A case of carcinosarcoma of the urinary bladder

We report a case of carcinosarcoma of the urinary bladder. A 68-year-old man visited our hospital with complaints of asymptomatic macroscopic hematuria, cold sweat and general malaise. Excretory urography revealed a filling defect in the left wall of the bladder, and subsequent cystoscopy revealed a non-papillary sessile tumor. The tumor was transurethrally resected and its histology showed carcinosarcoma which was characteristics of a mixture of transitional cell carcinoma with spindle cell sarcoma. The patient underwent total cystectomy and his bladder was reconstructed with the ileum. Nevertheless, he died of multiple organ metastases 3 months after the surgery.     

Primary heterologous carcinosarcoma of the ureter with necrotic malignant polyps. Report of a case and review of the literature

Carcinosarcoma is a rare and aggressive disease characterized by biphasic neoplasms with distinct mesenchymal and epithelial components. We report a case of ureteral carcinosarcoma with malignant necrotic polyps. The patient was a 58-year-old woman with painless hematuria, who was later diagnosed as having ureteral carcinosarcoma. Three long pendulous polypoid-shape tumors consisting of high-grade transitional cell carcinoma with chondrosarcomatous and osteosarcomatous elements were found. Two months after nephroureterectomy, the tumor relapsed in the bladder. Despite anterior exenteration, the patient died of local recurrence 6 months after her initial visit. To our knowledge, only 10 cases of this disease have been reported in the literature.     

Synchronous occurrence of bladder carcinosarcoma and testicular seminoma

We report a case of urinary bladder carcinosarcoma with simultaneous testicular seminoma. A 60-year-old male presented with painless gross hematuria and a left testicular mass. The bladder tumor was deeply infiltrating muscular tissue and had histologic features of both carcinoma and sarcoma. Testicular tumor was diagnosed as classical seminoma. Radical cystectomy, pelvic and left-modified retroperitoneal lymphadenectomy were performed. The lymph nodes did not show metastasis. At the 26 months follow-up, the patient is free of disease.     

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。     

The perineal implantation of a bladder tumor through urethro-vasal reflux]

Perineal implantation of urinary bladder cancer in a 57-year-old male is reported. The patient had been suffering from incomplete paraplegia and neurogenic bladder for these 29 years because of accidental injury of lumbar spinal cord with episodes of bladder stones two times and right epididymitis three times, and presented urinary leakage from a perineal fistula. The fistula orifice was surrounded by a hard mass lesion. Bilateral swelling of inguinal lymph nodes was present. Fistulogram and voiding cysto-urethrography revealed reflux from posterior urethra to the fistula through right vas and epididymis. Histological diagnosis of resected perineal mass and biopsied left inguinal lymph node was transitional cell carcinoma with predominant metaplasia of squamous cell carcinoma. Tissues obtained by TUR-biopsy of a mass lesion at bladder wall was also histologically diagnosed transitional cell carcinoma with metaplasia of squamous cell carcinoma. The present case indicates implantation of a bladder tumor to perineum by urethero-vasal reflux and metastases to inguinal lymphnodes from the perineal lesion.     

Quadruple cancer including bilateral breasts, Vater’s papilla, and urinary bladder: Report of a case

We herein report a rare case of quadrule carcinoma with heterochronous bilateral breast cancer, cancer of Vater's papilla, and cancer of the urinary bladder, which were all curatively resected. A 62-year-old woman previously underwent right and left modified radical mastectomies heterochronously. Recently, a dilatation of the lower bile duct, diagnosed as cancer of Vater's papilla, was resected by a pancreatoduodenectomy. Hematuria during surgery led to the discovery of a solid bladder tumor. The tumor was resected by a transurethral resection. The histopathologic findings differed for all four lesions. The patient had an uneventful postoperative course and to date has shown no recurrence.     

Intradiverticular bladder tumors. Three case reports

The bladder tumours in vesical diverticula is rare, and the poor prognosis, because it was often with early invasion. We reported three cases of bladder tumours in vesical diverticula, with delay of diagnosis two, eight and twelve months respectively. The radiology exploration suspected the diagnosis and the histology biopsy confirmed a diagnosis of primary transitional cell carcinoma in two cases: PTa GI and T2 GII, and in an other case it was a invasive epidermoid carcinoma. The first patient was dead by urethral resection of the bladder tumour. The second required a cytoprototectomy and the last patient. The treatment consisted of radiotherapy and chemotherapy. We insisted of the particularity diagnosis, histology and therapeutic for bladder tumour in vesical diverticula and the early diagnosis in order to have a good prognosis.     

