漿細胞變異型膀胱尿路上皮癌 – 案例報告

潘柏勳¹、張延驊^1,2、黃志賢^1,2

¹台北榮民總醫院 泌尿部；²國立陽明交通大學醫學院泌尿學科，書田泌尿科學研究中心

Bladder urothelial carcinoma with plasmacytoid variant: a Case Report

Po-Hsun Pan¹, Yen-Hwa Chang^1,2, William J.S. Huang^1,2

¹Department of Urology, Taipei Veterans General Hospital, Taipei, Taiwan

²Department of Urology, College of Medicine and Shu-Tien Urological Research Center, National Yang Ming Chiao Tung University, Taipei, Taiwan

Introduction:

Plasmacytoid urothelial carcinoma is a rare type of histological variation of bladder urothelial carcinoma (UC). It usually presents infiltrating pattern and rich of plasma cell like tumor. Its clinical features are more aggressive than ordinary UC without another variant including fewer resectable disease, more muscle invasive, metastatic disease and less overall survival.

Case Report:

A 82-year-old male patient has no specific systemic medical disease. He suffered from difficult voiding for about half year. According to the patient’s statement, he did not have any specific symptoms such as abdominal pain, flank pain or hematuria. He came to our emergent department due to acute urinary retention. However, foley catheter insertion was failed. So cystoscope was arranged which found polypoid tumor over whole left lateral wall, left trigone (involve left ureteral orifice) and dome. We performed transurethral resection of bladder tumor for him and pathology disclosed invasive urothelial carcinoma with plasmacytoid variant, cT2. Pelvis CT was done for tumor staging which revealed diffuse thickening of the bladder wall, compatible with infiltrative tumor growth with extraserosal and left pelvic side wall invasion. No abnormal enlarged lymph nodes or metastatic lesion. We prescribed neo-adjuvant chemotherapy with four cycles of gemcitabine and cisplatin and followed by radical cystectomy with extended pelvic lymph node dissection and ileal conduit reconstruction. The resection specimen was checked microscopically which made a final diagnosis ypT4N0 infiltrating urothelial carcinoma with plasmacytoid variant, seminal vesicles were also involved by tumor. PD-L1 expression analysis was done and showed high expression of PD-L1. Then Atezolizumab was used for subsequent adjuvant therapy.

Conclusions:

According to NCCN guideline, plasmacytoid bladder UC are usually treated as the same protocol as pure UC. We gave neo-adjuvant chemotherapy with gemcitabine and cisplatin, followed by radical cystectomy to this patient. Then adjuvant immunotherapy of atezolizumab was also prescribed for locally advanced disease. In this case, it remained metastasis free for 1 year and kept follow up until now. Perhaps more different therapeutic strategies will have better prognosis.