CC BY-NC-ND 4.0 · Urol Colomb
DOI: 10.1055/s-0038-1677034
Case Report | Caso Clínico
Sociedad Colombiana de Urología. Publicado por Thieme Revinter Publicações Ltda Rio de Janeiro, Brazil

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

Carcinoma urotelial de vejiga, variante plasmocitoide: reporte de un caso y revisión de la literatura
Ángela Molina Barrera
1  Resident, Urology, Universidad de Antioquia, Medellín, Antioquia, Colombia
,
Andrea Vásquez Franco
2  Urology, Clínica León XIII, Medellín, Antioquia, Colombia
,
Andrés Felipe Aristizábal
2  Urology, Clínica León XIII, Medellín, Antioquia, Colombia
,
David Correa Galeano
2  Urology, Clínica León XIII, Medellín, Antioquia, Colombia
,
Manuel Cabrales Hessen
2  Urology, Clínica León XIII, Medellín, Antioquia, Colombia
› Author Affiliations
Further Information

Publication History

07 July 2018

29 November 2018

Publication Date:
19 February 2019 (eFirst)

  

Abstract

Introduction Plasmacytoid urothelial carcinoma (PUC) of the bladder is a rare histological variant, accounting for 1 to 3% of the invasive urothelial carcinomas, and it is typically aggressive. So far, it has not been well characterized, and the literature is based on reports and case series.

Methods Descriptive observational study with a case report and literature review.

Results A 70-year-old male patient presenting with 4 months of constitutional and urinary symptoms, with an ultrasound finding of bilateral hydronephrosis and diffuse thickening of the bladder walls. In the cystoscopy, trigone of infiltrated appearance, a biopsy wass performed, whose immunohistochemistry revealed a PUC. The abdominopelvic image showed an infiltrative lesion that compromised the muscle of the bladder and extended to the perivesical fat, without adequate plane of cleavage with the prostate and a single hypogastric adenopathy suspected of malignancy. It was classified as cT3b vs cT4aN1M0 (chest computed tomography [CT] negative for malignancy), and the patient was submitted to a radical cystoprostatectomy, extended pelvic lymphadenectomy and non-continent urinary diversion with ileal conduit. The pathology revealed a diffuse PUC with prostatic stromal involvement and 22 of 39 lymph nodes positive for malignancy. Finally, the patient presented a series of postoperative complications and died.

Conclusion Plasmacytoid urothelial carcinoma of the bladder is a rare entity, characterized by high aggressiveness, an advanced stage at the time of diagnosis, and a poor prognosis. Currently, an aggressive approach is recommended due to its high invasive potential.

Resumen

Introducción El carcinoma urotelial plasmocitoide (CUP) de la vejiga es una variante histológica poco frecuente; representa el 1 al 3% de los carcinomas uroteliales invasivos y es típicamente agresiva. Hasta el momento no ha sido bien caracterizada, y la literatura se basa en reportes y series de casos.

Métodos Estudio observacional descriptivo, con reporte de caso y revisión de la literatura.

Resultados Paciente masculino de 70 años presentando por 4 meses síntomas constitucionales y urinarios, con hallazgo ecográfico de hidronefrosis bilateral y engrosamiento difuso de las paredes vesicales. En la cistoscopia, trígono de apariencia infiltrada, se realizó biopsia cuya inmunohistoquímica reveló un CUP. En imagen abdominopélvica, se evidenció lesión infiltrativa que comprometía la muscular de la vejiga y se extendía a la grasa perivesical, sin adecuado plano de clivaje con la próstata y un único ganglio hipogástrico sospechoso de malignidad. Se clasificó como cT3b vs cT4aN1M0 (TAC tórax negativo para malignidad) y fue llevado a cistoprostatectomía radical, linfadenectomía pélvica extendida y derivación urinaria no continente con conducto ileal. La patología reveló un carcinoma urotelial variante difusa plasmocitoide con compromiso de estroma prostático y 22 de 39 ganglios positivos para malignidad. Finalmente, el paciente presentó una serie de complicaciones posoperatorias y falleció.

Conclusión El carcinoma urotelial de vejiga variante plasmocitoide es una entidad poco frecuente, caracterizada por alta agresividad, un estadio avanzado al momento del diagnóstico, y un pobre pronóstico. En la actualidad, se recomienda un enfoque agresivo dado su alto potencial invasivo.

Note

The present study was conducted at IPS Universitaria Clínica León XIII, Medellín – Antioquia, Colombia.


Ethical Considerations

The present work followed the rules for research with human being according to what is provided by resolution no 008430/1993 in the 2013 Declaration of Helsinki. It was a non-experimental research with minimal risk. Even though the main goal of medical researches is to produce new knowledge, this goal will never prevail over the rights and interests of the people participating in them.