Small cell carcinoma of the bladder
Epidemiology
Small cell carcinoma accounts for 0.5% of all bladder tumours6. The average age of patients is 67 years1, mainly male6.
Clinical features
Patients present with haematuria or dysuria. A third of patients have metastatic carcinoma at the time of presentation, most often with spread to the liver or regional lymph nodes. Occasionally patients develop paraneoplastic syndromes hypercalcaemia or hypophosphataemia.
Histopathology
The tumour cells are small with pyknotic nuclei and "salt and pepper" chromatin. Most cases show a mix of small cell and transitional cell carcinoma, less often adenocarcinoma or squamous cell carcinoma. Tumour necrosis is common, most often punctuate. The Azzopardi effect is common.
Immunohistochemistry
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Synaptophysin
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16/231, 5/102, 22/448
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Chromogranin
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9/301, 5/102, 13/448
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NSE
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1/41, 10/102, 35/448
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PGP
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4/102
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Cam 5.2
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14/21(staining is punctate)1
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34bE12
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4/102
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CK7
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26/447
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CK20
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0/102,
0/44(but positive in the urothelial carcinoma component in 12 of the 24 cases where this component was present)7, 3/448
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TTF-1
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2/42, 2/33,1/54, 1/35, 2/106,
17/44(there was no staining for TTF-1 in the urothelial carcinoma component present in 29 of the cases)7,
11/44(in addtion, 2/2 large cell neuroendocrine carcinomas of the bladder were positive)8
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CD57
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30/448
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CD117
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2/71
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EGFR c-erb
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4/111, 5/102
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p53
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varies from 0% to 90%2
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Ki-67
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varies from 15% to 70%2
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Uroplakin
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0/447
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Prognosis
This tumour is aggressive with early metastases. The mean survival is six to nine months6.
References
1Abrahams NA, Moran C, Reyes AO, et al. Small cell carcinoma of the bladder: a contemporary clinicopathological study of 51 cases. Histopathology 2005; 46:57-63
2 Agoff SN et al. Thyroid transcription factor-1 is expressed in extrapulmonary small cell carcinomas but not in other extrapulmonary neuroendocrine tumours. Mod Pathol 2000;13:238-242.
3 Kaufmann O & Dietel M. Expression of thyroid transcription factor-1 in pulmonary and extrapulmonary small cell carcinomas and other neuroendocrine carcinomas of various primary sites. Histopathology 2000; 36: 415-420.
4 Ordonez NG. Value of thyroid transcription factor-1 immunostaining in distinguishing small cell lung carcinomas from other small cell carcinomas. Am J Surg Pathol 2000;24:1217-1223.
5 Cheuk W et al. Immunostaining for thyroid transcription factor-1 and cytokeratin 20 aids in the distinction of small cell carcinoma from Merkel cell carcinoma, but not pulmonary from extrapulmonary small cell carcinoma. Arch Pathol Lab Med 2001;125:228-231. (supplemented by personal communication) FULL TEXT
6 Soriano P, Navarro S, Gil M, et al. Small-cell carcinoma of the urinary bladder. A clinico-pathological study of ten cases. Virchows Arch 2004; 445:292-7
7 Jones TD, Kernek KM, Yang XJ, et al. Thyroid transcription factor 1 expression in small cell carcinoma of the urinary bladder: an immunohistochemical profile of 44 cases. Hum Pathol 2005; 36:718-23
8 Alijo Serrano F, Sanchez-Mora N, Angel Arranz J, et al. Large cell and small cell neuroendocrine bladder carcinoma: immunohistochemical and outcome study in a single institution. Am J Clin Pathol 2007; 128:733-9
This page last revised 29.11.2008.
©SMUHT/PW Bishop