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Takemura K, Motoi T, Tonooka A, Funata N, Nakanishi Y, Kataoka M, Ito M, Sakamoto K, Suzuki H, Tobisu KI, Koga F. Multifocal Synchronous Upper Urinary Tract Carcinosarcoma (Sarcomatoid Carcinoma) With Rhabdomyoblastic Differentiation. Int J Surg Pathol 2019; 27:547-552. [PMID: 30767589 DOI: 10.1177/1066896919828111] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Carcinosarcoma of the upper urinary tract is very rare. In this article, we report a case of upper urinary tract carcinosarcoma with rhabdomyoblastic differentiation showing distinct transition between the epithelial and mesenchymal components confirmed by morphology and immunohistochemistry. An 81-year-old female underwent radical nephroureterectomy under the diagnosis of left ureteral urothelial carcinoma (UC). Multiple invasive tumors showed combined histology with UC and rhabdomyosarcomatous elements (pT2-ureter and pT3-renal pelvis, pN0, u-lt0, ly0, v0, RM0). Each element demonstrated typical epithelial or mesenchymal staining patterns (positive for AE1/AE3 in the former and positive for vimentin and myogenin in the latter). Notably, immunohistochemical transition patterns of GATA-3, p63, SOX2, and myogenin between UC and rhabdomyosarcomatous elements were observed, implying possible involvement of neoplastic stem cells in the process of carcinosarcoma formation. The patient did not receive any adjuvant therapy and eventually succumbed to multiple visceral metastases (lungs and liver) at 11 months postoperatively. No autopsy was performed.
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Affiliation(s)
- Kosuke Takemura
- 1 Department of Urology, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, Tokyo, Japan
| | - Toru Motoi
- 2 Department of Pathology, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, Tokyo, Japan
| | - Akiko Tonooka
- 2 Department of Pathology, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, Tokyo, Japan
| | - Nobuaki Funata
- 2 Department of Pathology, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, Tokyo, Japan
| | - Yasukazu Nakanishi
- 1 Department of Urology, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, Tokyo, Japan
| | - Madoka Kataoka
- 1 Department of Urology, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, Tokyo, Japan
| | - Masaya Ito
- 1 Department of Urology, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, Tokyo, Japan
| | - Kazumasa Sakamoto
- 1 Department of Urology, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, Tokyo, Japan
| | - Hiroaki Suzuki
- 1 Department of Urology, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, Tokyo, Japan
| | - Ken-Ichi Tobisu
- 1 Department of Urology, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, Tokyo, Japan
| | - Fumitaka Koga
- 1 Department of Urology, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, Tokyo, Japan
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Lu W, Wang Y, Li Y, Cao Y, Han H, Zhou F. Sarcomatoid urothelial carcinoma with chondrosarcomatous differentiation of the ureter: A case report and review of the literature. Oncol Lett 2017; 13:1331-1337. [PMID: 28454257 DOI: 10.3892/ol.2017.5575] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2015] [Accepted: 04/29/2016] [Indexed: 12/19/2022] Open
Abstract
Sarcomatoid urothelial carcinoma of the urinary tract is associated with poor prognosis. The majority of sarcomatoid urothelial carcinomas are found in the urinary bladder, while a small minority have been shown to arise from the ureter. In the present case, a 72-year-old male patient was diagnosed with sarcomatoid urothelial carcinoma with chondrosarcomatous differentiation of the left ureter, and subsequently underwent nephroureterectomy and retroperitoneal lymph node dissection. Two lymph nodes from the renal hilum and one paraaortic lymph node were also found to have metastatic involvement; however, the patient refused to receive chemotherapy or radiotherapy and succumbed to bone and omentum metastasis at 6 months after the initial diagnosis. Sarcomatoid urothelial carcinoma of the ureter is uncommon. Even rarer is the presence of malignant heterologous elements, such as chondrosarcoma. The present study reports a rare case of sarcomatoid urothelial carcinoma with chondrosarcomatous differentiation of the ureter, as well as a review of the literature, in order to demonstrate the aggressive nature of this particular malignancy.
