CASE N°41 – Where these cells come from?

Clinical History:

Age: 72

Sex: female

2014-06 Hematuria for two months, weight loss, and poor general condition.

2014-07 Multiple bladder biopsies. diagnosis: papillary urothelial carcinoma (GIII) classic type.

2014-08 Ultrasonography: bladder with thickened walls and about 4 cm polypoid lesion protruding into the bladder lumen.
CT SCAN (abdomen): abdominal mass about 12 cm of probable origin from the uterine body. Ovaries are not well visualized. Ascites.

Cytological Image:

cytological speciemen: ascites

composit ascite 21_08_14

Cytological Report:

Presence of glandular epithelial malignant tumor cells arranged in papillary clusters and sometimes with cytoplasmic vacuoles.

Positive for malignancy.

Histological Image:

histological speciemen: Multiple bladder biopsies

i14-19423 composit isto vescica

Diagnosis: papillary urothelial carcinoma (GIII) classic type.

Histological speciemen:

abdominal mass, excision

composit isto

Diagnosis: Peritoneal localization of poorly differentiated carcinoma characterized by the following immunophenotype:
CK7 +, CK19 +, Estrogen , GATA3 – / +, CDX2-, CK20-, WT1-.

Discussions:

The morphology of the cells, the way to aggregate and the presence of cytoplasmic vacuoles of tumor cells present in the cytological specimen, were suggestive for a diagnosis of a localization adenocarcinoma.
However, the immunophenotype of tumor cells present in histology relative to removal of the abdominal mass was negative for markers of adenocarcinomas statistically more present in that district; indeed the positivity to CK7 and the weak immunoreactivity for GATA3 suggest an origin from the bladder, but not entirely convincing to indicate with certainty the origin of the neoplastic cells.

Probably the cytological diagnosis before histology and after the morphological comparison with simultaneous bladder cancer, was a little forced and has suffered too much of clinical suspicion and the images of TAC SCAN.

References:

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  1. Dr Gayani Ranaweera

    Hi I am currently studying for MD pathology and find this site extremely helpful. I think it will be even nice to have the cases in unknown mode rather than with the diagnosis. Thank you for your time and effort.

    • thank you for your suggestion, it is not so easy for me to put on the blog new cases (family, too much work, and other interests). the next time i will do that i will put on some quiz cases, stay tuned.

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