Plasma cells known as \"Mott cells\" present non-secretable accumulations of immunoglobulins called \"Russell bodies\". Its presence is related to hematological neoplasms, but it can appear in chronic inflammatory processes. The most common occurrence within the digestive tract is the gastric antrum associated with H. pylori infection. Our patient is added the rare extragastric cases where the association with H. pylori is inconsistent. We have found a frequent appearance of lower digestive and urological neoplasms in relation to these cases, justified by the expression of circulating cytokines in the tumor area that lead to the overactivation of plasma cells. This possible association could lead us to know data about the tumor environment and serve us for early diagnosis or future therapeutic targets.

A 62-year-old male presented with pain and haematuria starting 3 months before. The computed tomography showed focal and mural bladder thickening with ureteropelvic dilatation. The following transurethral bladder resection revealed a high-grade muscle-invasive urothelial carcinoma. In the subsequent cystoprostatectomy we found the same tumour, but adding focal tumour-associated stromal osseous metaplasia. Ossifying metaplasia is an extremely rare feature in urothelial carcinoma, with a few reported cases and represents a diagnostic challenge, mimicking radiotherapy-induced sarcoma or sarcomatoid carcinoma.

The recent addition of novel immunotherapy drugs for the treatment of urothelial carcinoma makes it necessary the establishment of criteria to harmonize the immunohistochemical assessment of PD-L1, both as a prognostic factor and for the selection of patients to be treated. In this scenario, a group of uropathologists from the Spanish Society of Pathological Anatomy, together with a medical oncologist as an external collaborator subspecialized in uro-oncology, have prepared this document of recommendations based on the available evidence. During PD-L1 assessment it is especially relevant the selection of the sample, its processing, the immunohistochemical platform and antibody used, and the algorithm applied in the interpretation of results. All these aspects must be indicated in the results report, which should be easily interpretable in a context of rapid evolution of immunological therapies.

BACKGROUND: Malignant tumors of the urinary tract are associated with high morbidity and mortality, and their prevalence can vary worldwide. Recently, the IDENTIFY study has published results on the prevalence of urinary tract cancer at a global level. This study evaluates the prevalence of cancer within the Spanish cohort of the IDENTIFY study to determine whether the published results can be extrapolated to our population.
METHODS: An analysis of the data from the Spanish cohort of patients in the IDENTIFY study was performed. This is a prospective cohort of patients referred to secondary care with suspected cancer, predominantly due to hematuria. Patients were recruited between December 2017 and December 2018.
RESULTS: A total of 706 patients from 9 Spanish centers were analyzed. Of these, 277 (39.2%) were diagnosed with cancer: 259 (36.7%) bladder cancer, 10 (1.4%) upper tract urothelial carcinoma, 9 (1.2%) renal cancer and 5 (0.7%) prostate cancer. Increasing age (OR 1.05 (95% CI 1.03-1.06; P < 0.001)), visible hematuria (VH) OR 2.19 (95% CI 1.13-4.24; P = 0.02)) and smoking (ex-smokers: OR 2.11(95% CI 1.30-3.40; P = 0.002); smokers: OR 2.36 (95% CI 1.40-3.95; P = 0.001)) were associated with higher probability of bladder cancer.
CONCLUSIONS: This study highlights the risk of bladder cancer in patients with VH and smoking habits. Bladder cancer presented the highest prevalence; higher than the prevalence reported in previous series and presented in the IDENTIFY study. Future work should evaluate other associated factors that allow us to create cancer prediction models to improve the detection of cancer in our patients.