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Affiliation(s)
- Wei Lu
- Department of Urology, State Key Laboratory of Oncology in Southern China, Sun Yat-Sen University Cancer Center, Guangzhou, Guangdong 510060, P.R. China.,Department of Graduate School, Anhui Medical University, Hefei, Anhui 230022, P.R. China.,Department of Urology, Shenzhen Second People's Hospital, The First Affiliated Hospital of Shenzhen University, Shenzhen, Guangdong 518035, P.R. China
| | - Yanjun Wang
- Department of Urology, State Key Laboratory of Oncology in Southern China, Sun Yat-Sen University Cancer Center, Guangzhou, Guangdong 510060, P.R. China
| | - Yonghong Li
- Department of Urology, State Key Laboratory of Oncology in Southern China, Sun Yat-Sen University Cancer Center, Guangzhou, Guangdong 510060, P.R. China
| | - Yun Cao
- Department of Pathology, State Key Laboratory of Oncology in Southern China, Sun Yat-sen University Cancer Center, Guangzhou, Guangdong 510060, P.R. China
| | - Hui Han
- Department of Urology, State Key Laboratory of Oncology in Southern China, Sun Yat-Sen University Cancer Center, Guangzhou, Guangdong 510060, P.R. China
| | - Fangjian Zhou
- Department of Urology, State Key Laboratory of Oncology in Southern China, Sun Yat-Sen University Cancer Center, Guangzhou, Guangdong 510060, P.R. China
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Inomata A, Hayakawa K, Aoki T, Hosokawa S. Spontaneous carcinosarcoma originating from the renal pelvis ina rat. J Toxicol Pathol 2016; 29:185-9. [PMID: 27559244 PMCID: PMC4958616 DOI: 10.1293/tox.2016-0007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2016] [Accepted: 03/08/2016] [Indexed: 11/19/2022] Open
Abstract
Carcinosarcoma is a rare neoplasm composed of malignant epithelial and stromal elements, and, for rats, carcinosarcomas in the kidney have not been reported. In a long-term study to gather background data, we encountered a spontaneous carcinosarcoma originating from the renal pelvis with metastasis to the lung. At necropsy, a mass was observed in the abdominal cavity, and white nodules were scattered in lung lobes. Microscopically, there was polypoid hyperplasia of the urothelium accompanied by hyperplasia of spindle stromal cells in the pelvis. The intra-abdominal tumor was composed of epithelial and stromal elements; in the lung, the tumor cells invaded along alveoli/bronchi and occasionally invaded the parenchyma from the blood vessels. Immunohistochemical and electron microscopic examinations revealed that the epithelial element consisted of transitional epithelial cells and that the stromal element consisted of lipoblasts. The tumor was diagnosed as a carcinosarcoma originating from the renal pelvis, and this is the first report of a carcinosarcoma originating from the renal pelvis in a rat.
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Affiliation(s)
- Akira Inomata
- Tsukuba Drug Safety, Global Drug Safety, Biopharmaceutical Assessments Core Function Unit, Eisai Co., Ltd., 5-1-3 Tokodai, Tsukuba, Ibaraki 300-2635, Japan
| | - Kazuhiro Hayakawa
- Preclinical Safety Research Laboratories, Kawashima Division, Sunplanet Co., Ltd., 1 Kawashimatakehaya-machi, Kakamigahara, Gifu 501-6024, Japan
| | - Toyohiko Aoki
- Preclinical Safety Research Laboratories, Kawashima Division, Sunplanet Co., Ltd., 1 Kawashimatakehaya-machi, Kakamigahara, Gifu 501-6024, Japan
| | - Satoru Hosokawa
- Tsukuba Drug Safety, Global Drug Safety, Biopharmaceutical Assessments Core Function Unit, Eisai Co., Ltd., 5-1-3 Tokodai, Tsukuba, Ibaraki 300-2635, Japan
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4
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Carcinosarcoma of the ureter with a small cell component: report of a rare pathologic entity and potential for diagnostic error on biopsy. Case Rep Pathol 2015; 2014:391615. [PMID: 25587477 PMCID: PMC4284926 DOI: 10.1155/2014/391615] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2014] [Revised: 11/05/2014] [Accepted: 12/09/2014] [Indexed: 11/25/2022] Open
Abstract
Carcinosarcomas of the ureter are rare biphasic neoplasms, composed of both malignant epithelial (carcinomatous) and malignant mesenchymal (sarcomatous) components. Carcinosarcomas of the urinary tract are exceedingly rare. We report a unique case of a carcinosarcoma of the ureter with a chondrosarcoma and small cell tumor component arising in a 68-year-old male who presented with microscopic hematuria. CT intravenous pyelogram revealed right-sided hydroureter and hydronephrosis with thickening and narrowing of the right ureter. The patient underwent robot-assisted ureterectomy with bladder cuff excision and subsequent adjuvant chemotherapy. The patient is disease-free at 32 months after treatment. We provide a brief synoptic review of carcinosarcoma of the ureter and bladder with utilization of immunohistochemical (IHC) stains and potential diagnostic pitfalls.
