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BACKGROUND: Osteoclast-like giant cell bladder carcinomas are an extremely unusual and aggressive histological subtype of urothelial carcinomas. Only 30 cases are reported in the international literature. CLINICAL CASE: A 79-year-old male patient attended our Urology department for a six-month history of macroscopic hematuria. As part of its diagnostic protocol, a CT scan of the abdomen and pelvis with elimination phase was performed, finding a 12-mm filling defect at the level of the posterior wall of the bladder; subsequently, a cystoscopy was performed confirming the presence of a 1.5 cm bladder tumor, which was completely resected. Pathology analysis with hematoxylin and eosin staining revealed a composition of mononuclear cells and osteoclast-like giant cells; immunohistochemistry was positive for epithelial markers CK AE-1 / AE-3, EMA, P53 and CD68. CONCLUSIONS: These tumors are extremely unusual and aggressive. The only diagnostic method is through immunohistochemistry where the presence of epithelial markers for urothelium in neoplastic cells is confirmed. Radical surgical treatment is recommended and to date there is no proven effective adjuvant treatment. Its median overall survival is 15 months.

INTRODUCCIÓN: los carcinomas de vejiga de células gigantes parecidas a osteoclasto son un subtipo histológico extremadamente inusual y agresivo de los carcinomas uroteliales. Solamente se encuentran reportados 30 casos en la literatura internacional. CASO CLÍNICO: un paciente masculino de 79 años acudió a valoración a nuestro departamento de Urología por un cuadro de hematuria macroscópica de seis meses de evolución. Como parte de su protocolo diagnóstico se realizó una TC de abdomen y pelvis con fase de eliminación, encontrando un defecto de llenado de 12 mm a nivel de la pared posterior de la vejiga; posteriormente se realizó una cistoscopia confirmando la presencia de un tumor vesical de 1.5 cm, el cuál fue resecado en su totalidad. El análisis por Patología con tinción de hematoxilina y eosina reveló una composición por células mononucleares y células gigantes parecidas a osteoclasto; la inmunohistoquímica fue positiva para marcadores epiteliales CK AE-1/AE-3, EMA, P53 y CD68. CONCLUSIONES: estos tumores son extremadamente inusuales y agresivos. El único método diagnóstico es a través de inmunohistoquímica en donde se confirme la presencia de marcadores epiteliales para urotelio en las células neoplásicas. Se recomienda un tratamiento quirúrgico radical y a la fecha no existe un tratamiento adyuvante efectivo demostrado. Su supervivencia media global es de 15 meses.

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BACKGROUND: Prostate cancer screening has reduced its mortality in 21%. However, this has also led to an increased number of biopsies in order to establish the diagnosis, many of them unnecessary. Current screening guidelines prioritize use of prostatic magnetic resonance and new biomarkers to reduce unnecessary biopsies, however, their implementation in developing countries screening programs is mainly limited by its costs. OBJECTIVE: We aimed to evaluate Prostate Biopsy Risk Collaborative Group (PBCG) and Prostate Cancer Prevention Trial Risk Calculator (PCPTRC) 2.0 predictions accuracy in Mexican patients in order to guide prostate biopsy decision making and reduce unnecessary biopsies. MATERIALS AND METHODS: We retrospectively analyzed patients between 55 and 90 years old who underwent prostate biopsy in a high-volume center in Mexico between January 2017 and June 2020. Clinical utility of PBCG and PCPTRC 2.0 to predict high-grade prostate cancer (HGPCa) biopsy outcomes was evaluated using decision curve analysis and compared to actual biopsy decision making. Receiver operating characteristics area under the curve (AUC) was used to measure discrimination and external validation. RESULTS: From 687 patients eligible for prostate biopsy, 433 met selections criteria. One hundred and thirty-five (31.17%) patients were diagnosed with HGPCa, 63 (14.54%) with low-grade disease and 235 (54.27%) had a negative biopsy. PCPTRC 2.0 ≥15% threshold got a standardized net benefit (sNB) of 0.70, while PBCG ≥30% and ≥35% had a sNB of 0.27 and 0.15, respectively. Use of both models for guiding prostate biopsy decision resulted in no statistical difference for HGCPa detection rates, while achieved a significant difference in reducing total and unnecessary biopsies. However, this difference was lower (better) for PCPTRC 2.0, being statistically significative when compared against PBCG thresholds. Both models were well calibrated (AUC 0.79) and achieved external validation compared with international cohorts. CONCLUSIONS: Our study is the first to effectively validate both PCPTRC 2.0 and PBCG predictions for the Mexican population, proving that their use in daily practice improves biopsy decision making by accurately predicting HGPCa and limit unnecessary biopsies without representing additional costs to screening programs.

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