摘要
Introduction: Osteoclast-like giant cell bladder carcinomas are an extremely unusual and aggressive histological subtype of urothelial carcinomas. Only 30 cases have been reported globally. Clinical case: A 79-year-old male patient was presented to our Urology Department due to macroscopic hematuria that persisted for six months. As part of his diagnostic protocol, a CT scan of the abdomen and pelvis with elimination phase was performed, finding a filling defect of 12 mm at the level of the posterior wall of the bladder. A cystoscopy was subsequently performed, confirming the presence of a 1.5 cm bladder tumor, which was resected in its entirety. Pathology analysis with hematoxylin and eosin stain revealed a composition of mononuclear cells and osteoclast-like giant cells. Immunohistochemistry was positive for epithelial markers cytokeratins AE1/AE3, EMA, P53, and CD68. Conclusion: Osteoclast-like giant cell bladder carcinomas are extremely unusual and aggressive. The only diagnostic method is through immunohistochemistry, confirming the presence of epithelial markers for urothelium in the neoplastic cells. Radical surgical treatment is recommended and there has been no proven effective adjuvant treatment to date. The patients’ median survival is 15 months.
参考
Moch H, Humphrey PA, Ulbright TM, et al., 2016, WHO Classification of Tumors of the Urinary System and Male Genital Organs, International Agency for Research on Cancer, Lyon.
Park S, Reuter V, Hansel D, 2018, Non-Urothelial Carcinomas of the Bladder. Histopathology, 74(1): 97–111.
Matulay J, Narayan V, Kamat A, 2019, Clinical and Genomic Considerations for Variant Histology in Bladder Cancer. Curr Oncol Rep, 21(3): 23.
Lobo N, Shariat S, Guo C, et al., 2020, What Is the Significance of Variant Histology in Urothelial Carcinoma?. Eur Urol Focus, 6(4): 653–663.
Grilo I, Rodrigues C, Soares A, et al., 2020, Facing Treatment of Non-Urothelial Bladder Cancers in the Immunotherapy Era. Crit Rev in Oncol Hematol, 153: 103034.
Aron M, 2019, Variant Histology in Bladder Cancer — Current Understanding of Pathologic Subtypes. Curr Urol Rep, 20(12): 80.
Hansel D, Amin M, Comperat E, et al., 2013, A Contemporary Update on Pathology Standards for Bladder Cancer: Transurethral Resection and Radical Cystectomy Specimens. Eur Urol, 63(2): 321–332.
Abd el-Latif A, Watts K, Elson P, et al., 2013, The Sensitivity of Initial Transurethral Resection or Biopsy of Bladder Tumor(s) for Detecting Bladder Cancer Variants on Radical Cystectomy. J Urol, 189(4): 1263–1267.
Lopez A, Cheng L, 2006, Histologic Variants of Urothelial Carcinoma: Differential Diagnosis and Clinical Implications. Hum Pathol, 37(11): 1371–1388.
Zaffuto E, Gazdovich S, Leyh-Bannurah S, et al., 2016, Contemporary Rates of Pathological Features and Mortality for Adenocarcinoma of the Urinary Bladder in the USA. Int J Urol, 24(2): 117–123.
Hayashi T, Tanigawa G, Fujita K, et al., 2011, Two Cases of Plasmacytoid Variant of Urothelial Carcinoma of Urinary Bladder: Systemic Chemotherapy Might be of Benefit. Int J Clin Oncol, 16(6): 759–762.
Tiwari R, Ngo N, Lee L, 2020, The Optimal Management of Variant Histology in Muscle Invasive Bladder Cancer. Transl Androl Urol, 9(6): 2965–2975.
Deuker M, Martin T, Stolzenbach F, et al., 2021, Bladder Cancer: A Comparison Between Non-Urothelial Variant Histology and Urothelial Carcinoma Across All Stages and Treatment Modalities. Clin Genitourin Cancer, 19(1): 60–68.
Mori K, Abufaraj M, Mostafaei H, et al., 2020, A Systematic Review and Meta-Analysis of Variant Histology in Urothelial Carcinoma of the Bladder Treated with Radical Cystectomy. J Urol, 204(6): 1129–1140.
Soave A, Schmidt S, Dahlem R, et al., 2015, Does the Extent of Variant Histology Affect Oncological Outcomes in Patients with Urothelial Carcinoma of the Bladder Treated with Radical Cystectomy?. Urol Oncol, 33(1): 21.e1–21.e9.
Daneshmand S, Nazemi A, 2020, Neoadjuvant Chemotherapy in Variant Histology Bladder Cancer: Current Evidence. EurUrol Focus, 6(4): 639–641.
Vetterlein M, Wankowicz S, Seisen T, et al., 2017, Neoadjuvant Chemotherapy Prior to Radical Cystectomy for Muscle-Invasive Bladder Cancer with Variant Histology. Cancer, 123(22): 4346–4355.
Porten S, Willis D, Kamat A, 2014, Variant Histology: Role in Management and Prognosis of Non Muscle Invasive Bladder Cancer. Curr Opin Urol, 24(5): 517–523.
Lin-Brande M, Pearce S, Ashrafi A, et al., 2019, Assessing the Impact of Time to Cystectomy for Variant Histology of Urothelial BladderCancer. Urology, 133: 157–163.
Park H, 2011, Osteoclast-Like Giant Cell Carcinoma of the Distal Ureter. Korean J of Urol, 52(1): 68.
Palazzetti A, Oderda M, Falcone M, et al., 2016, Osteoclast-Like Giant Cell Carcinoma Hiddenby a Bladder Stone in a Patient with Neurogenic Bladder. Clin Genitourin Cancer, 14(1): e127–e130.
Baydar D, Amin M, Epstein J, 2016, Osteoclast-Rich Undifferentiated Carcinomas of the Urinary Tract. Mod Pathol, 19(2): 161–171.
García-García F, García-Ligero J, Rico-Galiano J, et al., 2003, A Rare Case of Bladder Carcinoma with Osteoclast-Type Giant Cells: A Literature Review, Actas Urol Esp, 27(4): 317–320.
Wu P, Su C, Li J, et al., 2009, Osteoclast-Like Giant Cell Carcinoma of the Urinary Bladder. J Chin Med Assoc, 72(9): 495–497.
Osman C, Muammer B, Murat O, et al., 2018, Osteoclast-Type Giant Cell Carcinoma of the Urinary Bladder: An Unusual and Aggressive Variant of Urothelial Carcinoma. Urol Case Rep, 23: 50–51.