Neuroendocrine tumors of the urinary bladder – Report of two cases

Meenakshi Rao

All India Institute of Medical Sciences, Department of Pathology and Lab Medicine, Jodhpur, Rajasthan, India

Apoorvi Dubey

All India Institute of Medical Sciences, Department of Pathology and Lab Medicine, Jodhpur, Rajasthan, India

Himanshu Pandey

All India Institute of Medical Sciences, Department of Urology, Jodhpur, Rajasthan, India

Binit Sureka

All India Institute of Medical Sciences, Department of Radiodiagnosis and interventional Radiology, Jodhpur, Rajasthan, India

Pawan Kumar Garg

All India Institute of Medical Sciences, Department of Radiodiagnosis and interventional Radiology, Jodhpur, Rajasthan, India

Harishkumar Bohra

All India Institute of Medical Sciences, Department of Pathology and Lab Medicine, Jodhpur, Rajasthan, India

Poonam Elhence

All India Institute of Medical Sciences, Department of Pathology and Lab Medicine, Jodhpur, Rajasthan, India

Authors’ contributions: Meenakshi Rao substantially contributed to the conception and design of the work, the acquisition, analysis, and interpretation of data, drafting the manuscript and revising the work critically for important intellectual content, final approval of the version to be published, agreement to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work were appropriately investigated and resolved. Apoorvi Dubey substantially contributed to the acquisition, analysis, and interpretation of data for the work and drafting the work. Himanshu Pandey contributed to the acquisition of data and revised it critically for important intellectual content. Binit Sureka and Pawan Kumar Garg substantially contributed to the acquisition, and interpretation of data for the work, revised it critically for important intellectual content. Harishkumar Bohra and Poonam Elhence substantially contributed to the acquisition of data for the work and revising it critically for important intellectual content.

Correspondence Meenakshi Rao All India Institute of Medical Sciences, Department of Pathology and Lab Medicine AIIMS, 342005, Jodhpur, Rajasthan, India Phone: +91 8890425010 drmeenakshirao@gmail.com

	Urothelial carcinoma	Small cell neuroendocrine carcinoma	Paraganglioma
Age group	>50 years	>50 years	Any age, mean 43.3 years
Incidence	Most common bladder cancer, 80-90% of bladder cancers	Rare, <1% of bladder cancers	Rare, 0.05% of bladder tumors
Clinical features	Hematuria, urgency, nocturia, dysuria, Associated with smoking	Hematuria, dysuria, associated with smoking	Symptoms related to catecholamine secretion: hypertension, headache, blurred vision, intermittent gross hematuria
Morphological features	Nests, sheets, cords, trabeculae, single cells, variable cellular morphology. Well-differentiated tumors show nuclei lined up perpendicular to the basement membrane in nests. Poorly differentiated tumors may be difficult to identify as urothelial carcinomas on morphology	Sheets of small cells with hyperchromatic, overlapping nuclei and inconspicuous nucleoli	Cells arranged in distinctive nests (Zellballen), separated by delicate septa. Large, polygonal cells with smudged or hyperchromatic nuclei
IHC	Positive for epithelial markers, positive for CK7 and CK20, GATA3, p63	Positive for neuroendocrine markers, high Ki-67	Positive for neuroendocrine markers, sustentacular cells positive for S-100P
Mutation spectrum	TP53, FGFR3, PIK3CA, RB1, HRAS	RB1, genetically unstable, high numbers of genomic alterations, deletions of 10q, 4q, 5q, 13q	SDHA, SDHB, losses at 1p, 3q, 22q

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