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Int J Clin Exp Pathol 2012;5(6):601-608

Case Report
Plasmacytoid urothelial carcinoma of the urinary bladder: a clinical pathological study
and literature review

Zhihua Wang*, Tong Lu*, Lihuan Du, Zhiquan Hu, Qianyuan Zhuang, Youyuan Li, Cong-Yi Wang, Hui Zhu, Zhangqun Ye

Department of Urology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1095 Jiefang Ave., Wuhan,
430030, PR China; The Center for Biomedical Research, Tongji Hospital, Tongji Medical College, Huazhong University of Science and
Technology, 1095 Jiefang Ave., Wuhan, 430030, PR China; The Center for Biotechnology and Genomic Medicine, Georgia Health Sciences
University, 1120 15th Street, CA4098, Augusta, GA, 30912; Department of Urology, University Hospitals Case Medical Center, Case Western
Reserve University School of Medicine, Cleveland, OH, USA; *These authors contributed equally to this work.

Received May 23, 2012; Accepted June 28, 2012; Epub July 29, 2012; Published August 15, 2012

Abstract: Purpose: Plasmacytoid carcinoma of the urinary bladder or plasmacytoid urothelial carcinoma (PUC) is a rare and only recently
described histological variant of transitional cell carcinoma (TCC). We herein report the clinical and histopathological features for a new case of
PUC. By combining with those reported cases, we intend to define the characteristics of PUC and to provide a therapeutic and prognostic
guidance for this disease. Materials and Methods: The index case at our institution was a patient with complaint of lower abdominal pain but
without any urological symptoms. The patient underwent radical cystectomy, and the representative sections of tumor were submitted for
immunohistochemical analysis. The data for this patient were collected from clinical charts, histological review and follow-up studies. We also
performed an extensive literature review of PUC including clinical presentation, pathological features, therapy and prognosis. Results:
Clinically, patients with PUC are associated with nonspecific abdominal pain but absent of hematuria. Cystoscopy analysis revealed that PUC
is manifested by the coarse and indurated mucosal fold. Macroscopic studies demonstrated an ulcerated firm mass which was present in the
left lateral wall of the bladder. Histologically, PUC appeared to be dyscohesive, plasmacytoid cells with eccentric nuclei and abundant
eosinophilic cytoplasm with characteristics of plasmacytoid morphology. The tumor cells are negative for E-cadherin, but positive for CD138
expression. This particular patient died 3 months after the radical cystectomy and one course of adjuvant chemotherapy. Literature review
revealed that most PUC cases showed similar clinical and pathological features along with poor prognosis. Conclusions: PUC is a rare tumor
associated with poor prognosis due to its advanced clinical stage upon its diagnosis. The delayed diagnosis is mainly due to the late
occurrence of hematuria and absence of papulary mucosal surface at cystoscopy. Diagnosis can be achieved based on its typical histological
features, clinical history and immunohistochemical results. Other than radical cystectomy, postoperative adjuvant treatment could be a good
approach to prolong the survival time of PUC patients. (IJCEP1205009).

Keyword: Urinary bladder, plasmacytoid urothelial carcinoma, cystectomy

Address all correspondence to:
Dr. Zhihua Wang,
Department of Urology
Tongji Hospital affiliated to Tongji Medical College
Huazhong University of Science and Technology (HUST)
1095 Jiefang Ave., Wuhan, PR China.
Tel: -86-1399 5574 598; Fax: 86-27-8366-5288
E-mail: zhwang_hust@hotmail.com