Transitional cell carcinoma of bladder originating from transitional cell carcinoma of anus

A unique case of transitional cell carcinoma of the bladder with the primary being in the anus is reported. The patient presented with acute urinary retention from a large bladder tumor, which was thought to be primary to the bladder. Biopsy of the bladder revealed transitional cell carcinoma, microscopically indistinguishable from the primary cloacogenic carcinoma diagnosed seven years previously.     

泌尿系统肉瘤样癌和癌肉瘤八例报告并文献复习

目的 探讨泌尿系统肉瘤样癌和癌肉瘤的组织学特点、临床表现、治疗和预后.方法 泌尿系统肉瘤样癌和癌肉瘤8例.其中膀胱肉瘤样癌4例,男3例,女1例,年龄58、63、78、79岁,均因无痛性肉眼血尿就诊,肿瘤直径平均4.5(1.5～6.7)cm,为不规则、广基的浸润性肿物.行膀胱部分切除术2例,TURBt 1例,膀胱癌根治术1例.肾肉瘤样癌1例,男,64岁,因肉眼血尿就诊,伴同侧肾上腺和胰腺转移,行肾癌根治术和胰腺体尾切除术.转移性右肾上腺肉瘤样癌1例,男,47岁,原发灶为左肺肉瘤样癌,行左肺下叶和右肾上腺切除术.肾盂癌肉瘤1例,女,64岁,表现为无痛性肉眼血尿,行左肾、输尿管及部分膀胱切除术.膀胱癌肉瘤1例,男,77岁,无痛性肉眼血尿,肿瘤直径2.5～3.0 cm,行TURBt术.8例均经病理检查确诊.8例均获随访,随访时间36～96个月.结果 膀胱肉瘤样癌4例中:1例G_3、T_(2a)者行TURBt,术后行丝裂霉素膀胱灌注化疗,随访96个月无瘤生存;1例63岁女性先行TURBt,术后病理为肉瘤样癌、T_1伴有原位癌(T_m),1个月后行膀胱癌根治切除术.随访36个月无瘤生存;1例T3a者行膀胱部分切除术,术后辅以放疗,随访36个月无瘤生存;1例T4a者行姑息性膀胱部分切除术,术后病理切缘阳性,术后2个月死于肿瘤多脏器转移.肾肉瘤样癌患者术后2个月开始化疗(盐酸吉西他滨加卡铂),又出现肝、肺转移,术后5个月死亡.转移性右肾上腺肉瘤样癌患者术后在外院行3个疗程化疗(顺铂加依托泊苷),5个月后出现左肾上腺转移,术后7个月死亡.肾盂癌肉瘤患者的肿瘤以软骨肉瘤为主,伴少许鳞状细胞癌及未分化癌,随访60个月无瘤生存.膀胱癌肉瘤患者肿瘤病理分期为T2a,主要是平滑肌肉瘤,伴有鳞状细胞痛和腺癌,术后予以全身化疗(盐酸吉西他滨加卡铂),随访12个月死于慢性阻塞性肺气肿、肺部感染.结论 泌尿系统肉瘤样癌和癌肉瘤少见,多见于老年男性,恶性程度高,浸润性强,预后差.肿瘤的病理分期和治疗是影响预后的因素,早期诊断和积极的综合治疗可望获得较好的治疗结果、延长患者生存期.     

Duodenal metastatic leiomyosarcoma of the uterus. A case report

The digestive metastases of uterine leiomyosarcoma are rare. We report a case of a duodenal tumor detected in a 50 year-old woman, 3 years after she underwent a total hysterectomy for uterine leiomyosarcoma. The stenosing duodenal mass was thought to be a mesenchymal tumor. A pancreaticoduodenectomy was performed. The resected lesion was morphologically similar to the uterine leiomyosarcoma. In fact, the histopathological study confirmed a submucosal tumor with typical features of the uterine leiomyosarcoma. Immunohistochemistry was performed and it showed negative CD117 and CD 34. Markers displayed positivity for actin smooth muscle and desmin. Considering the patient history and the immunohistochemical observations, we diagnosed a duodenal metastasis of uterine leiomysarcoma. Through this exceptional observation we want to emphasize the epidemiological and the pathological features of the metastatic uterine leiomyosarcoma. We will also point out the progress of tumoral cells and the histopathological distinctive criteria with a primitive digestive mesenchymal tumor.     

