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LETTER TO EDITOR Table of Contents   
Year : 2010  |  Volume : 53  |  Issue : 4  |  Page : 879-880
Primary diffuse large B-cell lymphoma of the urinary bladder mimicking a clear cell variant of an infiltrating urothelial carcinoma


Department of Pathology, Rajiv Gandhi Cancer Institute and Research Centre, Sector-5 Rohini, Delhi - 110 085, India

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Date of Web Publication27-Oct-2010
 

How to cite this article:
Khurana A, Kamboj M, Mehta A. Primary diffuse large B-cell lymphoma of the urinary bladder mimicking a clear cell variant of an infiltrating urothelial carcinoma. Indian J Pathol Microbiol 2010;53:879-80

How to cite this URL:
Khurana A, Kamboj M, Mehta A. Primary diffuse large B-cell lymphoma of the urinary bladder mimicking a clear cell variant of an infiltrating urothelial carcinoma. Indian J Pathol Microbiol [serial online] 2010 [cited 2014 Nov 23];53:879-80. Available from: http://www.ijpmonline.org/text.asp?2010/53/4/879/72031


Sir,

Primary lymphomas constitute about 5% of the nonurothelial tumors of the urinary tract. [1] Only 84 cases of bladder lymphomas have been reported in the English literature to date. [2]

A 75-year-old female presented with pain in left hypochondriac region for the last 1 month. Ultrasonography revealed a heterogenous mass, measuring 6.0 × 5.4 × 5.2 cm, at the base of the urinary bladder with both intraluminal and extraluminal components. Routine examination of the urine showed 1+ albuminuria by the routine dip stick method with no abnormal cells on cytology.

A transurethral resection of the bladder tissue (TURBT) was performed and sent for histopathological examination.

Histology revealed an intact urothelium without any evidence of dysplasia. Reactive lymphoid follicles were noted in the submucosal layer in a few tissue bits [Figure 1]. In the majority of the lesions, the lamina propria was completely effaced by sheets of monotonous large malignant cells having clear cell morphology with oval nuclei, irregular margins, prominent nucleoli, and vacuolated cytoplasm [Figure 2]; the muscularis propria also showed invasion. The mitotic activity was brisk. Possibilities of an infiltrating urothelial carcinoma with clear cell differentiation and metastatic renal cell carcinoma were considered. On immunohistochemistry (IHC), the neoplastic cells showed membranous positivity for CD10 and were negative for pan cytokeratin, epithelial membrane antigen, and renal cell carcinoma (RCC) Ag. With an isolated CD10 expression, further application of lymphoid markers showed positivity for LCA (CD45) and CD20 [Figure 3]; CD3 was negative. Hence a diagnosis of diffuse large B-cell lymphoma (DLBCL) was made. No other regional lymphadenopathy was detected and a final diagnosis of primary DLBCL of the urinary bladder was rendered.
Figure 1: Photomicrograph showing an intact urothelial epithelium overlying reactive lymphoid follicles in the lamina propria (H and E, ×200)

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Figure 2: Photomicrograph showing infiltrating malignant cells with irregular nuclear contours, prominent nucleoli, and vacuolated cytoplasm (H and E, ×200)

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Figure 3: Immunopositivity of neoplastic cells for CD20 (IHC, ×400)

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A rigorous definition of a primary bladder lymphoma consists of initial symptoms attribu table to bladder involvement with no liver, spleen, lymph node, blood, or bone marrow involvement at diagnosis. [3] Secondary involvement by systemic lymphomas is relatively common than primary lymphomas. Primary non-Hodgkin lymphoma (NHL) of the urinary bladder is a rare neoplasm occurring at an age of 12-85 (median 60) years. Hematuria is the most common symptom, in combination with dysuria or urinary frequency. [2] Primary lymphomas are more commonly seen in females as compared to males. [1],[3] This gender distribution and presence of submucosal lymphoid follicles in the bladders of many women with recurrent cystitis have led to speculate that a chronic inflammatory state plays a pathogenic role in the development of bladder lymphoma. [3] Similar findings were noted in the indexed case.

Most of the primary bladder lymphomas are low-grade B-cell NHL of the mucosa-associated lymphoid tissue (MALT). Only 20% of them are of high grade, DLBCL being the most common phenotype. [4] The prognosis of the primary lymphomas is favorable because, they are, at the time of diagnosis, confined to a single organ. [5] Transurethral resection or biopsy and radiotherapy are the standard of care for the treatment of primary lymphoma. However, in the setting of secondary involvement of the bladder, the treatment of choice is combination chemotherapy with or without radiotherapy.

The indexed case has been highlighted for its rarity and unusual histologic appearance. An ancillary technique, IHC in our case, helped us arrive at the correct diagnosis and subsequent appropriate management.

 
   References Top

1.Marx A. Tumors of the urinary system. In: Eble JN, Sauter G, Epstein JI, Sesterhenn IA, editors. World Health Organization of the Urinary System and Male Genital Organs. Lyon: IARC Press; 2003. p. 147.   Back to cited text no. 1
    
2. Al-Maghrabi J, Kamel-Reid S, Jewett M, Gospodarowicz M, Wells W, Banerjee D. Primary low-grade B-cell lymphoma of mucosa-associated lymphoid tissue type arising in the urinary bladder: Report of 4 cases with molecular genetic analysis. Arch Pathol Lab Med 2001;125:332-6.  Back to cited text no. 2
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3.Colevas AD, Kantoff PW, DeWolf WC, Canellos GP. Malignant lymphoma of the genitourinary tract. In: Vogelzang NJ, Scardino PT, Shipley WU, Coffey DS, editors. Comprehensive Textbook of Genitourinary Oncology. 2 nd ed. Philadelphia, USA: Lippincott Williams and Wilkins; 2000. p. 1126-8.  Back to cited text no. 3
    
4.Tasu JP, Geffroy D, Rocher L, Eschwege P, Strohl D, Benoit G, et al. Primary malignant lymphoma of the urinary bladder: Report of three cases and review of the literature. Eur Radiol 2000;10:1261-4.  Back to cited text no. 4
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5.Bates AW, Norton AJ, Baithun SI. Malignant lymphoma of the urinary bladder: A clinicopathological study of 11 cases. J Clin Pathol 2000;53:458-61.  Back to cited text no. 5
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Correspondence Address:
Anuj Khurana
98 SFS Flats Phase-4, Ashok Vihar, New Delhi - 110 052
India
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DOI: 10.4103/0377-4929.72031

PMID: 21045464

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