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Bladder

Other carcinomas

Sarcomatoid carcinoma


Reviewer: Monika Roychowdhury, M.D., University of Minnesota Medical Center (see Reviewers page)
Revised: 16 May 2011, last major update May 2011
Copyright: (c) 2003-2011, PathologyOutlines.com, Inc.

Terminology
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● Also called carcinosarcoma (some differentiate these terms, but criteria are difficult to apply), spindle cell carcinoma, metaplastic carcinoma
● Most recent World Health Organization classification of urinary tract tumors uses the term “Sarcomatoid carcinoma” to denote all of these lesions (WHO Classification of Tumours: Pathology and Genetics of Tumours of the Urinary System and Male Genital Organs, 2004, pages 99-133)

Etiology
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● May develop from a pleuripotent neoplastic cell or be a true collision of independently arising epithelial and mesenchymal components
● Molecular studies suggest a monoclonal origin of both epithelial and mesenchymal components (J Pathol 2007;211:420)

Clinical features
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● Rare, <100 cases described, accounts for 0.3% of urothelial carcinomas
● Often elderly men (mean age 72, range 49 to 88 years), predominantly male smokers with very aggressive and advanced disease
● Patients usually present with hematuria, dysuria or recurrent urinary tract infections
● May involve ureter and renal pelvis
● Associated with cyclophosphamide and radiation therapy

Prognostic factors
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● Prognosis depends on depth of invasion
Good prognostic factors: negative surgical margins and absence of metastatic disease at the initial presentation

Treatment
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● Surgery (treat as an aggressive carcinoma)
● Total cystectomy followed by radiation or chemotherapy (Korean J Urol 2010;51:724)

Case reports
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● 64 year old man with biphasic and monophasic sarcomatoid carcinoma of the bladder (Can J Urol 2008;15:4106)
● 65 year old man with tumor of bladder diverticulum and coexisting prostatic adenocarcinoma (Arch Pathol Lab Med 2002;126:853)
● Tumors with liposarcomatous, MPNST and micropapillary components (Arch Pathol Lab Med 2000;124:1172)
● Post cyclophosphamide therapy for Wegener’s granulomatosis (Arch Pathol Lab Med 2004;128:e8, Am J Surg Pathol 1980;4:191) or lymphoma (Arch Pathol Lab Med 1991;115:1049)

Gross description
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● Large, polypoid or sessile mass, usually with well circumscribed base

Gross images
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Bladder and diverticulum containing large tumor

Micro description
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● Resembles similar tumors in upper aerodigestive tract
● High grade tumor with sarcomatoid and carcinomatoid components
● Sarcomatous component has spindled, round and pleomorphic giant cells, may consist of leiomyosarcoma, chondrosarcoma, rhabdomyosarcoma; rarely liposarcoma or with myxoid or sclerosing areas (Mod Pathol 1997;10:908)

● Carcinomatous component may be papillary or nonpapillary urothelial carcinoma, adenocarcinoma, squamous cell carcinoma or small cell carcinoma; may be present only as carcinoma in situ

Micro images
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Epithelioid (upper right) and sarcomatoid (lower left) areas


With osteoclast-like giant cells

       
With squamous cell carcinoma component

       

   
Various images


Small cell carcinomatous and chondrosarcomatous areas



Figure 1: infiltration of entire clitoris, 2/3: spindle shaped tumor cells (carcinoma cells elsewhere)

Positive stains
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● Keratin and EMA (both components), vimentin; variable CEA, hCG

Negative stains
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● Smooth muscle actin (usually), desmin (usually), HHF-35, calponin, caldesmon

Differential diagnosis
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Post operative spindle cell nodule
Inflammatory myofibroblastic tumor
Sarcoma: very rare, may have pseudoepitheliomatous hyperplasia
Urothelial carcinoma with reactive stroma: stroma is negative for epithelial markers (Am J Clin Pathol 1988;90:216)

Additional references
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Hum Pathol 2000;31:332, Am J Surg Pathol 1994;18:241, Am J Clin Pathol 1988;90:653

End of Bladder > Other carcinomas > Sarcomatoid carcinoma


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