What does a diagnosis of high-grade serous carcinoma on a bladder biopsy indicate?

From the Guidelines

High-grade serous carcinoma on a bladder biopsy most likely represents metastatic disease, requiring comprehensive evaluation and treatment with systemic chemotherapy, rather than primary bladder cancer treatment. This finding is unusual because high-grade serous carcinomas typically originate in the ovaries, fallopian tubes, or peritoneum in women, not in the bladder. The diagnosis of high-grade serous carcinoma on a bladder biopsy indicates a malignant tumor with features of serous carcinoma that has been found in bladder tissue.

Key Considerations

• The patient requires comprehensive evaluation including imaging studies (CT or MRI) of the abdomen and pelvis to identify the primary tumor site, as well as consultation with gynecologic and medical oncologists 1.
• Treatment typically involves systemic chemotherapy with platinum-based agents (such as carboplatin or cisplatin) combined with taxanes (like paclitaxel), rather than therapies typically used for primary bladder cancers.
• The prognosis depends on the extent of disease and response to treatment, but high-grade serous carcinomas are generally aggressive malignancies that require prompt and aggressive management.

Clinical Implications

• The distinction between primary and metastatic bladder cancer is crucial because treatment approaches differ significantly 1.
• Management of bladder cancer is based on the pathologic findings of the biopsy, with attention to histology, grade, and depth of invasion 1.
• Patients with invasive bladder cancer should be staged according to the TNM system and be grouped into the categories shown in Table 2 1.

Treatment Approach

• Systemic chemotherapy with platinum-based agents and taxanes is the recommended treatment approach for high-grade serous carcinoma found in the bladder, rather than therapies typically used for primary bladder cancers.
• The patient should be evaluated and treated by a multidisciplinary team, including gynecologic and medical oncologists, to ensure comprehensive care.

From the Research

Diagnosis of High-Grade Serous Carcinoma on Bladder Biopsy

A diagnosis of high-grade serous carcinoma on a bladder biopsy indicates a type of cancer that is typically associated with the gynecologic tract, but can occasionally involve the bladder wall and mimic primary urothelial carcinoma of the bladder 2.

Key Characteristics

• High-grade serous carcinoma involving the bladder wall can present as a large, transmural, primary bladder mass without precedent gynecologic history in women younger than 60 years 2.
• Morphologic features that can mimic urothelial carcinoma include nested growth patterns, squamouslike foci, spindled/sarcomatoid growth, basaloid morphology, and syncytial growth patterns 2.
• Immunohistochemical stains can be helpful in confirming the diagnosis, with immunoreactivity for CK7, WT1, UPII, PAX8, p63, and GATA3 2.

Differential Diagnosis

• Urothelial carcinoma of the bladder, which is a distinct type of cancer that arises from the lining of the bladder 3.
• Other types of cancer that can involve the bladder wall, such as sarcomatoid urothelial carcinoma 4.

Clinical Implications

• A diagnosis of high-grade serous carcinoma on a bladder biopsy requires further evaluation and staging to determine the extent of the disease 5.
• Treatment options may include surgery, chemotherapy, and radiation therapy, depending on the stage and extent of the disease 6.