Anatomical Pathology Interesting Case Conference

Microscopic Description:

Histology reveals large oval cells with abundant eosinophilic cytoplasm present in sheets and nests, in the background of myxoid stroma. These cells can be seen invading the Muscularis propria.

Immunohistochemistry was positive for AE1/AE3, EMA, CK 7, CK5.

Discussion:

Rhabdoid urothelial carcinoma is a very rare, aggressive variant of bladder tumor.

Etiology: recurrent UTI, urethral stricture/stent, family history.

Clinical features: dysuria, gross hematuria, abdominal mass.

Grossly, it is gray, firm, irregular, fleshy cut surface. Invasion of solid tumor into adjacent structures and peri vesical fat can be seen. Hemorrhage can also be seen.

Microscopy, large oval rhabdoid cells with abundant eosinophilic cytoplasm, eccentric nuclei and prominent nucleoli in myxoid background. The tumor cells can be seen invading the bladder muscle and sometimes into the peri-vesical fat.

Immunohistochemistry is positive for AE1/AE3, CK CAM 5.2, EMA, CK7, CK 20.

Management is similar to other bladder cancers, neoadjuvant chemotherapy followed by radical cystectomy, sometimes supplemented with radiation.

There is not much literature available due to the rarity of this variant however these tumors are highly aggressive, with a higher risk of metastasis and a poor overall prognosis compared to standard urothelial carcinoma.

References:

Tajima S. Rhabdoid variant of urothelial carcinoma of the urinary bladder: a case report with emphasis on immunohistochemical analysis regarding the formation of rhabdoid morphology. Int J Clin Exp Pathol. 2015 Aug 1;8(8):9638-42.

 

Parwani AV, Herawi M, Volmar K, Tsay SH, Epstein JI. Urothelial carcinoma with rhabdoid features: Report of 6 cases Hum Pathol. 2006;37:168–72.

Hafiz, A., Pasricha, S., Gandhi, J., & Mehta, A. (2011). Urothelial carcinoma of bladder having rhabdoid differentiation with isolated scapular metastasis. Journal of Cancer Research and Therapeutics, 7(4), 486–488.

 

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