Plasmacytoid urothelial carcinoma: a rapid autopsy case report with unique clinicopathologic and genomic profile.

Abstract

BACKGROUND:

Rapid ("warm") autopsies of patients with advanced metastatic cancer provide important insight into the natural history, pathobiology and histomorphology of disease in treatment-resistant tumors. Plasmacytoid urothelial carcinoma (PUC) is a rare variant of urothelial carcinoma characterized by neoplastic cells morphologically resembling plasma cells. PUC is typically aggressive, high-stage at presentation, and associated with poor outcomes. Recurrence is common in PUC, with the majority of recurrences occurring in the peritoneum.

CASE PRESENTATION:

Here, we report rapid autopsy findings from a patient with recurrent PUC. The patient had persistent pain after cystoprostatectomy, although initial post-operative imaging showed no evidence of disease. Imaging obtained shortly before his death showed only subtle growth along vascular tissue planes; however, extensive disease was seen on autopsy. Plasmacytoid tumor cells formed sheets involving many serosal surfaces. Molecular interrogation confirmed a mutation in CDH1 exon 12 leading to early truncation of the CDH1 protein in the tumor cells.

CONCLUSIONS:

The sheet-like growth pattern of PUC makes early phases of disease spread much more difficult to capture on cross-sectional imaging. Alternative forms of surveillance may be required for detection of recurrent PUC, and providers may need to treat based on symptoms and clinical suspicion.

• Authors: Caroline T Simon, Stephanie L Skala, Paul D Killen, Javed Siddiqui, Xuhong Cao, Yuanyuan Qiao, Hikmat Al-Ahmadie, Sandra I Camelo-Piragua, Jeffrey Jentzen, Arul M Chinnaiyan, Saravana M Dhanasekaran, Zachery R Reichert, Rohit Mehra
• Journal: Diagnostic pathology (Diagn Pathol) Vol. 14 Issue 1 Pg. 113 (Oct 21 2019) ISSN: 1746-1596 [Electronic] England
• PMID: 31638990 (Publication Type: Case Reports, Journal Article)

Chemical References

• Antigens, CD
• CDH1 protein, human
• Cadherins

Topics

• Antigens, CD (metabolism)
• Autopsy (methods)
• Cadherins (metabolism)
• Carcinoma, Transitional Cell (diagnosis, pathology)
• Genomics
• Humans
• Male
• Middle Aged
• Neoplasm Recurrence, Local (diagnosis, pathology)
• Plasma Cells (metabolism)
• Urinary Bladder (pathology)
• Urologic Neoplasms (diagnosis, pathology)