Osteogenic sarcoma and transitional cell carcinoma occuring simultaneously in the urinary bladder: report of a case

Osteosarcoma of the bladder: a case report

Background

Osteosarcoma arising from the bladder is extremely rare, with only 38 cases reported to our knowledge. It is often detected owing to hematuria, and is treated by surgery (for example, total cystectomy), radiation therapy, and chemotherapy; however, the prognosis is extremely poor.

Case presentation

An 83-year-old Japanese man underwent cystoscopy for postoperative follow-up of urothelial carcinoma of the bladder, which revealed a 2-cm nodular tumor on the right wall. He had a history of abdominal aortic aneurysm and hypertension, and had been smoking 15 cigarettes per day for 45 years. Seven years previously, the patient underwent transurethral resection of bladder tumor for a 5-cm tumor on the right wall of the bladder. The histopathological diagnosis was urothelial carcinoma. No recurrence had been detected since then. Transurethral resection of bladder tumor was performed, and the histopathological diagnosis was cystosarcoma. Because of his advanced age, we decided that it would be difficult to perform total cystectomy. We therefore performed a second transurethral resection of bladder tumor and found no residual tumor. At 29 months after surgery, the patient remains alive without recurrence.

Conclusion

Bladder osteosarcoma has a poor prognosis. However, our case was detected early, and treatment with transurethral resection of bladder tumor alone resulted in long-term survival without recurrence.

Supplementary Information

The online version contains supplementary material available at 10.1186/s13256-022-03346-2.

Carcinosarcoma of the bladder: case report and review of the literature

Primary osteosarcomas of the bladder account for about 0.04% of bladder neoplasms. Most of the patients in the literature expired within 6 months and, in almost all of the cases in the literature, radical cystectomy with postoperative chemotherapy was the treatment choice. A 79-year-old gentleman presented with gross hematuria. Cystoscopy demonstrated a 2- to 3-cm tumour along the lateral wall of the bladder. The tumour was resected incompletely via initial transurethral resection of bladder tumour (TURBT), and a second TURBT was subsequently performed to fully resect the residual mass. Surgical pathology from these 2 resections revealed osteosarcoma with invasion into the muscularis propria. A cystoprostatectomy was performed and final pathologic specimen revealed high-grade CIS without evidence of residual osteosarcoma. Postoperatively, the patient did not receive chemotherapy or radiation and currently remains disease-free 2 years post-radical cystectomy. Only 33 well-documented cases of primary osteosarcoma of the bladder have been reported to date. However, there are only 3 cases in which TURBT resulted in complete resection.

Primary osteosarcoma of the urinary bladder treated with external radiotherapy in a patient with a history of transitional cell carcinoma: a case report

INTRODUCTION

Primary osteosarcoma is one of the rare tumors affecting the urinary bladder. The occurrence of osteosarcoma in a patient with a long history of transitional cell carcinoma of the bladder is even more uncommon.

CASE PRESENTATION

We present the case of a 74-year-old Greek man who was diagnosed with osteosarcoma 10 years after he had been diagnosed with transitional cell carcinoma of the bladder from which he had been free from recurrences for the past three years. Our patient was treated for the osteosarcoma with transurethral resection of bladder tumor and external beam radiation therapy. He died eight months after the diagnosis, suffering poor quality of life in the last months.

CONCLUSION

Osteosarcoma of the bladder has a dismal prognosis. External beam radiation therapy as an adjunct to transurethral resection of bladder tumor not only provides no benefit to patients with primary osteosarcoma of urinary bladder, but also may be associated with poor quality of life.

TP53 mutational analysis supports monoclonal origin of biphasic sarcomatoid urothelial carcinoma (carcinosarcoma) of the urinary bladder

Sarcomatoid urothelial carcinoma of the urinary bladder is an uncommon neoplasm with biphasic morphology exhibiting both epithelial and sarcomatoid components. Whether this tumor arises from a single cancer stem cell with subsequent differentiation or represents collision of the progeny of two separate cancer stem cells is a matter of controversy. To clarify its clonal origin, we analyzed the TP53 mutation status of a series of 17 sarcomatoid urothelial carcinomas using single-strand conformation polymorphism, DNA sequencing and p53 immunohistochemistry. Sarcomatoid and epithelial tumor components were separately microdissected using laser capture microdissection. Five out of the 17 sarcomatoid urothelial carcinomas contained TP53 point mutations in exons 5 and 8. In all five cases, the TP53 point mutations were identical in both the epithelial and sarcomatoid components. The sarcomatoid and epithelial tumor components in all 17 cases showed concordant p53 expression patterns. Our results suggest that despite their conspicuous divergence at the phenotypic level, the sarcomatoid and carcinomatoid elements of this uncommon tumor share a common clonal origin.

