Two cases of plasmacytoid variant of bladder cancer

Abstract

Introduction: Plasmacytoid urothelial carcinoma (PUC) is a rare and aggressive variant of bladder cancer. Since PUC is infrequently encountered, its management continues to be a formidable challenge.
 Case 1: A 74-year-old gentleman was admitted with a 1-month history of gross hematuria and urinary overflow incontinence. Cystoscopy revealed an abnormal growth at the bladder base and biopsies were taken. This patient had high grade PUC sparing the muscularis propria (MP). He underwent nephrostomy tube insertion and subsequent conversion to internal stents 8 weeks later. Repeat resection showed muscle-invasive PUC. Repeat CT showed subcentimeter bilateral inguinal and external iliac lymphadenopathy. The surgeon discovered a dense infiltrative reaction within the retroperitoneum and colonic obstruction during radical cystoprostatectomy and palliative colostomy, confirming metastatic PUC.
 Case 2: A 72-year-old gentleman presented with gross hematuria, bleeding from an established end ileostomy, and bowel obstruction symptoms. Cystoscopy identified an anterior bladder tumour and CT staging confirmed a small bowel obstruction (SBO). Transurethral resection showed PUC with invasion of the MP and lymphovascular space. Obvious positive margins were identified during radical cystoprostatectomy, as the tumour clearly invaded bone and the rectal stump. Ileostomy output ceased post-operatively on day 4, and bowel contents began leaking through his urethra the following day. Reassessment of goals of care resulted in cessation of significant interventions. Unfortunately, he passed away 2 weeks post-operatively due to sepsis.
 Discussion: These cases illustrate the aggressiveness of PUC bladder tumours and how imaging frequently under-stages these patients. Neoadjuvant chemotherapy prior to attempting surgical control may be beneficial.