Contributed by Waseem Anani, MD and Anil Parwani, MD, PhD
A 21-year-old female with a history of elevated blood pressure as a child and right nephrectomy for pyelonephritis. In 2003, she underwent an excision of a bladder mass.
Gross examination revealed tan-brown mass 4.5 cm in greatest dimension with a central 2.5 cm wide and 0.5 cm deep ulcer. The histologic sections showed large, epithelioid cells in a nested pattern separated by a delicate network of fibrous stroma and vasculature. The tumor invaded into the deep muscularis propria with negative surgical margins. No angiolymphatic invasion, mitotic figures, or areas of necrosis were identified. One of eight lymph nodes was found to contain metastatic carcinoma, replacing the native tissue.
The neoplastic cells show strong, diffuse expression of synaptophysin and chromogranin and no expression of pankeratin. The sustentacular cells are highlighted with a S100 stain.
H&E sections of bladder mass.
H&E sections of the lymph node
Selected images of the immunohistochemistry performed of the lesion.