Plasmacytoid urothelial carcinoma: a case report

Abstract

The plasmacytoid variant of urothelial carcinoma is a rare entity with a very poor prognosis. The majority of patients present in advanced stages with extravesical disease. The awareness of this entity is important as the features can be confused with that of other malignancies. Accurate reporting is of critical importance due to the chemosensitve nature of this disease. We present a case of a 55-year-old who presented with left flank pain and who subsequently underwent CT which showed a thickened bladder wall. Urine cytology was positive for malignant cells. He went on to have a transurethral resection of the tumour with histological features of plasmacytoid urothelial carcinoma with muscle invasion. Immunohistochemical studies confirmed the diagnosis. Following a radiacal cystoprostatectomy, he was found to have extravesical fat involvement and adventitial tissue involvement around the resection margin of the left ureter. Regional lymph nodes were positive for small collections of malignant cells. This case report illustrates the very aggressive nature of this disease and the potential pitfalls in the diagnosis.