Case Report A Case of Plasmacytoid Variant of Bladder Cancer With a Single Penile Metastasis and a Complete Response to Carboplatin-Based Chemotherapy and Review of the Literature Carlo Messina, 1,2 Elisa Zanardi, 1,2 Chiara Dellepiane, 1,2 Laura Tomasello, 1 Maurizio Colecchia, 3 Gian Luigi Ravetti, 4 Francesco Boccardo, 1,2 Bruno Spina 4 Clinical Genitourinary Cancer, Vol. 14, No. 1, e139-42 ª 2016 Elsevier Inc. All rights reserved. Keywords: Bladder cancer, Carboplatin based chemotherapy, Penile metastases, Plasmocytoid variant, Urothelial carcinoma Introduction Bladder cancer is the most common tumor of the urinary system and the ninth most common malignancy worldwide. It has been estimated that 386,000 new cases are diagnosed annually, resulting in 150,000 deaths worldwide. 1 Urothelial carcinoma (UC) is the predominant histologic type in Western Europe and the United States, where it accounts for approximately 90% of all bladder cancer cases. 2 UC with plasmacytoid morphology, first described in 1991 as “similar to plasma cells seen in myeloma,” is a rare variant of UC and has been included in the World Health Organization classification since 2004. 3 The distinction between the plasmacytoid variant (PCV) and UC is important to define the stage and prognosis and deliver appro- priate therapy. However, differentiation sometimes causes a diag- nostic challenge for the pathologist, in particular, when the diagnostic material is a small biopsy specimen, and when the clinical data are incomplete. PCV is thought to behave more aggressively, with a high incidence of lymph node involvement and both ureteral and paravesical surgical margins. 4 In the present report, we describe the case of a patient who underwent radical cystectomy, bilateral lymphadenectomy, and adjuvant chemotherapy for locally advanced PCV of UC. After metastatic spread of the disease to the penis, the patient underwent Clinical Practice Points  The plasmacytoid variant of urothelial carcinoma is considered a rare variant of urothelial carcinoma, ac- counting for 3% of all malignant primary tumors.  The histologic and morphologic features are charac- terized by medium-size and dyshesive tumor cells with abundant eosinophilic cytoplasm, small hyper- chromatic nuclei, and frequent mitotic figures, resembling plasma cells.  We describe the case of a patient who underwent radical cystectomy, bilateral lymphadenectomy, and adjuvant chemotherapy for locally advanced plasma- cytoid variant of urothelial carcinoma.  After metastatic spread of the disease to the penis, the patient underwent 4 cycles of a carboplatin and paclitaxel regimen, experiencing a 12-month disease- free interval.  Currently, no role for chemotherapy has been defined, given the absence of data from clinical randomized trials supporting their use.  Therefore, we aimed to provide a comprehensive re- view of the published data focusing on the pathologic diagnosis and therapeutic management of this rare neoplasm. C.M. and E.Z. are co-first authors. 1 Academic Unit of Medical Oncology, IRCCS San Martino University HospitaleIST National Cancer Research Institute, Genoa, Italy 2 Department of Internal Medicine, University of Genoa School of Medicine, Genoa, Italy 3 Department of Pathology and Anatomical Pathology Unit, IRCCS National Cancer Institute, Milan, Italy 4 Pathology Unit, IRCCS San Martino University HospitaleIST National Cancer Research Institute, Genoa, Italy Submitted: Jun 15, 2015; Revised: Sep 23, 2015; Accepted: Oct 6, 2015; Epub: Oct 28, 2015 Address for correspondence: Carlo Messina, MD, Academic Unit of Medical Oncology, IRCCS San Martino University HospitaleIST National Cancer Research Institute, and Department of Internal Medicine, University of Genoa School of Medicine, Largo R. Benzi 10, Genoa 16132, Italy E-mail contact: carlo.messi@hotmail.it 1558-7673/$ - see frontmatter ª 2016 Elsevier Inc. All rights reserved. http://dx.doi.org/10.1016/j.clgc.2015.10.012 Clinical Genitourinary Cancer February 2016 - e139