A case of small cell carcinoma in a diverticulum of the bladder

We report a case of small cell carcinoma in a diverticulum of the bladder. A 64-year-old Japanese man visited our hospital with the chief complaint of urinary retention. Cystoscopy revealed a papillary tumor arising in a diverticulum on the right lateral wall of the bladder. Partial cystectomy was performed under the diagnosis of bladder cancer in the diverticulum. The histopathological diagnosis was a combination of small cell carcinoma and urothelial carcinoma, of which the former was dominant. It is often difficult to detect tumors in the bladder diverticula and its early penetration is not rare because of the thin wall. Therefore, the prognosis of the bladder cancer in the diverticulum is believed to be generally poor. On the other hand, small cell carcinoma originating in the urinary bladder is also characterized by its extreme rareness and poor prognosis. To our knowledge, this is the second case report of the small cell carcinoma arising in a diverticulum of the urinary bladder in the Japanese literature.     

Adrenal myelolipoma: a report of a case

This is a case report of an adrenal myelolipoma, accidentally diagnosed during a work-up for bladder tumor. A 67-year-old male presented with the chief complaint of gross hematuria. He was subsequently diagnosed as having a bladder tumor, which was resected transurethrally and was found to be a transitional cell carcinoma of Grade 2 and Stage pT2. During further examination for metastasis computed tomography (CT) scan revealed a round tumor (approximately 5 cm in diameter) in the left adrenal. A tentative diagnosis was reached based on the scan, and surgery was undertaken to remove the tumor. A well-encapsulated tumor, yellowish and partly dark brown in color and 60 grams in weight, was retrieved. The tumor consisted of mature lipoid cells with myeloid cells scattered among them which verified the pathological diagnosis of adrenal myelolipoma. The present case is the 16th clinical case of adrenal myelolipoma reported in the Japanese literature.     

Cutaneous leiomyosarcoma

A cutaneous leiomyosarcoma arose in the upper lip skin of a 22-year-old patient. This unusual tumor was diagnosed clinically as a basal cell carcinoma although histological studies confirmed a leiomyosarcoma. The tumor was excised using Mohs technique and the wound reconstructed with a nasolabial flap and full-thickness skin graft. No recurrence or distant metastasis has appeared in a two-year follow-up.     

A case of carcinosarcoma of the urinary bladder

We report a case of carcinosarcoma of the urinary bladder. A 50-year-old man visited our hospital with asymptomatic macroscopic hematuria as a chief complaint. Excretory urography revealed a filling defect in the right wall of the bladder, and subsequent cystoscopy revealed a non-papillary tumor above the right orifice. The patient underwent total cystectomy and had a neobladder constructed with the ileum (Hautmann's method). Microscopic examination showed a tumor composed of a mixture of transitional cell carcinoma and rhabdomyosarcoma. Immunohistochemical examination showed that the area of epithelium component was positive for cytokeratin and the non-epithelium area was positive for vimentin, there being no relationship between the two. The patient began complaining of coccyalgia 10 days after the operation. He died about 1 month after the operation because of the recurrence in the pelvic cavities.     

Sarcomatoid carcinoma of the urinary bladder with a spontaneous perforation: a case report

A 65-year-old woman was referred to our clinic with gross hematuria. Cystoscopy revealed a non-papillary and non-pedunculated tumor on the left lateral wall of the bladder. A piece of necrotic tissue obtained from the bladder irrigation was histologically squamous cell carcinoma. A perforation at the left lateral wall of the bladder was found on the cystogram. Bone scintigraphy showed multiple metastases and computed tomography scans showed multiple lymph node metastases in the pelvic cavity. The clinical diagnosis was bladder carcinoma of T4N2M1 stage with an abscess due to a spontaneous perforation. Total cystectomy with bilateral ureterocutaneostomy was performed. She died due to sepsis 13 days after the operation. Histologically, the tumor was composed of carcinomatous and sarcomatous elements. The carcinomatous element was compatible with squamous cell carcinoma and the sarcomatous element was composed of undifferentiated malignant spindle cells. Immunohistochemical examination showed that the carcinomatous component was positive for keratin and human chorionic gonadotropin (HCG) and the spindle cell component positive for vimentin, desmin and HCG. Therefore, we diagnosed the tumor as sarcomatoid carcinoma. We reviewed 56 cases of carcinosarcoma of the bladder in Japan and discussed the clinicopathology of the disease.     

