Immunohistomorphologic and molecular cytogenetic analysis of a carcinosarcoma of the urinary bladder

Carcinosarcomas of the urinary bladder are malignant biphasic tumors with an epithelial and a spindle cell component. For the histogenesis of the two components, a biclonal and a monoclonal origin are discussed. We present the immunomorphology and molecular cytogenetics of such a case. The immunohistology of biopsies of the urinary bladder revealed a poorly differentiated urothelial carcinoma (GIII) and a co-existing pleomorphic, spindle cell leiomyosarcoma (GIII). The two components were microdissected and further analyzed for gains and losses of chromosomal material using comparative genomic hybridization. In addition, loss of heterozygosity analyses were included. The tumor components revealed as overlapping core aberrations losses on the short arm of chromosome 9 and on the long arm of chromosome 11. However, both components showed additional aberrations exclusively detected in one of the components. The occurrence of overlapping aberrations strongly argues for a monoclonal origin of this tumor with a common ancestor. The additional aberrations of the components point to an independent and divergent course of tumor progression in both components.     

A carcinosarcoma/sarcomatoid carcinoma arising in a urinary bladder diverticulum

We describe an invasive polypoid carcinosarcoma/sarcomatoid carcinoma arising within a urinary bladder diverticulum in a 65-year-old patient with synchronous, moderately differentiated prostatic adenocarcinoma. Histologically, the diverticular tumor exhibits an admixture of different morphologic components, including invasive high-grade urothelial carcinoma, malignant glandular structures in a cellular background of malignant spindle cells, and areas formed exclusively by spindle and pleomorphic cells. There was full-thickness involvement of the diverticulum with extension of the tumor into the perivesical fat and ipsilateral seminal vesicle. In view of the early invasive behavior of carcinosarcoma/sarcomatoid carcinoma combined with the paucity of the muscular layer in the diverticulum wall, a graver prognosis was expected for this aggressive tumor that occurred in this unusual site.     

良性前列腺增生症并发急性尿潴留患者膀胱功能评估

目的 评估并发急性尿潴留(AUR)的良性前列腺增生症(BPH)患者逼尿肌功能,预测术后疗效.方法 对68例并发AUR的BPH患者术前通过尿动力学检查评估下尿路功能,术后行自由尿流率测定评估疗效.结果 53例完成自由尿流率测定的患者最大尿流率(7.3±2.8) mL/s,平均尿流率(3.5±1.7)mL/s,排尿量(189 ±94) mL.剩余尿小于50 mL者48例,其余5例平均剩余尿118 mL.压力-流率同步测定结果显示,储尿期膀胱功能容量减小、敏感性增高者58例,57例可见逼尿肌不稳定收缩(83.82％).高顺应性膀胱、逼尿肌收缩乏力者13例.术后61例排尿通畅,7例再次留置导尿7～15 d拔管,4例可以通畅排尿.3例仍不能自主排尿,其中1例行膀胱造瘘,2例间断清洁导尿.结论 对于并发AUR的BPH患者术前通过尿动力学检查准确评估下尿路功能,可以预测术后疗效.     

Cytologic diagnosis of metastatic seminoma to the prostate and urinary bladder: a case report

A 42-year-old man presented with severe abdominal pain, constipation, and hematuria. The patient had a history of seminoma treated by chemotherapy followed by bilateral orchiectomy and retroperitoneal lymph node dissection 16 years earlier. A computed tomography (CT) scan showed a 8.0 x 6.0 x 5.0 cm mass in the retrovesical space, encompassing the left side of his proximal bladder, the prostate, and the rectum. A urine cytologic specimen showed loosely cohesive cell clusters composed of highly atypical large cells and occasional large, single cells with macronucleoli present in a background of mainly lymphocytes and histiocytes was diagnosed as recurrent seminoma. Prostate biopsies showed extensively necrotic seminoma with accompanying granulomatous reaction. The tumor cells were immunoreactive for c-kit (CD117), placental-like alkaline phosphatase (PLAP), D2-40, and OCT4. To our knowledge, this is the second report on urine cytology of metastatic seminoma.     

