Sarcomatoid carcinoma of the kidney: a case report

Sarcomatoid carcinoma of the kidney is an uncommon tumor associated with a very poor prognosis. Because this tumor can be occasionally difficult to distinguish from renal sarcoma, immunohistochemistry and electronmicroscopy are sometimes necessary for diagnosis. Therapy is actually essentially surgical because if adjuvant therapies should follow radical nephrectomy, no standardized regimen has been at present defined.     

Sarcomatoid renal carcinoma

Sarcomatoid renal carcinoma made up 1 per cent of renal parenchymal tumors resected from 1967 to 1980. The majority of patients with this aggressive type of renal carcinoma were symptomatic and had a palpable renal mass at the time of diagnosis. Only 2 of 13 patients had tumor confined within the renal capsule at the time of operation. One of these patients survived and 12 of 13 died rapidly of metastatic renal carcinoma, with a median survival of 6.3 months from the time of diagnosis. This distinctive histologic variant of renal carcinoma has a highly malignant biological behavior and, as effective adjuvant treatment for renal carcinoma becomes available, should be one of the tumor types treated vigorously.     

Sarcomatoid carcinoma of the urinary bladder

Sarcomatoid carcinoma of the urinary bladder is a rare malignancy of an aggressive nature usually seen in patients in the seventh to eighth decade of life. A case of sarcomatoid carcinoma of the bladder in a 37 year old male presenting with gross haematuria is reported. A potency-preserving radical cystoprostatectomy with ileal conduit was performed.     

Sarcomatoid renal cell carcinoma

A case of sarcomatoid renal cell carcinoma is reported with light, immunohistochemical and electron microscopic findings. The tumour consisted of typical clear cells of renal cell carcinoma and spindle cells compatible with malignant fibrous histiocytoma (MFH). Although an epithelial membrane antigen was demonstrated in the clear cells, this was not detected in the MFH-like spindle cells. In contrast, the spindle cells expressed vimentin that was not identified in the clear cells. Electron microscopy revealed epithelial features in the spindle cells. Comparisons were made with previous sarcomatoid renal cell carcinoma in the literature. Thus, ultrastructural study was vital in diagnosis of sarcomatoid renal cell carcinoma.     

Sarcomatoid carcinoma of the kidney. Report of a new case and review of the bibliography

We report a new case of sarcomatoid renal cell carcinoma, in a male of 67 years old, with locoregional recidive four months after first surgery, with two episodes of retroperitoneal hemorrhage after second surgery. The objective of this work is to contribute a new case and of doing one revision.     

阴茎肉瘤样癌临床病理观察(附文献复习)

目的 探讨阴茎肉瘤样癌的临床和病理学特点.方法 对1例阴茎肉瘤样癌,通过临床表现、组织形态、免疫组化进行分析,并复习相关文献.结果 镜下见肿瘤大部分区域为梭形细胞肉瘤样,呈席纹状排列,较多大的单核样细胞和少数巨细胞,核分裂易见,少部分高分化鳞状细胞癌区域.免疫组化检测梭形肉瘤样区域vimentin阳性,p63、CK14和PCK散在阳性,Ki67(40%),EMA阴性.鳞状细胞癌形态区域:PCK、CK14阳性,vimentin和p63散在阳性,EMA阳性,Ki67(60%).p53、p16、S-100、desmin、action阴性.结论 阴茎肉瘤样癌是阴茎恶性肿瘤中的一种罕见类型,具有高度侵袭性,易在局部反复复发并早期发生淋巴结转移.     

Sarcomatoid carcinoma and carcinosarcoma of the urinary bladder

Two cases, sarcomatoid carcinoma and carcinosarcoma, of the urinary bladder are reported. A 68-year-old man with sarcomatoid carcinoma underwent total cystectomy and was alive and had had no recurrence after 21 months. A 78-year-old woman with carcinosarcoma underwent total cystectomy, but she died from increasing multiple lung metastases 4 months after surgery. The histopathological characteristics of both neoplasms are reported and discussed.     

膀胱肉瘤样癌与癌肉瘤

目的探讨膀胱肉瘤样癌及膀胱癌肉瘤组织学特性。提高对膀胱肉瘤样癌和膀胱癌肉瘤的病理学和临床特征的认识。方法报告1例膀胱肉瘤样癌和1例膀胱癌肉瘤的病例资料。2例均为男性。年龄分别为60岁、66岁。1例以肉眼血尿就诊,膀胱镜、CT和B超检查均诊断为膀胱肿瘤,肿瘤呈侵润性生长,术前活检提示为移行上皮细胞癌。行膀胱部分切除术,术后行全身化疗和膀胱灌注化疗;病理检查为癌肉瘤。另1例以膀胱血块填塞就诊,急诊手术行血块清除、止血及肿瘤姑息性切除,术后均行全身化疗和膀胱灌注化疗,术后病理检查为肉瘤样癌。结果1例行膀胱部分切除者,术后病理可见上皮和肉瘤样间质2种恶性成分,且可见到横纹肌肉瘤成分,诊断为膀胱癌肉瘤,3个月后复查局部肿瘤复发。行膀胱全切-回肠新膀胱术,目前仍在随访中。另1例术后病理可见上皮和肉瘤样间质2种恶性成分,癌与肉瘤样区有移行,诊断为膀胱肉瘤样癌,1个月后死于全身衰竭、多处转移。结论膀胱肉瘤样癌和癌肉瘤具有浸润性生长的生物学特性,恶性程度高,预后不良;化疗、放疗都不太敏感,手术仍是首选治疗方式。     

Sarcomatoid carcinoma with osseous differentiation in the bladder

INTRODUCTION: Bladder sarcomatoid carcinoma is a very rare variant of transitional cell carcinoma. With disputed nomenclature, the tumor has been described previously under a variety of names such as sarcomatoid carcinoma, pseudosarcoma, malignant mixed mesodermal/Müllerian tumor, metaplastic carcinoma and spindle cell carcinoma. This malignancy represents 0.3% of all bladder tumors and has an aggressive behavior yielding a poor prognosis despite radio and chemotherapy. CASE REPORT: An 81 y/o man presented with a transitional cell carcinoma and underwent a transurethral resection. Adjuvant onco-BCG was introduced. After 9 months of follow-up, a local tumoral recurrence occurred and a new transurethral resection revealed sarcomatoid carcinoma with osseous elements. A radical cystoprostatectomy was then carried out.     

