Pleomorphic giant cell carcinoma of the urinary bladder

Abstract

Pleomorphic giant cell carcinoma is a rare aggressive variant of urothelial carcinoma characterized by the presence of highly pleomorphic bizarre tumor giant cells similar to giant cell carcinoma of the lung. Although mentioned in the 2004 WHO classification as a type of urothelial carcinoma with giant cells, characteristics of pleomorphic giant cell carcinoma were described in the literature only in 2009 when Lopez Beltran et al . reported a series of 8 cases. It occurs more commonly in older males (ages ranging 55–88 years) with patients presenting with hematuria, dysuria or frequency. The pleomorphic giant cell component in the reported series varied from 20% to 100% of the tumor. This tumour has expansile masses of pleomorphic epithelioid tumor with bizarre anaplastic multinucleated and mononu-cleated tumor giant cells. Extensive necrosis is common. Tumor cells have abundant cytoplasm, and have frequent typical or atypical mitotic figures. Tumour cells are positive for CK7, CAM 5.2, AE1/AE3 and EMA. Some cases are positive for P63, thrombomodulin and Uroplakin111. This tumour must be differentiated from metastatic malignancy to the bladder including pleomorphic giant cell carcinoma of the prostate. This tumor has a very poor prognosis. Patients often have advanced stage cancer at presentation.