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Urothelial Carcinoma Variants

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  • Several variants have been described and include some unusual patterns.
  • Often is admixed with usual urothelial carcinoma.
  • Some have poor prognosis as more present with higher stage, although it's not clear if prognosis is worse than usual urothelial carcinoma of similar stage.
  • May mimic other non-urothelial tumors in bladder or at metastatic sites.
  • Histology:
    • Urothelial carcinoma with divergent differentiation (admixed with squamous or glandular components).
    • Micropapillary variant consists of small nests of papillae within retraction artifacts resembling micropapillary carcinoma of breast or lung (image A).
    • Nested variant resembles florid von Brunn's nests (image B).

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    • Lymphoepithelioma-like carcinoma is an undifferentiated carcinoma with abundant lymphocyte and plasma cell infiltrates resembling those in head and neck (image C).
    • Plasmacytoid urothelial carcinoma resembles plasma cell tumor (image D).
    • Urothelial carcinoma with clear (glycogen rich) cytoplasm resembles clear cell renal cell carcinoma (image E).

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    • Other variants include microcystic carcinoma (image F), urothelial carcinoma with rhabdoid features, lipoid-rich variant and urothelial carcinoma with trophoblastic differentiation.