Sarcomatoid carcinoma of the bladder: a case report.

We reported a case of sarcomatoid carcinoma of the bladder in a 78-year-old woman presenting with pollakisuria. She has remained well without any evidence of recurrence for 25 months after radical cystectomy. Microscopic examination revealed a composition almost exclusively of spindle and dedifferentiated cells, accompanied by only a few cells retaining epithelial features of differentiation. The latter cells were immunohistochemically positive for epithelial membrane antigen (EMA). A concomitant carcinoma in situ was present in the adjacent mucosa. Immunohistochemical exploration with EMA proved useful for reinforcing the conventional histological diagnosis.     

Sarcomatoid carcinoma of the urinary bladder: a case report

A 63-year-old man was admitted to our hospital for a bladder tumor. Drip infusion pyelography, computerized tomography (CT) and magnetic resonance imaging suggested the presence of a large invasive tumor in the right wall of the bladder. Histopathological findings by transurethral resection of bladder tumor showed the presence of sarcomatous and carcinomatous elements. Immunohistochemical examination showed that the sarcomatous component did not stain for S-100 protein or for smooth muscle actin but it stained for epithelial markers. Under the diagnosis of sarcomatoid carcinoma, we performed a total cystectomy and ileal conduit without chemotherapy or radiation. A follow-up CT taken at four months postoperatively showed no evidence of recurrence.     

Sarcomatoid carcinoma of the renal pelvis: a case report

A 65-year-old man visited our hospital with the complaint of left hypochondrial pain. Since he had left giant hydronephrosis due to ureteral stone, we performed left nephrectomy. Unexpectedly, macroscopic examination of the resected kidney revealed multiple yellowish nodules located in the renal pelvis and calyces. Histopathologically the nodules consisted of two pattern of malignancy, transitional cell carcinoma and spindle sarcomatous tumor. Immunohistochemical examination showed that spindle cells were stained positive for cytokeratin, and the final diagnosis was sarcomatoid carcinoma of left renal pelvis. Postoperatively, the patient underwent two courses of adjuvant chemotherapy, but metastases to retroperitoneal lymph nodes were noted two months after operation. He died of the disease eight months postoperatively.     

Sarcomatoid renal cell carcinoma with scant carcinomatous components

A 30‐year‐old male underwent radical nephrectomy for a right renal tumor 15 cm in diameter. On microscopic examination of initial 17 sections, the tumor consisted of pleomorphic giant cells and spindle neoplastic cells. There was no carcinomatous component. Immunohistochemically, the neoplastic cells were negative for keratin and epithelial membrane antigen but positive for vimentin. The giant cells were also scatteringly, weakly positive for myoglobin. At that time a diagnosis of rhabdomyosarcoma of the kidney was made. However, further microscopic examination of another eight sections revealed small areas of clear cell‐type renal cell carcinoma (RCC) which transited to sarcomatous components and led to a diagnosis of sarcomatoid RCC. The patient underwent three cycles of adjuvant chemotherapy. He has been free of the disease for 14 months after nephrectomy.     

Sarcomatoid carcinoma of the urinary bladder: report of a case

The patient was a 78-year-old man with gross hematuria. A non-papillary and non-pedunculated tumor was found on the posterior wall of the bladder by cystoscopic examination. Total cystectomy with construction of ileal conduit was performed. Histologically, the tumor was composed of carcinomatous and sarcomatous elements. The carcinomatous element was compatible with grade 3 transitional cell carcinoma. The sarcomatous element was composed of osteosarcomatous, chondrosarcomatous pattern and undifferentiated malignant spindle cell component. Immunohistochemical examination demonstrated the presence of keratin, cytokeratin and epithelial membrane antigen in both carcinomatous and sarcomatous elements. Therefore, we diagnosed this tumor as sarcomatoid carcinoma. The patient has remained well without any evidence of recurrence for 10 months after operation.     

Sarcomatoid carcinoma of the urinary bladder: the final common pathway of urothelial carcinoma dedifferentiation

Sarcomatoid carcinoma of the urinary bladder is an unusual malignancy composed of both carcinomatous and sarcomatous components. It is an aggressive tumor that presents at an advanced stage and confers a much poorer prognosis than conventional urothelial carcinoma. The proper nomenclature and histogenesis of these tumors have been subjects of debate for some time. There is an emerging consensus that sarcomatoid carcinoma is the most appropriate term for these neoplasms. The recent World Health Organization classification has applied this term to all tumors showing morphologic and/or immunologic evidence of both malignant epithelial and mesenchymal differentiation. Such tumors have been postulated to represent either multiclonal collision tumors or monoclonal cancers with divergent differentiation; recent molecular studies favor the latter theory. In this study, we discuss the nomenclature, clinical features, pathology, differential diagnosis, molecular genetics, and histogenesis of sarcomatoid carcinoma. We emphasize the importance of molecular genetic studies in providing insight into the histogenesis of this neoplasm. Sarcomatoid carcinoma seems to represent the final common pathway of urothelial carcinoma dedifferentiation.