CASE OF THE WEEK
2020-5 / FEBRUARY 3
(CONTRIBUTOR: CONSTANTINA PETRAKI)
80 y/o male with hematuria and a bladder tumor. NKX3.1 and prostein immunostains are shown. Otherwise the tumor is positive for AR, PSMA and PSAP and is negative for GATA3, UroplakinII, CKHMW, p63, CK5/6.
Quiz
1. What is the correct diagnosis?
a. Giant cell urothelial carcinoma
b. Poorly differentiated urothelial carcinoma with osteoclast-like giant cells
c. Pleomorphic giant cell variant of prostatic adenocarcinoma
d. Sarcomatoid urothelial carcinoma.
e. Urothelial carcinoma with trophoblastic differentiation
1. c
1. Pleomorphic giant cell variant of prostatic adenocarcinoma
The pleomorphic giant cell variant of prostatic adenocarcinoma is an exceptionally aggressive rare variant with giant, bizarre, anaplastic cells containing pleomorphic nuclei and lacking a spindle cell component (WHO 2016). Some patients have a history of conventional prostatic carcinoma treated with antiandrogen or radiation therapy which was the case in this patient. The prognosis is poor. The differential diagnosis includes poorly differentiated carcinomas mainly of the urinary bladder, urothelial carcinoma or other tumors with trophoblastic differentiation and tumors with osteoclast-type giant cells.
Humphrey PA, Moch A, Cubilla AL, Ulbright TM, Reuter VE. The 2016 WHO classification of tumours of the urinary system and male genital organs-Part B: Prostate and Bladder Tumours.
Eur Urol 2016, 70: 106-119.
Parwani AW, Herawi M, Epstein JI. Pleomorphic giant cell adenocarcinoma of the prostate: report of 6 cases.
Am J Surg Pathol 2006, 30: 1254-1259.
Lopez-Beltran A, Eble JN, Bostwick DG. Pleomorphic giant cell carcinoma of the prostate.
Arch Pathol Lab Med 2005, 129: 683-685.
Constantina Petraki
Metropolitan Hospital, Athens, Greece
constantinapetraki@gmail.com
Bladder
prostate cancer, pleomorphic giant cell variant, antiandrogen therapy