Case of the Week

2021-03 / January 18

Contributors: Marcelo Luis Pereira de Souza Filho, Carlos Alberto dos Santos Silva, Daniel Athanazio

A man in his 80s presented with gross hematuria for the past three months. He underwent transurethral resection of a bladder tumor.

Click on the below thumbnails to enlarge photos.

Quiz

1. What is the correct diagnosis?

A. Urothelial carcinoma and small cell carcinoma

B. Prostatic adenocarcinoma and small cell carcinoma

C. Primary bladder adenocarcinoma and small cell carcinoma

D. Metastatic mixed neuroendocrine non-neuroendocrine neoplasms

Both urothelial and prostate carcinoma may coexist with small cell neuroendocrine carcinoma. In this case, a predominant component of small cell carcinoma coexisted with an epithelial neoplasm with villoglandular and cribriform morphology. Advanced age and cribriform morphology are suggested as indicatives of prostate adenocarcinoma, which may show papillary or pseudopapillary features. In this scenario, pathologists should have a low threshold to perform immunostains. In this case, despite cribriform morphology, the immunoprofile was supportive of urothelial carcinoma with glandular differentiation. As shown in the figures above, the villoglandular component was reactive for cytokeratins 7 and 20, and GATA3 while the solid tumor was reactive only for CD56. The entire tumor was negative for PSA and CDX2.

Based on current CAP, ICCR and NCCN guidelines, any amount of small cell carcinoma component within a urothelial carcinoma qualifies the whole tumor as small cell carcinoma since this morphology will guide treatment.

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5. Roy S, Smith MA, Cieply KM, Acquafondata MB, Parwani AV. Primary bladder adenocarcinoma versus metastatic colorectal adenocarcinoma: a persisting diagnostic challenge. Diagn Pathol. 2012 Nov 2;7:151.
6. International Collaboration on Cancer Reporting (ICCR) - Carcinoma of the Bladder Histopathology Reporting Guide Cystectomy, Cystoprostatectomy and Diverticulectomy Specimen. http://www.iccr-cancer.org/getattachment/Datasets/Published-Datasets/Urinary-Male-Genital/Carcinoma-of-the-Bladder-Cystectomy-Cystoprostatec/ICCR-Urinary-Tract-Bladder-bookmarked-guide.pdf
7. National Comprehensive Cancer Network Clinical (NCCN) Practice Guidelines in Oncology - Bladder Cancer. [https://www.nccn.org/professionals/physician_gls/default.aspx].
8. Paner GP, Zhou M, Srigley JR et al. College of American Pathologists. Protocol for the examination of specimens from patients with carcinoma of the urinary bladder, 2020

About GUPS

The Genitourinary Pathology Society (GUPS) was formed with the vision of advancing the care of patients with urologic diseases through enhancements of best practices, research, and education in the subspecialty of Urological Pathology.

GUPS is an official Companion Society of the United States and Canadian Academy of Pathology (USCAP).

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