Primary angiosarcoma of urinary bladder: 13th reported patient

S, Rehman S, Daing A, Gopagoni R, Alyas Akram M, Saeed A, Sadiq KO, Farrukh AM, Harikrishna A. Bladder angiosarcoma: a systematic literature review and survival analysis

Background

Bladder angiosarcoma is a rare type of cancer with only sporadic cases reported.

Methods

We performed a systematic review to describe clinicopathological features and survival outcomes.

Results

Thirty-five cases reporting 68 patients were reviewed. Among them, 35 (51.4%) were diagnosed with de novo bladder angiosarcoma and 33 (48.6%) with radiation-induced bladder angiosarcoma. The mean age at presentation was 65.255 years (±14.6), and the median tumor size was 4.6 cm (interquartile range 2.9-6.7). Hematuria was the most common symptom, reported in 52/68 patients (76.4%). Microscopic examination revealed an epithelioid-shaped morphology in 43/47 patients (91.5%), spindle-shaped cells in 13/47 (27.6%), and mixed epithelioid and spindle-shaped cells in 9/47 (19.1%). Immunohistochemical analysis showed that CD31 was positive in 36/36 patients (100%), CD34 in 17/23 (73.9%), and Factor VIII-related antigen in 17/20 (85%). Metastasis was reported in 43/60 patients (71.6%). Chemotherapy was administered to 22/68 patients (32.4%). The median follow-up time was 5 months (interquartile range 3-12). Of the 54 patients with available survival data, 16 (29.6%) survived and 38 (70.4%) died of the disease. Multivariate Cox regression analysis identified female gender (hazard ratio [HR], 2.59; P = 0.01), metastasis (HR, 2.58; P = 0.01), and chemotherapy (HR, 0.28; P = 0.01) as independent prognostic factors. No statistically significant differences in survival were observed between de novo and radiation-induced bladder angiosarcoma.

Conclusions

These findings suggest that BA is an aggressive disease regardless of its etiology. Early detection and timely initiation of chemotherapy may improve patient survival.

Epithelioid Angiosarcoma of the Urinary Bladder After Brachytherapy for Prostatic Carcinoma: A Case Report and Literature Review

Angiosarcoma of the urinary bladder is an extremely uncommon entity, with only a limited number of cases reported, making its diagnosis and management particularly challenging. This case report presents a rare occurrence of angiosarcoma within the urinary bladder and discusses its clinical presentation, radiological findings, histopathological features, and possible treatment approach for this challenging malignancy. An 84-year-old male presented at the emergency department with hematuria. Relevant history includes prostate carcinoma Gleason 7 in 2007, treated by brachytherapy. Imaging revealed bilateral hydronephrosis, urinary retention, and an irregular lesion growing through the bladder wall. Histopathology showed a highly cellular, poorly differentiated tumor composed of epithelioid cells. Immunohistochemistry was negative for epithelial, urothelial, and prostate markers. There was positivity for ERG, CD34, CD31, factor VIII, and c-myc, confirming the diagnosis of an epithelioid angiosarcoma. RNA-based sequencing did not reveal gene rearrangements. Follow-up CT showed pulmonary metastatic disease. The patient chose to undergo euthanasia six months after symptoms onset because of the decline in quality of life. We present a rare case of angiosarcoma arising in the urinary bladder, emphasizing the importance of considering this malignant vascular tumor in the differential diagnosis of bladder masses. Accurate diagnosis through histopathological evaluation and immunohistochemical staining is crucial for appropriate management. Characteristic features include its infiltrative vascular phenotype with marked atypia and positive staining for endothelial markers. Further studies are warranted to enhance our understanding of this rare entity and establish optimal treatment strategies.

Primary bladder angiosarcoma synchronous with prostatic acinar adenocarcinoma in an 82-year-old male

Primary bladder angiosarcoma is a rarely encountered and poorly described malignancy. Only 34 cases have been described in the English literature according to PubMed, accounting for only 2% of the genitourinary soft tissue sarcomas and 0.6% of all bladder tumors. We report a case of a primary angiosarcoma of the urinary bladder in an 82-year-old patient and present the clinical history, histopathological and immunohistochemical features of this tumor, in order to provide better understanding of the diagnosis, possible therapies and clinical outcome.

Angiosarcoma of the Urinary Bladder Following Radiotherapy: Report of a Case and Review of the Literature

Background and objectives: Angiosarcomas are uncommon and extremely aggressive malignancies derived from vascular endothelial cells. Although they can occur anywhere in the body and at any age, they are more frequently found in the skin of the head and neck regions and in the elderly. Few cases have been recorded in deep soft tissues and in parenchymal organs. Angiosarcomas of the urinary bladder are exceedingly rare. They usually arise in adult patients with a history of radiation therapy, cigarette smoking, or exposure to chemical agents (e.g., vinyl chloride). Despite multidisciplinary treatment approaches combining surgery, radiotherapy, and chemotherapy, prognosis is dismal. Materials and Methods: We describe a case of a 78-year-old Caucasian man presenting with a vesical mass incidentally discovered with abdominal computerized tomography (CT). He underwent transurethral resection of the bladder (TURB), and histology was compatible with angiosarcoma. Results: The patient had been a heavy smoker and his medical history included therapeutic irradiation for prostate cancer eight years previously. Radical cystoprostatectomy was feasible, and pathologic examination of the surgical specimen confirmed angiosarcoma involving the urinary bladder, prostate, and seminal vesicles. Post-operative peritonitis resulted in progressive multi-organ failure and death. Conclusions: Angiosarcoma primary to the urinary bladder is seldom encountered, however, it should be considered in the differential diagnosis of vesical tumors, especially in elderly men with a history of pelvic radiotherapy.

Primary Urinary Bladder Angiosarcoma with Osteoclast-Like Multinucleated Giant Cells: A Case Report and Literature Review

Patient: Male, 68

Final Diagnosis: Urinary bladder angiosarcoma

Symptoms: —

Medication: —

Clinical Procedure: TURBT

Specialty: Diagnostics, Laboratory