Case 6Case 6

Basic clinical dataBasic clinical data

• Archive case of I. Alvarado-Cabrero Archive case of I. Alvarado-Cabrero (Centro Medico, Mexico City)(Centro Medico, Mexico City)

• Hispanic male, 65 yearsHispanic male, 65 years

• Tumor of the urinary bladderTumor of the urinary bladder

• TRUS with subsequent cystectomyTRUS with subsequent cystectomy

Your opinion, diagnosis?Your opinion, diagnosis?

Scorpio Euscorpius spec

Micropapillary urothelial Micropapillary urothelial carcinomacarcinoma

• cca 95 cases were publishedcca 95 cases were published• Amin et al:Micropapillary variant of Amin et al:Micropapillary variant of

transitional cell carcinoma of the urinary transitional cell carcinoma of the urinary bladder. Histologic pattern resembling bladder. Histologic pattern resembling ovarian papillary serous carcinoma. Am J ovarian papillary serous carcinoma. Am J Surg Pathol 18, 1994, 1224-1232Surg Pathol 18, 1994, 1224-1232

• WHO 2004-variant of TCCWHO 2004-variant of TCC

Basic clinico-pathologic Basic clinico-pathologic features of micropapillary features of micropapillary transitional cell carcinomatransitional cell carcinoma• Main age: 66 yearsMain age: 66 years• Male prevalenceMale prevalence• Vascular invasion is usually present in Vascular invasion is usually present in

time of diagnosistime of diagnosis• Usually high-grade tumorsUsually high-grade tumors• EMA/CK 7 usually positiveEMA/CK 7 usually positive• High stage in time of diagnosis, very bad High stage in time of diagnosis, very bad

prognosis (up to 12 months after prognosis (up to 12 months after establishing of the diagnosis)establishing of the diagnosis)

Differential diagnosticsDifferential diagnostics

• High-grade „classic“ TCCHigh-grade „classic“ TCC

• Inverted papillomaInverted papilloma

• „„Nested“ variant of TCC Nested“ variant of TCC

Micropapilary ca vs. inverted papillomaMicropapilary ca vs. inverted papilloma

Micropapillary ca-variantsMicropapillary ca-variants

Micropapillary ca-variantsMicropapillary ca-variants

Micropapilary ca vs. inverted Micropapilary ca vs. inverted papillomapapilloma