1. Urine cytology (washed) KCP 802 Urine cytology (washed) 이대목동병원 박상희

2. M / 74 C.C : Gross hematuria Duration: 1 month DM / HTN / Tbc / Hbs (- / - / - / -) Smoking Hx (-)

3. Cystoscopy (13/8/27) Lt. lateral wall, dome, bladder neck 까지 broad base 의 papillary & solid component 를 가지는 mass Cytology: Atypical urothelial cells, consistent with urothelial carcinoma

4. Cystoscopy (13/8/27)

9. TURB (13/9/2) Incomplete resection Pathology confirm & radical cystectomy

15. CD138

16. Squamous Features of squamous carcinoma including keratinization and intrace llular bridges in conjunction with urothelial carcinoma. Glandular True glandular spaces within the urothelial component which can be tubular or enteric glands with mucin secretions. Micropapillary Small tight clusters or thin papillae of tumor cells with eosinophilic to clear cytoplasm surrounded by prominent retraction artifact. Nested Deceptively bland appearance resembling von Brunn nests infiltratin g the lamina propria. Sarcomatoid Biphasic tumor with malignant mesenchymal component often with a high-grade spindle cell appearance in addition to an epithelial compo nent of urothelial carcinoma. Small cell carcinoma Small tumor cells with scant cytoplasm and nuclear molding and inco nspicuous nucleoli. Plasmacytoid Malignant cells resembling those of a plasmacytoma often with a co mponent of high-grade urothelial carcinoma. Large-cell neuroendoc rine Nests, trabeculae, organoid, or palisaded collections of tumor cells w ith prominent nucleoli. Lipoid Lipid-rich areas composed of large, clear, multivacuolated tumor cell s resembling lipoblasts. Trophoblastic Appearance ranging from scattered syncytiotrophoblasts to chorioca rcininomatous differentiation as the predominant pattern. Microcystic Multiple cysts, up to 2 mm in diameter, filled with necrotic material or pink secretions. Cyst lining may be absent, urothelial, or flattened.

17. APCT (1)

18. APCT (2)

19. Exploratory laparotomy (13/9/23) - Bladder anterior wall 로 pubic bone 과 adhesion 되어 있었 으며 invasion 된 것으로 보였음. - Bladder Lt. lateral 로도 mass 만져지고 bladder 가 전체적 으로 fixed 되어 있었음. - Peritoneum 을 open 하였을 때 peritoneum 내에 metastatic lesion 의심되는 부위 발견되었음. - Peritoneum lesion 과 pubic bone 의 주변조직을 모두 frozen 보내었으며, metastatic cancer 로 report 됨 - 보호자 설명 후 open & closure 하였음.

20. Amin et al, Am J Pathol 1994 Conclusion: the presence of a MPC in TCC is associated with high-grade and high-stage TCC with a tendency to vascular invasion. Our data suggest that a surface MPC in bladder biopsy specimens is a poor prognostic histologic feature and, if the biopsy does not contain muscularis propria, deeper biopsies should be recommended to determine the presence of muscle invasion.

22. 2001

23. Acta cytologica 2009

24. EMA and E-cadherin downregulation

26. 2006 Kamat et al, Cancer 2007

27. Fairey et al, Urol Oncol 2012 Wang et al, World J Urol 2012

28. USCAP 2014 Abstract

29. USCAP 2014 Abstract

32. Zukerberg et al, Am J Surg Pathol 1991 Sahin et al, Acta Cytol 1991

33. 2008 AJSP In summary, plasmacytoid TCC tends to present at an advanced stage and to have a poor prognosis. Morphologic recognition and distinction from other plasmacytoid malignant neoplasms is critical for its clinical management and immunohistochemical studies may be required for differential diagnosis.

34. Ricardo-Gonzalez et al, J Urol 2012

35. Dayyani et al, J Urol 2013

36. cytopathol 2009

37. Dignostic cytopathol 2012

38. Chemotherapy Gemcitabine + cisplatin regimen x2 (2013/9/30 -11/20)

39. APCT

41. 감 사 합 니 다