Stage pT1 signet ring cell carcinoma of the urinary bladder: a case report

A case of primary signet ring cell carcinoma of the urinary bladder is described. A 59-year-old man presented with microscopic hematuria, and cystoscopy revealed a white nonpapillary tumor. Histopathological examination of the resected tumor revealed signet ring cell carcinoma and transitional cell carcinoma. Histological depth of invasion was pT1. No adjuvant therapy was performed. Primary signet ring cell of the urinary bladder is a rare tumor with 37 cases reported to date in Japan. We investigated previously reported cases and discussed adjuvant therapies of superficial signet ring cell carcinoma of the urinary bladder.     

膀胱憩室癌5例报告

目的：探讨膀胱憩室癌的临床特征，提高其诊治水平。方法：对5例膀胱憩室癌患者均行CT和膀胱镜检查确诊。3例行根治性膀胱全切、尿流改道手术．2例行膀胱部分切除术。结果：病理诊断移行细胞癌2例，鳞状细胞癌2例，恶性神经鞘瘤1例。3例于术后2个月内死亡，均为非移行性细胞癌；另外2例术后随访10个月，无局部复发和远处转移。结论：CT和膀胱镜检查是确诊膀胱憩室癌的重要方法；膀胱憩室癌的临床分期不同，预后明显不同，非移行细胞癌病理类型有早期浸润行为．预后差。     

Squamous cell carcinoma of bladder diverticulum with initial symptoms produced by metastasis to maxillary sinus

A rare case of squamous cell carcinoma in the bladder diverticula of a 74-year-old man with initial clinical symptoms caused by metastasis to the maxillary sinus is reported. The histopathological examination at autopsy confirmed the metastatic squamous cell carcinoma in the maxillary sinus from the bladder diverticula. The vertebral vein plexus seems responsible for this type of metastasis.     

Leiomyosarcoma of the urinary bladder in a patient with bilateral retinoblastoma

Abstract:   We report a case of bladder leiomyosarcoma in a 27-year-old woman who had previously been treated with surgery and radiation for bilateral retinoblastoma. The patient was admitted to hospital with discomfort on micturition. Cystoscopy revealed a bladder tumor covered by normal urothelium. Transurethral resection of the bladder tumor was performed, and the histopathological diagnosis was leiomyosarcoma. Partial cystectomy was performed. The leiomyosarcoma of the bladder did not invade the muscle layer. However, bladder tumors recurred at new intravesical locations repeatedly. After transurethral resection of the bladder tumor had been performed twice, total cystectomy and creation of an ileal conduit were performed.     

Primary carcinoma in diverticulum of the bladder: a report of three cases]

The first case was in a 48-year-old man admitted with a chief complaint of macroscopic hematuria and sense of residual urine. A tumor in the diverticulum of the bladder was detected by cystoscopy, computed tomography (CT) and magnetic resonance imaging (MRI). We made the diagnosis of an invasive tumor in the diverticulum of the bladder. Total cystourethrectomy and ileal conduit diversion was performed. Histopathological finding was transitional cell carcinoma including squamous cell carcinoma. Adjuvant chemotherapy was performed. No recurrence and metastasis has been recognized for 12 months. The second case was a 56-year-old man having an intradiverticular tumor diagnosed by cystoscopy, CT, and MRI. Total cystectomy and ileal conduit diversion was performed. Histopathological findings was squamous cell carcinoma. No recurrence has been recognized for 8 months. The last case was an 81-year-old man. The patient had the complication of a primary progressive squamous cell carcinoma of the skin. Transurethral resection of diverticular tumor was performed under the diagnosis of superficial tumor. Histopathological findings revealed transitional cell carcinoma. One hundred and sixty one cases of tumor in the diverticulum of the bladder were reviewed. Importance of aggressive treatment including total cystectomy was emphasized.