Plasmacytoid bladder cancer: a rare case report

Abstract

Plasmacytoid carcinoma of the bladder is a rare histological variant of urothelial carcinoma associated with late presentation. This pattern of disease may portend an extremely poor prognosis and significant challenges for treatment with curative intent.

Case presentation: The authors report a case of a patient with locally advanced plasmacytoid urothelial carcinoma (PUC) of the bladder. A 71-year-old man with a history of chronic obstructive pulmonary disease presented with gross hematuria. The rectal examination revealed a fixed bladder base. A computed tomography scan showed a pedunculated lesion arising from the anterior and left lateral bladder wall and extended to the perivesical fat. The patient underwent transurethral resection of the tumor. The histologic examination revealed the presence of muscle-invasive PUC of the bladder. The decision of the multidisciplinary consultation meeting was to do palliative chemotherapy. Thus, the patient could not receive systemic chemotherapy and died 6 weeks after transurethral resection of the bladder tumor.

Clinical discussion: A plasmacytoid variant of urothelial carcinoma is a rare subtype of urothelial carcinoma that has a poor prognosis with a high mortality rate. The disease is usually diagnosed at an advanced stage. Given the rarity of plasmacytoid bladder cancer, treatment guidelines are not clear; therefore, more aggressive treatment may be required.

Conclusion: PUC of the bladder is characterized by high aggressiveness, an advanced stage at the time of diagnosis, and a poor prognosis.

Keywords: bladder cancer; case report; plasmacytoid variant; urothelial carcinoma.

Figure 1

Computed tomography scan showing an enhancing, pedunculated lesion arising from the anterior and left lateral bladder wall (plasmacytoid urothelial carcinoma of the bladder).

Figure 2

Photomicrographs of bladder high-grade urothelial carcinoma showing (A) glandular differentiation (hematoxylin and eosin, H&E ×40); (B) discohesive tumor cells with scant and eccentric cytoplasm mimicking plasma cells (arrow). Note the presence of prominent apical snouts (arrowhead) (H&E ×400).