Plasmacytoid urothelial carcinoma (PUC): Imaging features with histopathological correlation

Abstract

Cite as: Can Urol Assoc J 2017;11(1-2):E50-7. http://dx.doi.org/10.5489/cuaj.3789 Published online January 12, 2017 AbstractIntroduction: Plasmacytoid urothelial carcinoma (PUC) is a highgrade variant of conventional urothelial cell carcinoma. This study is the first to describe the imaging findings of PUC, which are previously unreported, using clinical and histopathological correlation. Methods: With internal review board approval, we identified 22 consecutive patients with PUC from 2007-2014. Clinical parameters, including age, gender, therapy, surgical margins, and longterm outcome, were recorded. Baseline imaging was reviewed by an abdominal radiologist who evaluated for tumour detectability/location/morphology, local staging, and presence/location of metastases. Pelvic peritoneal spread of tumour (defined as >5mm thick soft tissue spreading along fascial planes) was also evaluated. Followup imaging was reviewed for presence of local recurrence or metastases. Results: Median age at presentation was 74 years (range 51-86), with only three female patients. Imaging features of the primary tumour in this study were not unique for PUC. Muscle-invasive disease was present on pathology in 19/22 (86%) of tumours, with distant metastases in 2/22 (9%) at baseline imaging. Pelvic peritoneal spread of tumour was radiologically present in 4/20 (20%) at baseline. During followup, recurrent/residual tumour was documented in 16/22 (73%) patients and 7/16 (44%) patients eventually developed distant metastases. Median time to disease recurrence in patients who underwent curative surgery was three months (range 0-19). Conclusions: PUC is an aggressive variant of urothelial carcinoma with poor prognosis. Pelvic peritoneal spread of tumour as thick sheets extending along fascial planes may represent a characteristic imaging finding of locally advanced PUC.

Plasmacytoid Urothelial Carcinoma: An Unusual Variant That Warrants Aggressive Management and Critical Distinction on Transurethral Resections

“…15 Pelvic peritoneal infiltration by PUC can be detected on radiology as thick sheets extending along the fascial planes and is suggested to be a characteristic imaging finding. 23 On follow-up, PUC has an aggressive course, with high recurrence rates. 8,9,11,[13][14][15] In the largest series of 98 PUCs from Memorial Sloan Kettering Cancer Center, the median overall survival was reported to be 3.8 years, 4.1 years shorter than in matched conventional urothelial carcinoma (8 years).…”

Plasmacytoid Urothelial Carcinoma of the Bladder: Case Report and Review of the Literature

“…20,21,26,27 Recently, GATA3 has shown to be of value in UC, including PUC. 3,22 Zhao et al reported high specificity of GATA3 as a diagnostic marker in PUC, showing a higher expression in regional metastasis. 28 Therefore, GATA3 seems to be an appropriate marker for differential diagnosis, useful in recognizing the urothelial lineage of PUC in metastatic patients.…”

Update on multiparametric MRI of urinary bladder cancer

“…Recently, imaging findings of PUC have been described resembling histological spread of tumor with invasive T 2 W hypointense sheets of soft tissue extending from the primary tumor and spreading along fascial planes with restricted diffusion (Fig. ) . A propensity for locally recurrent disease and peritoneal metastases has also been described in PUC .…”

“…7). 79 A propensity for locally recurrent disease and peritoneal metastases has also been described in PUC. 80 Imaging features of micropapillary and sarcomatoid variants have not, to our knowledge, been described in the imaging literature.…”