Bladder
Urothelial carcinoma-invasive
Sarcomatoid carcinoma

Author: Monika Roychowdhury, M.D. (see Authors page)

Revised: 20 July 2016, last major update December 2014

Copyright: (c) 2003-2016, PathologyOutlines.com, Inc.

PubMed Search: Sarcomatoid carcinoma [title] bladder
Cite this page: Sarcomatoid carcinoma. PathologyOutlines.com website. http://www.pathologyoutlines.com/topic/bladdersarcomatoid.html. Accessed December 8th, 2016.
Terminology
Etiology
  • 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
  • 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
  • Prognosis depends on depth of invasion
  • Good prognostic factors: negative surgical margins and absence of metastatic disease at the initial presentation
Treatment
  • Surgery (treat as an aggressive carcinoma)
  • Total cystectomy followed by radiation or chemotherapy (Korean J Urol 2010;51:724)
Case Reports
Gross Description
  • Large, polypoid or sessile mass, usually with well circumscribed base
Gross Images

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Bladder and diverticulum containing large tumor

Large tumor in lateral wall of urinary bladder

Micro Description
  • 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

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With osteoclast-like giant cells<

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With squamous cell carcinoma component


Various images


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Small cell carcinomatous and
chondrosarcomatous areas

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

Positive Stains
Negative Stains