Urothelial carcinoma (UC) has histological subtypes whose phenotype reflects their molecular diversity, behavior and response to conventional therapy. Immune checkpoint inhibitors (ICIs) have improved the management of UC by evaluation of PD-L1. In the case of PD-L1 22C3, the initiation of ICI is considered from a combined positive score (CPS) greater than 10. However, UC subtypes with absent PD-L1 22C3 expression in cases with CPS>10 may not respond to these treatments. This study aims to establish a correlation between the PD-L1 immunoexpression and molecular alterations in divergent differentiation and histological subtypes of UC (UC-s).
Twenty-six samples of UC were detected from a total of 24 patients. Two pathologists performed separately an assessment of UC-s on hematoxylin-eosin as well as PD-L1 expression. Molecular study of each case was performed by next generation sequencing (NGS). A descriptive analysis of the variables included was conducted.
Nine cases (34.61%) showed a CPS>10, some with negative PD-L1 immunoexpression in aggressive UC-s. The molecular study revealed alterations in genes belonging to the p53/cell cycle control, RAS, and DNA repair pathways, among others. None of the alterations were exclusive to any histological subtype.
Special attention should be paid to CPS>10 cases that include histological subtypes of UC with divergent expression for PD-L1 as they may not respond to treatment with ICI. We recommend examining the proportion and PD-L1 status of each subtype, especially if it has aggressive behavior.

The Paris System (PS) has replaced the classical Papanicolaou System (PapS) in reporting urine cytology, due to its improved sensitivity and negative predictive value (NPV) without loss of specificity. Furthermore, it has enabled the risk of malignancy to be established in each cytological category. The aim of this study is to compare the Paris System with previous results and determine the changes in sensitivity, specificity, positive predictive value, NPV and risk of malignancy in our centre, MATERIALS AND METHODS: Evaluation of the diagnostic power of urine cytology by means of a retrospective cohort study, comparing two series of 400 cytological studies, one using the Papanicolaou System and the other the Paris System.
In the detection of high-grade urothelial carcinoma, Paris System has better specificity (93.82% PapS vs 98.64% PS; P=.001) and PPV (39.5% PapS vs 70.6% PS; P=.044) than Papanicolaou System, without changes in sensitivity (53.5% PapS vs 37.5% PS; P=.299) or NPV (96.4% PapS vs 94.8% PS; P=.183). The risk of malignancy for the atypical category increases from low to high levels (1.6% PapS vs 40.0% PS; P=.001); the other categories showed no significant statistical changes.
The Paris System improves specificity and positive predictive value and establishes a better indication of risk of malignancy for each category, enabling specific clinical management in each case.

BACKGROUND: Lymphoepitheliomalikedifferentiation is a rare histological variant of urothelialbladder carcinoma, therefore its prognosis and treatmentare not clearly defined. A retrospective study of 5cases in the last 10 years in our center was performed.
METHODS: cystectomy was performed in 4 of5 because they were non-metastatic muscle-invasivetumors at diagnosis, in the 5th TURB + BCG because itwas non-muscle-invasive. 2 patients received chemotherapyand 1 adjuvant radiotherapy, and 1 immunotherapyafter relapse. 2 had a pure lymphoepithelioma-like pattern, 2 predominant and 1 focal.
CONCLUSIONS: In predominant or pure forms, agood response to treatment with TURB and adjuvantchemotherapy has been described, even superior tocystectomy, as it is a variant with a very favorable responseto platinum. Immunotherapy is currently onlyindicated as second-line treatment.
CONCLUSIONS: adjuvant treatment plays an importantrole as it is a highly chemosensitive variant, but more studies are needed to define the best therapeuticstrategy.
INTRODUCCIÓN: La diferenciaciónlinfoepitelioma-like es una variante histológica pocofrecuente del carcinoma urotelial vesical, por lo que supronóstico y tratamiento no está claramente definido.Se presenta un estudio retrospectivo de 5 casos en losúltimos 10 años en nuestro centro.DESCRIPCIÓN DE CASOS: en 4 de los casos se realizócistectomía por ser tumores músculo-invasivosno metastásicos al diagnóstico, en el 5º RTU + BCGpor ser no músculo-invasivo. 2 pacientes recibieronquimioterapia y 1 radioterapia en adyuvancia, y 1 inmunoterapiatras recidiva. 2 presentaban un patrónlinfoepitelioma-like puro, 2 predominante y 1 focal.DISCUSIÓN: en formas predominantes o puras seha descrito buena respuesta al tratamiento con RTU yquimioterapia adyuvante, incluso superiores a cistectomía,por ser una variante con respuesta muy favorableal platino. La inmunoterapia actualmente solo estáindicada como tratamiento en segunda línea. CONCLUSIONES: el tratamiento adyuvante tiene unpapel importante por ser una variante muy quimiosensible,pero son necesarios más estudios para definirla mejor estrategia terapéutica.