Osteosarcoma of the urinary bladder occurring simultaneously with prostate and bowel carcinomas: report of a case and review of the literature

Osteosarcoma is a very rare tumor of the urinary bladder, with only 28 well-documented cases reported in the literature to date. The tumors have characteristically been large and polypoid and most commonly have been located in the trigone. An abdominal mass has occasionally been palpated, and rectal examination has frequently revealed a mass in the region of the bladder. The prognosis for this tumor is very poor. In this report, a 75-year-old man with hematuria was found to have a primary osteosarcoma of the urinary bladder with superficial invasion. Radical cystoprostatectomy and ileal conduit urinary diversion were performed. During surgery, a synchronous mucinous adenocarcinoma of the ascending colon was found, and a right hemicolectomy was performed. Prostatic adenocarcinoma was discovered from the histology. The patient died 7 months after surgery with systemic spread of the osteosarcoma. Osteosarcoma of the bladder should be distinguished from other bladder tumors that may be associated with bone formation, such as carcinosarcomas and transitional cell carcinomas with osseous metaplasia of their stroma, both of which have a better prognosis than osteosarcoma.

Primary osteogenic sarcoma of the urinary bladder successfully treated with combination therapy

A 54-year-old woman presented with a large bladder mass and left hydroureteronephrosis. At radical cystectomy (with ileal loop urinary diversion), an unresectable left obturator mass was found. Combination chemotherapy postoperatively resulted in significant shrinkage, and she underwent excision of the residual mass. No residual cancer was seen. The patient remains free of disease 56 months after cystectomy and 51 months after resection of the residual mass. Primary osteogenic sarcoma of the urinary bladder may respond to combination chemotherapy and surgery. All patients found to have advanced disease should be considered for this approach.

Primary mesenchymal tumors of the urinary bladder. A histological and immunohistochemical study of 30 cases

The light microscopic and immunohistochemical features of 30 primary mesenchymal neoplasms of the urinary bladder are reported. Half of the cases represented smooth and striated muscle tumors (five leiomyomas, seven leiomyosarcomas including epithelioid and myxoid subtypes, one rhabdomyoma, one embryonal rhabdomyosarcoma and one alveolar rhabdomyosarcoma). One third of the tumors were of fibrohistiocytic origin (one fibrous histiocytoma and eight malignant fibrous histiocytomas including fascicular and storiform, inflammatory and pleomorphic subtypes). In addition, a malignant epithelioid schwannoma, a round cell liposarcoma, two hemangiomas and two mixed mesodermal tumors were observed. The morphology of the vesical mesenchymal tumors was identical to that of their counterparts known to occur in other sites, particularly in the soft tissue. Muscle-specific actin, alpha-1-antichymotrypsin, S-100-protein and neuron-specific enolase proved to be useful and reliable immunomarkers for differential diagnosis of poorly differentiated leio- and rhabdomyosarcomas, malignant fibrous histiocytomas and malignant schwannomas. Since some tumors coexpressed several classes of intermediate filaments, diagnostic immunocytochemistry should only be used considering a larger panel of antibodies and in close correlation with the histological and cytological features of the neoplasms.

Giant cell reparative granuloma of the bladder associated with transitional cell carcinoma

We report a case of benign giant cell tumor of the bladder associated with transitional cell carcinoma. This giant cell granuloma represents a reactive reaction that must be distinguished from the giant cell malignant tumor. The morphological, histochemical and immunohistochemical criteria that can aid in the differential diagnosis are discussed.

Malignant mesenchymoma of the bladder

A case of malignant mesenchymoma of the bladder, containing fibroleiomyomatous, myxomatous, osteoid, and cartilaginous components is presented. The primary pedunculated tumor measuring 18 X 10 X 9 cm and weighing 934 g, arose from the anterior wall of the bladder and was treated by partial cystectomy. Six months after surgery, cystoscopy revealed a recurrent tumor situated at the dome of the bladder. The patient received surgery, chemotherapy, and irradiation for recurrent tumor, but died of the disease 21 months after the first operation. Autopsy revealed extensive local recurrence with wide-spread metastases of malignant mesenchymoma of the bladder and an incidental finding of coexisting clear cell carcinoma in the right kidney (pTl, NO, MO). There have been no previous reports of association of malignant mesenchymoma of the urinary bladder and renal cell carcinoma.

Angiosarcoma of the bladder: a case report

We report a case of angiosarcoma of the bladder. Numerous cases of hemangioma of the bladder have been reported previously but only 3 cases of angiosarcoma have been published. In our case immunoperoxidase staining for factor VIII antigen was useful in substantiating the diagnosis of angiosarcoma.

