PathWays Case Study: March 21

A 67-year-old woman presented with multiple episodes of gross hematuria. Urine cytology was consistent with malignancy and follow-up CT urogram demonstrated polypoid and sessile lesions in the bladder dome. The patient underwent cystectomy. Microscopy is shown below for two adjacent ares of tumor (area one—image 1, area two—images 2 & 3). Area two demonstrated diffuse positivity for synaptophysin and chromogranin.

Area One (10x)
Area Two (10x)
Area Two (40x)

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Matthew Woge, M.D.
Resident, Anatomic/Clinical Pathology
Mayo Clinic




Carrie Inwards, M.D.
Consultant, Anatomic Pathology
Mayo Clinic
Professor of Laboratory Medicine and Pathology
Mayo Clinic College of Medicine


Rene Revier

Rene Revier is an Editorial Assistant at Mayo Medical Laboratories. She supports Mayo Clinic PathWays and other corporate communications activities.


There is prominent retraction artifact. Neuroendocrine differentiation should be ruled out by doing neuroendocrine markers.

Based on positivity for neuroendocrine markers, it is has both small cell carcinoma and micropapillary components!

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