A case of high-grade leiomyosarcoma of the bladder with delayed onset and very poor prognosis

Surgical Management of Large Liver Metastases from Urinary Bladder Leiomyosarcoma

Leiomyosarcoma is a malignant tumor developed from the smooth muscle. It can arise in different sites especiallyin gastrointestinal tract (stomach, small bowel and colon), genitourinary tract (uterus, bladder and kidney) and the retroperitoneum (inferior vena cava) (1,2). It’s localization in the bladder is rare, representing 0.5% of all urinary bladder malignancies. There are over 210 cases reported in literature(3).Ten to 30% of the patients willpossibly develop metastases and the most common sites are lungs, liver and bone(4,5). There is no concensus on a standard treatment due to its very low incidence.

We report here a rare case of a surgical management of large liver metastases from urinary bladder leiomyosarcoma.

A clinicopathological and immunohistochemical study of non-urothelial bladder tumours

BACKGROUND

Non-urothelial bladder tumors (NUBTs) are uncommon accounting for approximately 10% of the total urinary bladder tumors while 90% are urothelial in origin. There are very limited comprehensive studies on NUBTs.

AIMS AND OBJECTIVES

The objectives of the study were to analyze the clinicopathological and immunohistochemical features of NUBTs.

MATERIALS AND METHODS

This is a retrospective study of NUBTs diagnosed over a period of 9 years. Patients' files were retrieved from the archives. Gross and microscopic features were recorded. Simple percentage and frequencies were used to interpret the data.

RESULTS

A total 16 cases (10.8% of all bladder tumors) of NUBT were found. Patients' ages ranged from 19 to 87 years with a male: female ratio of 4.3:1. The most common presenting symptom was gross hematuria (81.2%), and the most common location was posterolateral bladder wall. Muscle invasion was seen in 81.2% of cases, and large areas of necrosis were observed in 62.5%. There were two cases of squamous cell carcinoma, five cases each of adenocarcinoma (four secondary and one urachal) and mesenchymal tumors (four malignant and one benign), two cases of amyloid, and one case each of plasmacytomas and paraganglioma. Large areas of necrosis and muscle invasion were noted in high-grade and advanced staged tumors. In all, 43.7% had poor survival.

CONCLUSION

NUBTs present with similar clinicoradiological findings; however, their histological features along with immunohistochemistry help in the definite diagnosis. One should be aware of these tumors as they frequently present diagnostic and therapeutic challenge. Most of these neoplasms present at an advanced stage. Large or multicentric randomized controlled studies are needed to know the exact behavior and prognosis of these tumors.

Urinary bladder leiomyosarcoma with osteoclast-like multinucleated giant cells: a case report

Background

Bladder leiomyosarcoma is the most frequent mesenchymal neoplasm of the bladder. However, the rarity of the disease and some morphological aspects could give serious problems to differential diagnosis.

Case presentation

A 86-year-old male patient was referred to our institution to undergo endoscopic low-urinary-tract re-evaluation 2 months after the detection of a “low-grade urothelial neoplasia” in urinary cytology. A TURBT (transurethral resection of bladder tumor) was performed and revealed a tumor extending for 3.5 cm with thin stalk peduncle on the left lateral wall of the bladder, cephalad and lateral to the left ureteral orifice. The exophytic part of the tumor was resected with the underlying bladder wall. Histologically, the tumor showed a quite complex pattern, composed of spindle cells, with often invasion to the surrounding bladder muscular wall, and the presence of numerous multinucleated, osteoclast-like giant cells, scattered throughout the neoplasia.

Conclusions

Here we report a unique case of urinary bladder leiomyosarcoma with osteoclast-like multinucleated giant cells (OGCs). These cells, confounding the morphological aspect, indeed showed an immunohistochemical phenotype of non-neoplastic origin (most likely a histiocyte/macrophage differentiation). We feel that the presence of the OGCs within this tumor is reactive. Nevertheless, more research is necessary to understand the role of OGCs in urinary bladder tumors and leiomyosarcoma, in paticular.

Partial cystectomy for a primary locally advanced leiomyosarcoma of the bladder: a case report and review of the literature

Partial cystectomy with wide local excision may be considered a suitable option for selective cases of locally advanced bladder leiomyosarcoma without evidence of distant metastasis; thereby preserving the functional outcome and quality of life. A negative margin, complete tumor resection, and frequent follow-up in such patients are mandatory.