OBJECTIVE: Although an immediate postoperative instillation of chemotherapy (IPOIC) after transurethral resection of bladder tumors (TURBT) is recommended for the prevention of recurrences of non-muscleinvasive bladder cancer (NMIBC), evidence shows there is an important compliance failure worldwide. We believe that an immediate neoadjuvant instillation of chemotherapy (INAIC) can act similarly, reducing the recurrence risk of NMIBC. Here we present the interim analysis of the PRECAVE clinical trial.
METHODS: Patients with clinically diagnosed NMIBC were randomized to receive an INAIC with mitomycin C before TURBT (Group A) or to a control group with TURBT only (Group B). Primary end point was to compare the efficacy of an INAIC in the early recurrence-free survival (RFS). Secondary end points were: RFS in patients who did not receive adjuvant treatments, toxicity, and feasibility.
RESULTS: A total of 124 patients with Ta/T1 G1-G3NMIBC were included in the initial analysis (Group A:64, Group B: 60). Demographics, risk classification, complications, and adjuvant treatments were balanced between groups. Eighty-four patients (Group A: 45, Group B: 39) who completed a one-year follow-up were included in the efficacy analysis and no difference was observed in the RFS between groups (p=0.3). In the subgroup of patients who did not receive adjuvant treatments, we found a significant difference in favor of an INAIC (p=0.009) and an 80% reduction in the risk of early recurrences (Hazard Ratio: 0.20; 95% confidence interval: 0.05-0.81; p=0.0024). No differences were observed in adverse events. Only 4 patients did not receive an INAIC despite being planned.
CONCLUSIONS: In this interim analysis, although we could not demonstrate a reduction in the RFS of all patients, we did find a significant decrease of recurrences in patients who did not receive adjuvant treatments. The administration of an INAIC seems to be safe and our protocol appears feasible and reproductive.
UNASSIGNED: Aunque el uso de una instilación postoperatoria inmediata de quimioterapia (IPOIQ) tras una resección transuretral vesical (RTUV) esta recomendada para prevenir recurrencias de carcinoma vesical no músculo invasivo (CVNMI), no se llega a realizar en muchos casos debido a fallos en su cumplimiento. Nosotros creemos que una instilación neoadyuvante inmediata de quimioterapia (INAIQ) puede actuar de manera similar reduciendo el riesgo de recurrencias. Presentamos el análisis intermedio del ensayo clínico PRECAVE.MATERIAL Y MÉTODOS: Se aleatorizó a pacientes diagnosticados de CVNMI a recibir una INAIQ con mitomicina C antes de la RTUV (Grupo A) o a un grupo control con RTUV solamente (Grupo B). El objetivo primario fue comparar la eficacia de una INAIQ en la supervivencia libre de recurrencia (SLR) temprana. Los objetivos secundarios fueron la SLR en pacientes que no recibieron tratamientos adyuvantes, toxicidad y viabilidad.
UNASSIGNED: Analizamos un total de 124 pacientes con CVNMI Ta/T1G1-G3 fueron analizados (Grupo A:64, Grupo B: 60). No se encontraron diferencias entre datos demográficos, grupos de riesgo, complicaciones o tratamientos adyuvantes. Para el análisis de eficacias e incluyeron 84 pacientes (Grupo A: 45, Grupo B:39) con al menos un año de seguimiento, sin observar diferencias en la SLR (p=0,3). Sin embargo, en el subgrupo que no recibió tratamientos adyuvantes, sí encontramos una diferencia significativa a favor de la INAIQ (p=0,009), y una reducción del riesgo de recurrencias tempranas del 80% (Hazard Ratio: 0,20; intervalo de confianza 95%: 0,05-0,81; p=0,0024). No se observaron diferencias en la aparición de eventos adversos. Solo 4 pacientes no recibieron un INAIC a pesar de estar planificado.
UNASSIGNED: En este análisis intermedio, aunque no pudimos demostrar una reducción en la SLR de todos los pacientes, sí encontramos una diferencia en el subgrupo que no recibió tratamientos adyuvantes. La administración de una INAIC parece ser segura, y nuestro protocolo parece factible y reproducible.

