicin, and cisplatin (MVAC) or gemcitabine and cisplatin (GC) 14,20 …”

“…19 Usually, platinum‐based chemotherapy is given with regimes such as methotrexate, vinblastine, doxorubicin, and cisplatin (MVAC) or gemcitabine and cisplatin (GC). 14 , 20 …”