Unusual Visceral Sarcomas: Report of 2 Cases with Review of Literature

Sarcomas account for only 1% of adult solid tumours. Visceral sarcomas except Gastrointestinal Stromal Tumours (GIST) are rare and therefore little is known about the natural history and prognosis of these tumours. They tend to occur in older adults with no sex predilection and are characterized by an aggressive behaviour. Proper evaluation of these tumours is necessary because these are uncommon tumours which often present with advanced disease in an anatomically complex location. Since there are very few published studies on visceral sarcomas, the data is insufficient to suggest prognosis and optimum treatment strategies. We present two cases of such unusual malignancies in spleen and urinary bladder.

[Leiomyosarcoma of the bladder in a 64 year old patient]

Le leiomyosarcome représente une tumeur rare de la vessie. Sa présentation clinique est non spécifique et dominée par l'hématurie. La résection endoscopique de la vessie avec un examen anathomopathologique permet de poser le diagnostic. La rareté de cette localisation ne permet pas d’établir une stratégie thérapeutique standard, néanmoins la chirurgie reste le traitement le plus utilisé. Nous rapportons le cas d'une patiente âgée de 64 ans, ayant présenté une hématurie. L'examen anatomopathologique d'une résection endoscopique de la vessie a posé le diagnostic d'un leiomyosarcome.

Leiomyosarcoma, a nonurothelial bladder tumor: a rare entity with therapeutic diversity

A 22-year-old young woman presented with dysuria and lower urinary tract symptoms that had persisted for 6 months. She was diagnosed with a tumor near the bladder neck. Transurethral resection was done under anaesthesia. The histopathological examination with immunohistochemical staining showed the tumor to be a low-grade leiomyosarcoma. Adjuvant chemoradiation was given, and the patient has been doing well for 12 months of follow-up. Nonurothelial tumors of the bladder are rare and consensus is lacking regarding their definitive treatment. Furthermore, little is known about the natural history and prognosis of this type of bladder sarcoma. We present a minimally invasive treatment for this relatively rare tumor in which bladder preservation was achieved with no evidence of local or distant recurrences during the follow-up to date.

Leiomyosarcoma of the urinary bladder: A review and a report of two further cases

OBJECTIVES

To review the published cases of leiomyosarcoma of the urinary bladder and to report two further cases.

METHODS

The databases Pubmed and Hinari were searched using the keywords 'bladder', 'leiomyosarcoma' and 'smooth muscle neoplasm'. The 14 articles identified were reviewed, and we present a further two cases.

RESULTS

Of more than 100 cases reported, 77 were reviewed. There is a lack of consensus about the standard treatment, and little is known about the natural history and prognosis of the tumour, due to its very low incidence. These tumours occur in older adults of either sex and are characterised by an aggressive behaviour. There is usually an unfavourable outcome, with the lungs being the most common site of metastasis. The two further cases we report had a different presentation and outcome.

CONCLUSIONS

Because of the limited experience with this rare tumour, there are insufficient data to suggest the optimum management strategy and prognosis.

Rapid progression of a urinary bladder leiomyosarcoma: report of a case

The case we report shows rapid progression and a very poor prognosis only for a month that differs from the clinical course reported in the literature. An 83-year-old man was referred to our hospital for macroscopic hematuria. Computed tomography (CT) revealed a large bladder tumor measuring 4 cm × 3 cm and magnetic resonance imaging revealed extravesical invasion and pelvic wall invasion of the tumors. Chest CT and bone scintigraphy revealed no evidence of distant visceral metastases, and a clinical diagnosis of T4N0M0 was made. Transurethral resection of the bladder tumor (TUR-BT) was performed for histopathological diagnosis 18 days after admission, and no further adjuvant treatment was given. At 15 days after TUR-BT, the patient's clinical status worsened with symptoms of exertional dyspnea. CT showed multiple metastatic lesions in the lung, liver, and retroperitoneal lymphadenopathy. The patient died 2 days later and underwent autopsy. A final histopathological diagnosis of leiomyosarcoma was made based on immunohistochemical staining.