A 60-year-old man came for consultation in January 2009 due to episodes of occasional macroscopic haematuria over two years. Ten months after the first episode, he began to have pollakiuria and dysuria, and 2 months later an ultrasound study was performed which revealed thickening of the right bladder wall, leading to ureterohydronephrosis. A thoraco-abdominal CT scan and bone scintigraphy were performed to determine the extent of the lesions and confirmed the ultrasound findings. In February 2009, she received surgical treatment by bladder TUR with a diagnosis of plasmacytoid carcinoma of the bladder with invasion of the muscularis propria and the presence of foci of lymphovascular embolisation, for which a radical cysto-prostatectomy with ileal diversion was indicated, which was performed without incident on 27 March 2009.
The anatomopathological report revealed an atypical epithelial neoformation of diffuse growth with some nests or cords, consisting of small cells, scanty cytoplasm and large, pleomorphic and polylobulated nuclei. In addition, some areas were observed where the nuclei were more pleomorphic, polylobulated, large and very hyperchromatic than the rest of the tumour population. Both typical and atypical mitoses and apoptosis were frequent. The neoplastic cells infiltrated the bladder wall and reached the muscularis propria. Cytoplasmic immunohistochemistry was 100% positive for cytokeratin-7 and 70% positive for cytokeratin-20 and diffuse high molecular weight cytokeratin. The definitive diagnosis was poorly differentiated, high-grade, plasmacytoid cell variant urothelial carcinoma.

The patient was then referred to the Oncology department and started adjuvant chemotherapy treatment with Cisplatin and Gemcitabine (4 cycles), which concluded in August 2009.
In March 2010, during a follow-up examination and while the patient was asymptomatic, lesions suggestive of metastasis in the spine were observed, so an MRI of the spine was performed, which revealed possible metastasis at D3, D8, D9, D10 and L1. Bone scintigraphy and PET-CT scans were performed, which were inconclusive, so a follow-up examination in three months was recommended. At this check-up, growth of the known bone lesions was observed, which were biopsied and were inconclusive for malignancy.
In September 2010, the PET-CT scan was repeated, showing no signs of pathological bone uptake, but multiple lymph nodes in the left axillary, perivascular mediastinal, subcarinal and internal mammary regions, as well as in the retroperitoneal region. Another fine needle puncture of the spine was performed and reported as a metastatic lesion compatible with a plasmacytoid urothelial tumour. In addition, a biopsy of the mammary lymph nodes was performed, which were also reported to be compatible with metastatic lesions originating from the plasmacytoid urothelial tumour.
At that time, a new line of chemotherapy treatment was started with Paclitaxel and Carboplatin, in a three-weekly schedule with a total of 6 cycles, which concluded in January 2011. Halfway through the chemotherapy treatment, a new control CT scan was performed in which the disease remained stabilised.
On 17 February 2011, a re-evaluation CT scan showed moderate-severe right ureterohydronephrosis at the expense of a nodular image protruding into the ureteral lumen suggestive of a new tumour lesion. In addition, there was functional atrophy of the contralateral kidney with an increase in plasma creatinine up to 2.9 ng/mL. It was decided to perform a right percutaneous nephrostomy with placement of a double J ureteral catheter via the antegrade route. During this admission, he suffered an inferoposterior and right ventricular AMI, which was effectively treated by primary angioplasty.
The patient finally died in mid-March 2011.

