Leiomyosarcoma of urinary bladder

Smooth muscle neoplasms of the urinary bladder: a clinicopathologic comparison of leiomyoma and leiomyosarcoma

We report the clinicopathologic, immunohistochemical, and DNA ploidy findings of 18 leiomyosarcomas of the urinary bladder. In addition, we compare these malignant smooth muscle tumors with 10 cases of urinary bladder leiomyoma. The 14 male and four female patients with leiomyosarcoma ranged in age from 25 to 88 years (mean 64 years). The tumors ranged from 3.0 to 15.0 cm (mean 7.1 cm) in greatest dimension and were moderately to highly cellular, consisting of interlacing fascicles of spindled cells with mild to marked nuclear atypia. Coagulative tumor necrosis was identified in 14 cases (78%), and mitotic activity ranged from 1 to 42 mitotic figures (MF) per 10 high power fields (HPF) (mean 12 MF/10 HPF). Tumors were classified as either high-grade (12 cases) or low-grade (six cases) based on nuclear atypia, mitotic activity, and tumor necrosis. Actin positivity was present in 15 tumors (83%), and desmin immunoreactivity was present in seven tumors (39%). All cases were negative for epithelial markers and S-100. Proliferative activity, as assessed by MIB-1 staining, ranged from 0.1% to 51.4% (median 9.1%). Seven (39%) of the leiomyosarcomas were DNA aneuploid, eight (44%) were tetraploid, and three (17%) were diploid. Five patients underwent radical cystoprostatectomy, one radical cystectomy, seven had partial cystectomy, two underwent pelvic exenteration, and three patients had transurethral resection only. Follow-up information was available on all 18 cases and ranged from 2 to 68 months (mean 22 months). Of the 12 patients with high-grade tumors, six (50%) died of disease from 2 to 20 months (mean 7 months) after diagnosis and three patients (25%) are alive with metastatic tumor. Two of the six patients with low-grade leiomyosarcoma died of tumor, 61 and 68 months after diagnosis. There were five male and five female patients with leiomyoma ranging in age from 22 to 78 years (mean 61 years). The tumors ranged from 0.5 to 4.5 cm (mean 1.6 cm) in greatest dimension, were well circumscribed, and had low cellularity. Mitotic activity, necrosis, and cellular atypia were absent, and the tumors were strongly positive for both actin and desmin. MIB-1 staining ranged from 0% to 3.8% (median 0.8%). Seven (87.5%) of the leiomyomas were DNA diploid or near-diploid and one (12.5%) was DNA aneuploid. Six patients were treated with transurethral resection and four with partial cystectomy. All 10 patients were alive at the last follow-up (mean follow-up 75 months), and no tumor recurred or metastasized. Our study shows that low-grade leiomyosarcomas are capable of malignant behavior, and high-grade leiomyosarcomas appear to behave more aggressively than low-grade tumors. In addition, the diagnosis of urinary bladder leiomyoma should be reserved for noninfiltrative smooth muscle tumors lacking mitotic activity, cytologic atypia, and necrosis.

Bladder leiomyosarcoma: a review of 10 cases with 5-year followup

Of 10 patients with leiomyosarcoma of the bladder followed for a minimum of 5 years 4 remain free of disease at 5, 6, 6 and 9 years, respectively, following partial cystectomy. An additional patient who was treated sequentially by radiation, radical cystectomy and chemoimmunotherapy survived for 10 years before death of metastatic disease. Wide surgical extirpation (partial or radical cystectomy) remains the curative treatment of choice.

Leiomyosarcoma of urinary bladder

A retrospective analysis of 5 cases of primary leiomyosarcoma of the bladder seen during 1958 through 1978 revealed that segmental resection is curative in selected cases but that more extensive extirpation may be warranted, depending on the stage of the disease. Radiation therapy had no effect on regional disease. Early diagnosis and aggressive surgical therapy are important.

Leiomyosarcoma of the bladder and subsequent urethral recurrence

A case of leiomyosarcoma of the bladder with subsequent urethral recurrence is presented. Although it is well documented that urethral recurrence, or more likely new occurrence, is not uncommon following transitional cell carcinoma of the bladder, we believe that this is the first reported instance of a sarcoma of the bladder and urethral recurrence. Therefore, management of sarcoma of the bladder might include distal urethrectomy at the time of cystoprostatectomy.

Urachal leiomyosarcoma

A case of urachal leiomyosarcoma in a twenty-eight-year-old man is presented. His treatment and a review of the literature are discussed.

Leiomyosarcoma of urinary bladder

Leiomyosarcoma of the bladder remains a rare diagnosis with poor therapeutic results. The available data continue to support surgical intervention as the mainstay of therapy, although other modalities have been employed with varying success. A case report and review of the literature with current treatment alternatives are presented.

Leukaemoid reaction in a case of leiomyosarcoma of the bladder

The first case of leiomyosarcoma of the urinary bladder associated with leukaemoid reaction is herein presented. There was no secondary involvement of bone marrow to explain the leukaemoid reaction. It may have been due either to tumour necrosis or to an unknown humoral substance elaborated by the tumour.