Pseudospirochaetosis of the urinary bladder

This report describes an elderly patient with urinary symptoms who showed surface colonisation of the transitional mucosa of the bladder by an unusual haematoxophilic microorganism superficially resembling the "blue fuzz" seen in colonic biopsies showing intestinal spirochaetosis. Special stains showed that the organisms were Gram and Giemsa positive, weakly argyrophilic, and Ziehl-Nielsen negative. Immunostains were negative for Helicobacter pylori and electron microscopy revealed curious curved bodies, which were difficult to classify. Therefore, this condition was described as pseudospirochaetosis of the urinary bladder. The urinary symptoms regressed on treatment with ciprofloxacin. The clinicopathological relevance of these findings is discussed in the report.     

Carcinosarcoma of the urinary bladder

Summary A case of urinary bladder carcinosarcoma (UBCS) is reported with light, immunohistochemical and electron microscopical findings. The tumour consisted of a squamous cell carcinoma, variable spindle cell stromal elements compatible with fibrosarcoma, and rhabdomyoblasts. Intermediate filament co-expression of cytokeratin and vimentin was shown by immunohistochemistry. Electron microscopy (EM) confirmed the nature of the three components, and indicated some similarities between the three cell-types present. Comparisons with the previous UBCS in the literature are made.     

Pheochromocytoma of the urinary bladder

The case of a 65-year-old male with pheochromocytoma arising in the urinary bladder is presented. Clinical evaluation included ultrasonography, intravenous pyelography and computerized tomography (CT) scan. Transurethral resection of an exophytic tumor 1 cm in diameter was performed. The histological diagnosis was pheochromocytoma of the bladder. The evaluation and management of this type of tumor is discussed.     

Adenocarcinoma of the urinary bladder

Primary adenocarcinoma of urinary bladder is an uncommon neoplasm and is a source of diagnostic confusion with adenocarcinomas arising in adjacent organs, especially colon. These tumors show varied histologic picture and degree of differentiation. Clinical association with bladder exstrophy and schistosomiasis has been well documented. Primary bladder adenocarcinomas have overlapping histologic and immunohistochemical features with adenocarcinomas arising from other primary sites and the suggested immunohistochemical panel includes cytokeratins 7 and 20, 34βE12, thrombomodulin, CDX2, and β-catenin. Clinical, imaging, histologic, and immunohistochemical correlation should be done while rendering this diagnosis, as prognosis and therapeutic options for primary versus metastatic adenocarcinoma vary widely.     

Successful treatment of a colonic ulcer penetrating the urinary bladder caused by the administration of calcium polystyrene sulfonate and sorbitol.

A 77-year-old woman was urgently admitted for the treatment of diabetic ketoacidosis and a duodenal ulcer hemorrhage in March 1999. She had a history of diabetes and angina pectoris. After admission, she received oral calcium polystyrene sulfonate and sorbitol to treat hyperkalemia. Nine days later, severe abdominal pain developed. A colonoscopic examination revealed a sigmoid colonic ulcer and stenosis; the patient was treated conservatively. At a 1-year follow-up examination, the colonic stenosis was found have worsened; pneumaturia developed in January 2001. The patient was found to have a sigmoidovesical fistula and underwent sigmoidectomy and partial resection of the ileum and urinary bladder. The histological findings were a benign colonic ulcer with the infiltration of inflammatory cells, mainly lymphocytes. Rhomboidal, dark violet Kayexalate crystals were observed on microscope examination in the submucosa in both the first and second colonic biopsy specimens. We concluded that the colonic ulcer and the sigmoidovesical fistula had been caused by the administration of calcium polystyrene sulfonate and sorbitol. Reports of colonic perforation as a result of the administration of calcium polystyrene sulfonate and sorbitol are rare. Here, we report the successful treatment of a colonic ulcer that had penetrated the urinary bladder.     

Malignant carcinoid of the urinary bladder

The paper reports a case of a rare tumor of diffuse endocrine system--a malignant carcinoid of the urinary bladder.     

Nonepithelial neoplasms of the urinary bladder

Nonepithelial tumors are rare in the urinary bladder, but their exact classification is very important in the differential diagnosis between these tumors and epithelial lesions. In the new WHO classification and in the third series of the Armed Forces Institute of Pathology (AFIP) "Atlas of Tumor Pathology" on urinary bladder tumors, various mesenchymal tumors, mixed epithelial and mesenchymal tumors and myofibroblastic proliferations are summarized. In the following we will describe the histology, immunohistology, and cytogenetics of nonepithelial tumors and lesions.