ECP 2023 Abstracts

S368 Virchows Archiv (2023) 483 (Suppl 1):S1–S391 13 E-PS-24-006 A rare presentation of relapsed multiple myeloma: ureteric plasmacytoma A. Alves*, C. Courelas, J.L. Amaral, J. Pimentel, R. Almeida, M.A. Cipriano *Pathology Department, Coimbra Hospital and University Centre (CHUC), Portugal Background & objectives: Multiple myeloma (MM) and plasmacy- toma are clonal plasma cell neoplasias, the former affecting the bone marrow, with serum/urine elevation of monoclonal immunoglobulin and end-organ damage and the latter being solitary lesions, isolated or in the context of relapsed MM. Methods: Male patient in his 70’s, with history of multiple mye- loma (in remission), Diabetes Mellitus II, dyslipidemia and chronic renal disease, presented to the emergency room with dysuria and pollakiuria. The ultrasound study revealed hydronephrosis and a left ureteric wall thickening on its middle third, with 5cm length, confirmed by abdominopelvic CT-scan. The patient underwent a left nephroureterectomy. Results: In macroscopic study, the ureter had a whitish firm nodular mass at its middle third, causing a reduction of the ureteric lumen and an upstream dilation, where the diameter was of 2,2cm. Histologically, the tumour was composed of sheets of small cells with small, eccentric, hyperchromatic nuclei and basophilic cyto- plasm, with occasional multinucleated cells. The neoplastic cells showed immunopositivity to CD138 and were negative to CD45, Cam5.2, AE1/AE3, P63, E-Cadherin, Melan-A and pS100. In situ hybridization revealed lambda chain restriction. This patient did not show any other concurrent lesions and the bone marrow aspiration and immunophenotyping were normal. An extramedullary plasmacytoma diagnosis was rendered. Conclusion: Extramedullary plasmacytomas, solitary or in the con- text of MM, are infrequent and generally located in the upper air- way, with genitourinary involvement being rare. In the ureter, they can cause obstruction, leading to pollakiuria/anuria that can be the presentation symptom. In this case, because there was no bone marrow involvement nor any other lesions, no adjuvant therapy was performed. At last follow-up, one year after surgery, the patient remained in remission. E-PS-24-007 The effect of COVID-19 pandemic on renal cell carcinomas’ staging and grading at diagnosis: a tertiary centre perspective A. Alves*, G. Fontinha, J. Gama, J. Madeira, S. Bárbara, R. Almeida, M.A. Cipriano *Pathology Department, Coimbra Hospital and University Centre (CHUC), Portugal Background & objectives: COVID-19 was a hard test for healthcare institutions, having to manage Sars-CoV2 infections while maintain- ing daily practice. We intended to evaluate if the pandemic and its challenges had any impact on renal cell carcinomas (RCC)’ stage at presentation. Methods: We selected all renal cell tumours diagnosed at our institution between 2019-2022 (n=311) and compared their clinical and pathologi- cal features, highlighting the pTNM stage at diagnosis in pre-pandemic (2019), pandemic (2020-2021) and post-pandemic (2022) periods. Results: Our sample comprised clear cell RCC (43,9%), chromo- phobe RCC (22,3%), papillary RCC (19,7%), clear cell papillary RCC (7,2%) and other rarer subtypes of RCC (5,6%). The patients were mainly males (70,8%), with a mean age of 65 years. In 34,2% of cases ISUP grade was not applicable, but when it was, the majority were ISUP 2 (51,2%), followed by ISUP 3 (34,3%). Regarding staging, 50,5% were pT1a at presentation. When comparing RCC’s pTNM stage at diagnosis, there were no differ- ences with statistical significance between pre-pandemic, pandemic and post-pandemic times (ANOVA test, p=0,585). ISUP grade, when appli- cable, had statistical significant differences (ANOVA test, p=0,013; Linear regression test, coefficient beta<0,024). Conclusion: Although the common perception that healthcare insti- tutions, when facing COVID-19 challenges, have not given a proper response to daily practice issues, that does not seem to have interfered with the well-timed diagnosis of RCC at our institution, as the stage at diagnosis of these entities on pandemic and post-pandemic periods was similar to the stage on pre-pandemic era. However, there were statisti- cal differences regarding ISUP grade among these periods. E-PS-24-008 Battling multiple fronts: metachronous triple urogenital cancers and prostate BCGitis in one patient R.A. Barna*, L. Daminescu, V. Dema, M. Iacob, D. Herman, B. Nata- ras, A. Dema *Anapatmol Research Center, Victor Babes University of Medicine and Pharmacy, Romania Background & objectives: Renal cell carcinoma (RCC) patients have a higher risk of a second urogenital malignancy. While urinary bladder and prostate cancer often coexist, occasionally with Bacillus Calmette- Guérin (BCG) therapy-associated granulomatous inflammation, diag- nosing three urogenital tumours in a single patient is exceptional. Methods: A 67-year-old man was incidentally diagnosed on CT with a renal tumour. A year later, the patient had macroscopic haematuria caused by a bladder tumour, treated by transurethral resection (TURBT) and BCG instillations. A year after that, a PSA level of 5.06 ng/ml, enlarged prostate, and an “indeterminate” lesion detected by multipara- metric MRI required needle biopsy, followed by radical prostatectomy. Results: Radical nephrectomy grossly unveiled a 42x35x30 mm orange, solid tumour, with cystic and haemorrhagic areas. Microscopy demonstrated a clear cell RCC, WHO/ISUP grade 2, infiltrating the renal sinus fat. Histologically, TURBT showed a non-muscle invasive bladder cancer – papillary urothelial carcinoma with focal areas of high-grade com- ponent and squamous differentiation. Gross examination of the radical prostatectomy was non-specific. Microscopic results of the needle-biopsy and resection specimen correlated. The “indeterminate” lesion was a chronic granulomatous inflammation in the right lobe, with eosinophilic, amorphous necrosis, Langhans giant cells, epithelioid macrophages, lymphocytes, and fibro- sis. The left lobe presented an acinar adenocarcinoma, Gleason score 3+3=6 (Grade group 1), with tertiary pattern 4 (<5%). Conclusion: The association of these triple malignant cancers can be caused by genetic (e.g. Lynch syndrome-associated upper urinary tract urothelial cancers) and epigenetic modifications, carcinogenic expo- sure, therapy for one of the tumours, or may be unrelated. A thorough investigation will be conducted. Granulomatous prostatitis following BCG instillation can mimic pros- tate cancer on imaging tests. Prolonged elevated PSA level in these patients should prompt additional evaluation. Histopathological exami- nation remains the definitive method for establishing a diagnosis. E-PS-24-009 HER2 expression in bladder invasive urothelial carcinoma, a study of 60 cases A. Bdioui*, K. Ben Lazreg, N. Kalaii, Z. Lajmi, W. Majdoub, S. Hmissa *Sahloul hôpital of sousse, Tunisia Background & objectives: Bladder urothelial carcinoma (UCB) is common, prognosis of invasive forms is poor; identification of thera- peutic targets could improve the prognosis.