BACKGROUND: Urethral or upper urinary tract (UUT) recurrence of urothelial carcinoma (UC) after radical cystectomy (RC) are rare (4-6%), and their diagnosis usually occurs within the first two years. Although it is known that its early detection offers benefit in terms of survival, currently there are no clear recommendations for the detection of recurrence in the remnant urothelium (RU). Our aim is to determine the diagnostic value of urinary cytology for the detection of recurrences in the RU and to estimate its impact as an early diagnostic method on survival.
METHODS: Retrospective review of patients who underwent RC for urothelial carcinoma between 2008-2016, with a follow-up of at least 24 months.
RESULTS: The study included 142 patients. In a median follow-up of 68.5 months, nine patients (6.3%) presented recurrences in the RU (urethra: four, UUT: four, synchronous: one). The sensitivity and specificity of urinary cytology for the diagnosis of UUT recurrences were 20% and 96%, respectively. No significant differences were found between overall survival and cancer-specific survival among patients according to the urinary cytology results.
CONCLUSIONS: Recurrences in the RU after RC are infrequent; our study has shown that urinary cytology offers a low sensitivity for their diagnoses. For these reasons, we do not consider that urinary cytology provides useful information for surveillance of these patients.

BACKGROUND: Bladder Cancer (BC) is11th most common malignancy. In terms of pathology, the vast majority of patients suffer from transitional cell carcinoma. Apart from this common type of BC, there are many morphological subtypes with different oncological characteristics. Plasmacytoid BC is a well-recognized subtype of BC with great diagnostic importance as it usually presents in locally advanced or even metastatic stage.
OBJECTIVE: The objective of this study was to evaluate our experience in diagnosing and treating patients with this rare BC subtype.
METHODS: A retrospective analysis of 5 patients diagnosed with plasmacytoid BC in our department during they ears 2014-2016 was performed. Transurethral resection of the tumors was performed in all patients and pathology diagnosis of plasmacytoid variant was based on several morphologic and immunohistochemical parameters. Staging included abdominal and thoracic CT.
RESULTS: 3 of 5 patients were diagnosed with metastatic disease. These patients were referred to the oncology department. 2 patients presented with non-metastatic BC after initial staging and thus a radical cystectomy was performed. Follow up of all patients was carried out and their survival was recorded.
CONCLUSIONS: We concluded that despite the fact that the plasmacytoid variant of BC is rare, it is important to take into account the pathologic and clinical features of this tumor in order to manage the optimal treatment of this poor prognosis cancer.
INTRODUCCIÓN: El cáncer de vejiga es el 11o cáncer mas común. Del punto de vista de la patología, la mayoría de pacientes tienen carcinoma urotelial de vejiga.A parte de la forma mas común, el cáncer de vejiga plasmocitoide es un subtipo ampliamente reconocido de cáncer de vejiga con una gran importancia diagnóstica  ya que habitualmente se presenta como localmente avanzadoo en estadio metastático.OBJETIVO: El objetivo de este estudio fue evaluar nuestra experiencia en el diagnóstico y tratamiento en pacientes con esta entidad.MÉTODOS: Análisis retrospectivo de 5 pacientes diagnosticados con cáncer de vejiga plasmocitoide en nuestro departamento entre 2014 y 2016. Se realizó una resección transuretral de vejiga en todos los pacientes y un análisis histopatológico que demostró la variante plasmocitoide del punto de vista morfológico e immunohistoquímico. El estadiaje incluyó TAC toracoabdominopélvico.RESULTADOS: 3 de los 5 pacientes fueron diagnosticado sen estadio metastático. Estos pacientes pasaron a cargo del departamento de oncología medica. 2 pacientes se diagnosticaron en estadio localizado por lo que se realizó una cistectomía radical.  Se realizó el seguimiento y se determinó la supervivencia de estos pacientes. CONCLUSIONES: Se concluye que todo y que el diagnóstico de cáncer de vejiga plasmocitoide es raro; es importante reconocer esta variedad histológica para poderdar un manejo optimo a esta variedad con muy mal pronostico.