Proceedings: A case of carcinosarcoma of ureter

Sarcomatoid urothelial carcinoma with chondrosarcomatous differentiation of the ureter: A case report and review of the literature

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.

Carcinosarcoma of the ureter with a small cell component: report of a rare pathologic entity and potential for diagnostic error on biopsy

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.

Molecular genetic findings in two cases of sarcomatoid carcinoma of the ureter: evidence for evolution from a common pluripotent progenitor cell?

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.

Carcinosarcoma of the ureter: Report of a case with unusual histology and review of the literature

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.

Mixed mesodermal tumours of the ureter

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.

Primary carcinosarcoma: a rare cause of unilateral ureteral obstruction

We report a case of unilateral ureteral obstruction owing to carcinosarcoma of the distal ureter. Tumor recurred 6 months after ureteronephrectomy and the patient died 2 1/2 years later. A review of the literature revealed only 3 other cases of ureteral carcinosarcoma, all of which had a similar aggressive course. Recognition and separation of this entity from the more usual transitional cell carcinoma are important because of its apparent poorer prognosis.

Carcinosarcoma of the urinary bladder

The clinical and pathologic features of three new and 35 previously reported carcinosarcomas of the urinary bladder were reviewed. This type of tumor is three times more common in men than women, and has occurred in patients from 33 to 82 years of age (average, 62 years), most of whom presented with hematuria of short duration. The tumors are usually large and polypoid, and on microscopic examination contain an intimate admixture of malignant epithelial and mesenchymal elements. The former may resemble transitional cell carcinoma, squamous cell carcinoma, adenocarcinoma or undifferentiated carcinoma; and the latter, fibrosarcoma, leiomyosarcoma, or undifferentiated sarcoma: skeletal muscle, osseous, and/or cartilaginous differentiation has occurred in from 25% to 50% of the tumors. Sixteen patients died as a result of their tumors; four others had metastatic disease and three were lost to follow-up. Twelve patients were alive and free of disease from 5 months to 7 years postoperatively. Most of the 12 underwent radical cystectomy, preceded in some cases by radiation therapy, but four underwent a more conservative operation.