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Völker HU, Zettl A, Schön G, Heller V, Heinrich E, Rosenwald A, Handwerker M, Müller-Hermelink HK, Marx A, Ströbel P. Molecular genetic findings in two cases of sarcomatoid carcinoma of the ureter: evidence for evolution from a common pluripotent progenitor cell? Virchows Arch 2008; 452:457-63. [PMID: 18266004 DOI: 10.1007/s00428-008-0583-z] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2007] [Revised: 01/14/2008] [Accepted: 01/16/2008] [Indexed: 11/28/2022]
Abstract
The current World Health Organization classification recommends the usage of the term sarcomatoid carcinoma (SC) for all biphasic malignant neoplasms of the urinary tract exhibiting morphologic and/or immunohistochemical evidence of epithelial and mesenchymal differentiation. While most SC have been described in the urinary bladder, ureteral SC are extremely rare tumors. Here, we report on the clinical, morphological, and molecular biological findings of two cases in this unusual location. The genetic alterations investigated by comparative genomic hybridization in the epithelial and the mesenchymal component of both cases showed considerable but not complete overlap. Moreover, in spite of many morphological differences between the two cases, both cases shared some genetic gains and losses. Our findings are compatible with the concept that SC originates from a common pluripotent progenitor cell with a potential for epithelial and mesenchymal differentiation.
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Affiliation(s)
- Hans-Ullrich Völker
- Institute of Pathology, University of Würzburg, Josef-Schneider-Strasse 2, 97080 Würzburg, Germany.
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Darko A, DAS K, Bhalla RS, Heller D. Carcinosarcoma of the ureter: Report of a case with unusual histology and review of the literature. Int J Urol 2006; 13:1528-31. [PMID: 17118030 DOI: 10.1111/j.1442-2042.2006.01570.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Carcinosarcomas of the ureter are rare biphasic neoplasms, with distinct malignant epithelial and mesenchymal components. To the authors' knowledge there have been only 12 cases reported in the literature. Primary cartilaginous tumors of the ureter are also rare tumors. Thus far there has been a single case report of an extraskeletal mesenchymal chondrosarcoma of the ureter in the German literature. Herein a unique case is reported of ureteral carcinosarcoma in an 81-year-old woman presenting with gross hematuria in which the sarcomatous component had extraskeletal mesenchymal chondrosarcomatous differentiation. This is thought to be the first reported case of a carcinosarcoma with such a differentiation in the sarcomatous component.
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Affiliation(s)
- Angela Darko
- Department of Pathology and Laboratory Medicine, UMDNJ--New Jersey Medical School, Newark, NJ 07101, USA
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Argüelles Salido E, Travado Soria P, Pérez Espejo MP, Rodríguez Corchero J, Medina López RA, Pena Outeiriño JM. [Carcinosarcoma of the bladder: report of our cases and review of the literature]. Actas Urol Esp 2004; 28:262-8. [PMID: 15248397 DOI: 10.1016/s0210-4806(04)73074-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Carcinosarcomas of the bladder are rare. As a result, the natural history of them and the best methods of treatment remain uncertain. These tumors tend to be rapidly growing, invasive and recur locally. We reviewed our experience with four patients presenting between 1995 and 2002. Epidemiology findings, clinical aspects, histological features, diagnostic methods, treatment and survival are discussed in relation to literature.
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Murata T, Soga T, Tajima K, Saito K, Komeda Y, Ioshii SO, Shiraishi T, Sakakura T, Yatani R. Sarcomatoid carcinoma of the urinary tract. Pathol Int 1994; 44:138-44. [PMID: 7517761 DOI: 10.1111/j.1440-1827.1994.tb01698.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Sarcomatoid carcinoma is a rare variant of malignant tumor arising from the urinary tract. This tumor had been termed carcinosarcoma because of its carcinomatous and sarcomatous components. There is still some confusion in the terminology between true carcinosarcoma and sarcomatoid carcinoma; however, the latter is now regarded as primarily a malignant epithelial tumor with pseudosarcomatous transformation. Four cases of sarcomatoid carcinoma arising from the urinary tract are reported. The patients were a 77 year old female, and three males aged 62, 69 and 80 years. All but the eldest patient complained of gross hematuria. Surgical removal was performed in the younger three cases, and an autopsy was done in the remaining case. All the tumors were macroscopically polypoid. Histopathologic examination revealed fasciculated spindle-cell tumors with myxoid stroma or malignant fibrous histiocytoma-like spindle cell tumors. The epithelial nature was proven in these sarcomatous cells by immunohistochemical and/or electron-microscopic examinations. Only a small amount of squamous cell carcinoma components was also evident in the latter three cases. Although the younger three patients were alive at 44, 23 and 39 months' follow-up, respectively, constant careful monitoring is recommended.
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Affiliation(s)
- T Murata
- Division of Pathology, JA Suzuka Hospital, Suzuka, Japan
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Abstract
This report is of a 78 year-old male with a mixed mesodermal tumour of the left ureter. A comparison of all reported patients with such neoplasms has been made in the discussion, in an attempt at characterization of this neoplasm.
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Affiliation(s)
- U Kini
- Department of Pathology, St. John's Medical College, Bangalore, India
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