74 years old man.  
Transurethral resection of the bladder tumour was made.  
 
Microscopic view:  
Fragments of fibromuscular stroma with transitional epithelium and infiltrative tumour, composed of nests and solid areas of medium sized cells with eccentricaly located polymorphous nuclei and light, clear margin cytoplasm with "friable" inclusions and focaly with PAS+ intracytoplasmic globules. Wide zones of necrosis.  
There is conventional high grade transitional cell carcinoma next to the latter mentioned.  
 
Immunohistology: PANCK+, CKHMW+, CK7/CK20+, pCEA+, CD138+ focal 30%, CK5(-), TTF1/CDX2(-), PSA(-), Vimentin(-).  
EBER CISH(-).  
 
My thoughts is about plasmacytoid transitional cell carcinoma.  
Questions: what about intracytoplasmic inclusions and PAS+ globules?  
Immunohistochemistry - CD138 is it specific and is it enough 30% of all tumour volume?  
 
I would appreciate any other opinion.

kunze 2011-05-04 23:03	I favor in this case the diagnosis of an urothelial carcinoma with rhabdoid features. That's a rare variant of invasive urothelial carcinomas with an aggressive behaviour. The plasmocytoid variant is characterized by discohesive cells with a similar appearance. CD138 is in my opinion not helpful in the diff. diagnosis.
simvai 2011-05-05 08:30	Thank You for Your opinion.   The variant You suggest was under consideration either. Just Vimentin was not very helpful in this situation, as it should be positive at least focaly.