plasmacytoid urothelial carcinoma
Tuesday 2 November 2010
The WHO classification of 2004 defines new histological and molecular variants of urothelial carcinoma. However there are limited data available on the clinico-pathological characteristics or prognosis of these variants.
In summary, PUC is a aggressive variant of bladder cancer with molecular features of advanced bladder cancer and evidence of WNT pathway activation in some of the cases.
molecular features of aggressive urothelial carcinoma
usually diagnosed in advanced pathological stage (64% pT3, 23% pT4)
metastases in 60 % of the patients
Average survival of PUC treated with radical cystectomy and adjuvant chemotherapy is lower than what is typically seen for comparable conventional urothelial carcinomas.
CD138 is positive in 78 %
87% of the PUCs show a negative or strongly reduced membranous staining of E-cadherin. (#20878954#, #20818341#)
Beta-catenin staining is negative in 22.5 % and 16.7% of the remaining tumors show nuclear accumulation.
Aberrant CK20 expression (negative or >10% of cells stained) and negative CK7 staining is found in 100% and 22.6 %, respectively.
97% reveal positive staining for PAN-CK.
MUM-1 expression is negative in all cases.
Multi-target fluorescence in situ hybridization showed all PUCs to be highly aneuploid and polysomic.
Deletions on chromosome 9p21 seem to play an important role in this variant.
Molecular biology (#20878954#)
FGFR3 and PIK3CA mutation analyses yield no mutations in any of the PUCs analyzed.
TP53 mutation analysis show mutations in 29%.
The plasmacytoid carcinoma of the bladder - rare variant of aggressive urothelial carcinoma. Keck B, Stoehr R, Wach S, Rogler A, Hofstaedter F, Lehmann J, Montironi R, Sibonye M, Fritsche HM, Lopez-Beltran A, Epstein JI, Wullich B, Hartmann A. Int J Cancer. 2010 Sep 28. PMID: #20878954#
E-cadherin expression in plasmacytoid, signet ring cell and micropapillary variants of urothelial carcinoma: comparison with usual-type high-grade urothelial carcinoma. Lim MG, Adsay NV, Grignon DJ, Osunkoya AO. Mod Pathol. 2010 Sep 3. PMID: #20818341#
Plasmacytoid urothelial carcinoma of the bladder. Lopez-Beltran A, Requena MJ, Montironi R, Blanca A, Cheng L. Hum Pathol. 2009 Jul;40(7):1023-8. PMID: #19297008#
Plasmacytoid urothelial carcinoma: detailed analysis of morphology with clinicopathologic correlation in 17 cases. Nigwekar P, Tamboli P, Amin MB, Osunkoya AO, Ben-Dor D, Amin MB. Am J Surg Pathol. 2009 Mar;33(3):417-24. PMID: #19011563#