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Sarcomatoid Urothelial Carcinoma of the Bladder With Axillary Lymph Nodal Mass: Case Report and Review of the Literature

ABSTRACT

A 55-year-old female presented with recurrent hematuria and urinary tract infections. Evaluations with computed tomography urogram, flexible cystoscopy, and urine cytology revealed an extensive bladder tumor with a vesicovaginal fistula. The TNM pathologic stage of the tumor was pT3a N0 M0. Histological evaluation showed that there were cohesive epithelioid malignant cells suggestive of urothelial carcinoma in few areas. However, most of the neoplasm consisted of singly dispersed cells with eccentric, abundant eosinophilic cytoplasm and bizarre, spindly nuclei characteristic of sarcomatoid urothelial carcinoma (SUC). The patient had anterior pelvic exenteration and adjuvant chemotherapy. No evidence of metastasis was found in preoperative or postoperative imaging. However, the patient presented with a rare axillary mass 3 months after surgery. Biopsy of the mass showed sarcomatous differentiation similar to the SUC primary tumor in the bladder. A CT scan of the chest and a whole body scan revealed lung, liver, abdominal, and mesenteric lymph node metastases. She died approximately 6 months after the initial diagnosis. The authors compare this case of axillary metastasis from sarcomatoid variant of urothelial cancer with other reports in the literature.

KEYWORDS: Sarcomatoid urothelial carcinoma; Axillary metastasis; Survival rate.

CORRESPONDENCE: Dr. Satya Allaparthi, Department of Surgery, University of Massachusetts Medical School, S4868, Division of Urology, 55 Lake Avenue North, Worcester 01655, MA ([email protected]).

CITATION: UroToday Int J. 2010 Jun;3(3). doi:10.3834/uij.1944-5784.2010.06.01

ABBREVIATIONS AND ACRONYMS: CS, carcinosarcoma; CT, computed tomography; SUC, sarcomatoid urothelial carcinoma; TCC, transitional cell carcinoma; UC, urothelial carcinoma.

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