A 75-year-old male with a urinary bladder mass

Contributors:

Yu Yang, MD

Urology Fellow, Department of Pathology and Laboratory Medicine

Indiana University School of Medicine

and

Liang Cheng, MD

Virgil Moon Professor of Pathology

Department of Pathology and Laboratory Medicine

Indiana University School of Medicine

Clinical history:

A 75‐year‐old male patient presented with 3 months of painless gross hematuria. A complete physical examination was unremarkable. Hematuria was identified on urinalysis. His renal function was normal. Computed tomography was performed and revealed a large enhancing mass on the left lateral bladder wall that was highly suspicious for deep muscle invasion. Cystoscopy revealed a sessile mass.

Gross examination: The patient underwent urinary bladder transurethral resection, followed by radical cystectomy and pelvic lymphadenectomy. The cystectomy specimen showed the presence of a 5 x 4 x 2 cm tumor with a white-tan fleshy cut surface deeply invading into the bladder wall.

Microscopic examination and immunohistochemistry: The tumor was composed of small nests and slender papillae of neoplastic cells within prominent retraction artifact mimicking lymphovascular invasion (Figure 1). The tumor exhibited epithelial ring form structure within the lacunar spaces (Figure 2) and showed high-grade nuclei and cytoplasmic vacuoles (Figure 3). Immunohistochemistry showed tumor cells were positive for GATA3 (Figure 4).

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Fig. 1