Bladder - Osteosarcoma

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Bladder

Other tumors

Osteosarcoma

Reviewers: Gillian Levy, M.D., Yale Medical Center (see Reviewers page)
Revised: 22 April 2011, last major update April 2011
Copyright: (c) 2003-2011, PathologyOutlines.com, Inc.

Definition
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● Malignant mesenchymal tumor with osteoid formation

Epidemiology
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● Sarcomas comprise <1% of malignant bladder tumors
● Rare; <50 cases reported
● 80% male
● Mean age 64 years, range 41 to 86 years

Sites
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● Usually trigone

Etiology
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● Patients may have prior or simulataneous urothelial carcinoma

Clinical features
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● Associated with urinary tract schistosomiasis
● Patients present with hematuria, urgency and dysuria

Prognostic factors
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● Poor prognosis
● Most patients die within 6 months due to local spread with urinary tract obstruction and secondary infection

Case reports
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● 24 year old woman post cyclophosphamide for SLE (J Med Case Reports 2009 Jan 29;3:39)
● 75 year old man with hematuria, colonic and prostatic adenocarcinoma (Arch Pathol Lab Med 2001;125:793)

Treatment
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● Radical cystectomy, radiation and chemotherapy
● Occasionally responsive to radiotherapy and chemotherapy

Gross description (Macroscopy)
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● Large, polypoid, infiltrative, often gritty tumor

Gross images
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24 year old woman

Micro description (Histopathology)
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● High grade sarcoma with spindle cells showing marked pleomorphism; no definite carcinomatous component
● Abundant lace-like osteoid
● May have chondroid matrix in background

Micro images
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Hypercellular tumor composed of spindle cells and osteoid

Various images; keratin negative but p53 positive

Renal tumor

Cytology description
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● Spindle cell lesion with marked nuclear pleomorphism

Positive stains
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● Vimentin

Negative stains
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● Pankeratin, epithelial membrane antigen, smooth muscle actin, desmin, CD34

Differential diagnosis
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● Sarcomatoid carcinomas and urothelial carcinomas with osseous metaplasia: keratin positive, desmosomes on EM
● Carcinosarcoma: admixture of carcinoma and sarcoma, often with carcinoma in situ of the bladder

End of Bladder > Other tumors > Osteosarcoma

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