Urothelial carcinoma of the bladder with choriocarcinomatous differentiation: A report of two cases and review of the literature

Urothelial carcinoma with choriocarcinomatous differentiation is a rare morphologic variant of bladder cancer, and only a limited number of cases have been reported. We present two cases of bladder cancer with choriocarcinomatous features that had different outcomes. The clinical and pathologic features are reviewed to better understand the natural history of this malignant neoplasm. The histologic features of the tumor were compared between the two cases. Immunoperoxidase staining was performed on the tumor cells with polyclonal beta human chorionic gonadotropin (β-hCG) antibody. A comprehensive literature search revealed an additional 25 confirmed cases, which are summarized in this presentation. Of the 27 patients, only 3 patients were reported to be alive without evidence of disease after treatment. The majority presented with invasive tumors and had a mean survival of 12 months after diagnosis. Chemotherapy, radiation, or radical surgery in advanced stages did not improve survival. Choriocarcinoma in visceral organs usually occurs with high-grade carcinomas and we believe that it is best considered dedifferentiation of the tumor. Urothelial carcinoma with choriocarcinomatous differentiation is an extremely aggressive tumor, and in the rare patient with early stage disease and normal to moderately elevated serum β-hCG levels, long-term survival can be achieved with radical surgery.