PMC5138476_01
(a) Bladder mass, before chemotherapy. (b) Pelvic lymphadenopathy, before chemotherapy. (c) 100x: biopsy of bladder, before chemotherapy, and surface papillary component of the tumor. (d) 200x: biopsy of bladder, before chemotherapy; shown here are invasive malignant cells.
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The CT scan showed large posterior-lateral dome bladder thickening that measured 4.6 cm x 2.5 cm, 3 mm lung nodule, bilateral exophytic hypodensities of the kidneys, and pelvic and retroperitoneal lymphadenopathy (Figures 1(a) and 1(b)). Pathology confirmed high grade invasive urothelial carcinoma of the bladder with indeterminate lymphovascular invasion and was staged as T2N3M1 (Figures 1(c) and 1(d)).
(a) Bladder mass, after chemotherapy. (b) Pelvic lymphadenopathy, after chemotherapy. (c) Retroperitoneal lymph node above aortic bifurcation, after chemotherapy. (d) Axillary lymph nodes, after chemotherapy.
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After 3 months of chemotherapy, follow-up CT scan showed further progression of lymphadenopathy with prominent lymph nodes in axilla (one on the left measuring 17 mm and one on the right measuring 13 mm), mediastinal and hilar nodes 9-11 mm in short axis, retroperitoneal nodes (prominent node measuring 25 x 13 mm above the aortic bifurcation on the right), and interval growth in external iliac and pelvic nodes (Figures 2(a)-2(d)).
(a) 200x: left axillary monotonous population of small lymphocytes with mature nuclear chromatin and distinct rims of cytoplasm. (b) 400x: left axillary monotonous population of small lymphocytes with mature nuclear chromatin and distinct rims of cytoplasm.
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Histologic sections of the axillary node showed a monotonous population of small lymphocytes with mature nuclear chromatin and distinct rims of cytoplasm (Figures 3(a) and 3(b)).
Flow cytometry of core needle biopsy: surface kappa clonal and CD19/CD20+ B cell population along with coexpression of CD5 and CD23 (tumor = red population; background polyclonal B cells = blue).
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Flow cytometric studies from this specimen showed a dim surface kappa clonal, relatively bright CD19/CD20+ B cell population with coexpression of CD5 and CD23 without expression of CD10 or significant CD38 (Figure 4).