Osteosarcoma of the urinary bladder. Report of a case and review of the literature

A 65-year-old man with hematuria had a large polypoid tumor of the urinary bladder which on microscopic examination was an osteosarcoma, only the 22nd example reported in this organ. The tumor was initially misinterpreted as a transitional cell carcinoma because of an absence of osteoid in the initial slide prepared from a biopsy of the neoplasm. Most of the patients with osteosarcoma of the bladder have been male; they have ranged from 41 to 83 (average 62) years of age. The tumors have characteristically been large and polypoid and have most commonly been located in the trigone. Follow-up is available for 21 patients; 18 of them died within 6 months or less. Three patients were still alive 14 months, 18 months, and 2 years postoperatively. Osteosarcoma of the bladder should be distinguished from other bladder tumors that may be associated with bone formation such as carcinosarcomas and transitional cell carcinomas with osseous metaplasia of their stroma, both of which have a better prognosis than osteosarcoma.

Coexisting leiomyosarcoma and transitional cell carcinoma of the urinary bladder

A rare case of coexisting sarcoma and carcinoma of the urinary bladder is reported and the literature is reviewed. Because of the differences in the histogenesis and prognosis, such cases should be differentiated from cases of carcinosarcoma of the urinary bladder.

Malignant mixed mesodermal tumor of bladder occurring after radiotherapy for cervical cancer: report of a case

A rare case of radiation-induced malignant mixed mesodermal tumor of the bladder is reported. A 78-year-old woman complained of hematuria, which originated from a polypoid tumor in the bladder 15 years after radiotherapy for squamous cell carcinoma of the uterine cervix. The bladder tumor recurred 9 months after resection and partial cystectomy then was performed. Histological findings revealed malignant mixed mesodermal tumor composed of carcinomatous and sarcomatous elements. The former element consisted mainly of transitional cell carcinoma with occasional foci of squamous metaplasia and glandular differentiation, while the latter consisted of spindle cell sarcoma showing partly cartilaginous and osseous differentiation. The histogenesis of malignant mixed mesodermal tumor of the bladder also is discussed.

Giant cell tumor of the bladder associated with transitional cell carcinoma

We report in detail the first giant cell tumor associated with transitional cell carcinoma of the bladder. The giant cell tumor was composed of multinucleated giant and mononuclear stromal cells, and was morphologically indistinguishable from giant cell tumor of the bone. The giant and transitional cell carcinomas showed no evidence of recurrence or metastasis 8 months after transurethral resection. No histogenetic correlation between the cancers was found.

The epithelial origin of a malignant mesodermal mixed tumor of the bladder: report of a case with long-term survival

Malignant mesodermal mixed tumors of the bladder are complex neoplasms consisting of elements of carcinoma and differentiated sarcoma. They are rare, aggressive and usually rapidly fatal. We report on a patient who remained free of disease 7 years after resection by partial cystectomy of a malignant mesodermal mixed tumor. Only 1 other long-term survivor has been reported. Our case is of particular interest because urothelial carcinoma in situ was found in the bladder epithelium on the surface and at the periphery of the invasive tumor, strongly suggesting an epithelial origin of this and similar tumors of other organs.

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.

Mixed mesodermal tumor of urinary bladder: a light and electron microscopic study

Light and ultrastructural findings in a mixed mesodermal tumor of the urinary bladder are reported. The mesenchymal component of the tumor contained undifferentiated mesenchymal cells and cells with chondroblastic differentiation. The neoplastic chondrocytes displayed an abundance of cytoplasmic microfilaments and had a scalloped cell surface.

Carcinosarcoma of the urinary bladder in an adult male

Carcinosarcoma of the urinary bladder in a 64-year-old man is described. Total cystectomy with bilateral ureteroileostomy was performed. The patient is in good health 12 months after the operation. Histologically the main bulk of the tumour tissue was rhabdomyosarcomatous, but in some areas atypical glands were intermingled with the rhabdomyoblasts. This histologic pattern has not previously been described. The histologic features, clinical manifestations and treatment of these rare bladder tumours are discussed in relation to the literature.

Sarcoma of the bladder and prostate

A retrospective analysis of 30 patients with primary sarcoma of the bladder and prostate is presented. Prognosis seems to be better in adults irrespective of the type of treatment. The survival rate is poor for children with sarcoma of the prostate. Two children were cured of sarcoma of the bladder by a radical operation. Sarcomas of the bladder and prostate are more common in adults more than 50 years old. The type of treatment and the results are reviewed. The place of multimodal treatment in the management of these sarcomas is discussed.

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.

Carcinosarcoma of the bladder: case report and review of the literature

A 36-year-old man with carcinosarcoma of the bladder is described. The literature is reviewed and the clinicopathology is discussed. These tumors tend to be bulky, rapidly growing, invasive and recur locally. Metastases are generally hematogenous and may rarely involve regional nodes. Deaths are commonly owing to local invasion and sepsis. Preoperative overstaging may occur and pelvic arteriography and exploration are recommended in questionable cases. Because of the difficulty in locally extirpating these tumors radical cystectomy and urinary diversion are recommended.