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Review
. 2013 Jul 15;6(8):1671-6.
Print 2013.

Sarcomatoid carcinoma with small cell carcinoma component of the urinary bladder: a case report with review of the literature

Mitsuaki Ishida  1 , Muneo Iwai, Keiko Yoshida, Akiko Kagotani, Hidetoshi Okabe
Affiliations
Review

Sarcomatoid carcinoma with small cell carcinoma component of the urinary bladder: a case report with review of the literature

Mitsuaki Ishida et al. Int J Clin Exp Pathol. .

Abstract

Sarcomatoid carcinoma of the urinary bladder is an uncommon neoplasm characterized histopathologically by the presence of malignant spindle cell and epithelial components. Albeit extremely rare, sarcomatoid carcinoma with small cell carcinoma has been reported. Herein, we describe an additional case of sarcomatoid carcinoma with small cell carcinoma and squamous cell carcinoma of the urinary bladder and review the clinicopathological features of this type of tumor. An 82-year-old Japanese male presented with hematuria. Computed tomography demonstrated a large tumor in the urinary bladder. Histopathological study of the resected urinary bladder tumor showed that approximately 80% of the tumor was comprised of small cell carcinoma, and the remaining components were spindle cell proliferation (approximately 15%) and squamous cell carcinoma (5%). Both the spindle cell and squamous cell carcinoma components were intermingled with nests of the small cell carcinoma. This is the fifth documented case of sarcomatoid carcinoma with small cell carcinoma of the urinary bladder. Our review of the clinicopathological features of this type of tumor revealed that: i) elderly males are mainly affected, ii) the most common chief complaint is hematuria, iii) the epithelial component may include urothelial carcinoma, adenocarcinoma, and/or squamous cell carcinoma, and iv) the sarcomatous component is composed of spindle cell proliferation. The histogenesis of this type of tumor remains a matter of controversy. However, recent molecular analyses demonstrated a monoclonal origin of both components. This theory can account for the various types of carcinomatous components in this tumor as seen in the present case.

Keywords: Carcinosarcoma; small cell carcinoma; urinary bladder.

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Figures

Figure 1
Figure 1
Computed tomography shows an irregular-shaped tumor involving the entire layer of the urinary bladder in the right anterior wall.
Figure 2
Figure 2
Histopathological features of the urinary bladder tumor. A: Proliferation of small round cells invading into the muscular layer of the urinary bladder. The neoplastic cells have scant cytoplasm and round to oval nuclei without conspicuous nucleoli. Mitotic figures are scattered (arrows, inset). HE, x40, x400 (inset). B: Proliferation of atypical spindle cells adjacent to the small round cells. Multinucleated giant cells and bizarre cells are observed. HE, x100. C: A squamous cell carcinoma component is present adjacent to small round cell nest. HE, x200.
Figure 3
Figure 3
Immunohistochemical features of the urinary bladder tumor. A: Synaptophysin is expressed in the small round cells, x200. B: p63 is expressed in the squamous cell carcinoma, x200. C: Desmin is expressed in the small round cells (note: vascular wall is also positive for desmin), x200.
See this image and copyright information in PMC

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