BERKELEY, CA (UroToday.com) - In Case Reports in Medicine, we have recently reported a case of a giant bladder carcinosarcoma which was fortunately removed by transurethral resection (TUR-Bt), and without submucosal invasion.
Carcinoma in situ found at second-look transurethral bladder biopsy was treated with intravesical BCG instillation every week for six weeks. Subsequent to publication of our article, we had decided to continue maintenance BCG instillation. So far 80mg of BCG was administered intravesically twice at an interval of 1 week and at 3 and 6 months following initial BCG therapy. More than a year has passed since the initial diagnosis and there is still no local recurrence and no distant metastasis as assessed by cystoscopy, urine cytology, and a CT scan every three months. Considering the poor prognosis of bladder carcinosarcoma, this case is very rare and lucky.
Because we did not have a great deal of experience with bladder carcinosarcoma, judging whether more aggressive therapy needed to be given was tough given the pathological diagnosis of specimens resected by the first TUR-Bt. Retrospectively, the judgement not to advance to radical cystectomy or chemo-radiation therapy at that time might have been appropriate in this case, as there has been no recurrence thus far. Close and vigorous follow-up must still be continued.
Takumi Takeuchi as part of Beyond the Abstract on UroToday.com. This initiative offers a method of publishing for the professional urology community. Authors are given an opportunity to expand on the circumstances, limitations etc... of their research by referencing the published abstract.