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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.

Synopsis

- high-grade tumor
- molecular features of aggressive urothelial carcinoma
- usually diagnosed in advanced pathological stage (64% pT3, 23% pT4)
- metastases in 60 % of the patients
- CD138 is positive in 78 %

Prognosis

Average survival of PUC treated with radical cystectomy and adjuvant chemotherapy is lower than what is typically seen for comparable conventional urothelial carcinomas.

Immunochemistry (#20878954#)

- 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.

Cytogenetics (#20878954#)

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%.

Open references

- Plasmacytoid urothelial carcinoma of the bladder metastatic to the stomach: a case report. Nabbout P, Furr J, Paari M, Slobodov G. Case Rep Urol. 2012;2012:715951. doi: 10.1155/2012/715951. PMID: #22953154# [Free]

References

- Plasmacytoid urothelial carcinoma, a chemosensitive cancer with poor prognosis, and peritoneal carcinomatosis. Dayyani F, Czerniak BA, Sircar K, Munsell MF, Millikan RE, Dinney CP, Siefker-Radtke AO. J Urol. 2013 May;189(5):1656-61. doi:10.1016/j.juro.2012.11.084 . PMID: #23159581#

- Plasmacytoid urothelial carcinoma of the bladder: a rare malignancy. Philippou P, Kariotis I, Volanis D, Ploumides A, Delakas D. Urol Int. 2011;86(3):370-2. doi:10.1159/000322389 . PMID: #21325783#

- 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, Sibony 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#