The demographic features, clinical outcomes, prognosis and treatment options for patients with sarcomatoid carcinoma of the urinary bladder: a single centre experience

ABSTRACT Introduction Carcinosarcoma of the bladder is a very rare neoplasm. The pathogenesis of carcinosarcomas is not clearly understood and remains a subject of debate. Whilst there is some research conceptualizing the histopathological findings of bladder carcinosarcomas, the demographic features, clinical outcomes, prognosis and treatment options remain unclear. Materials and Methods We analyzed 12 consecutive cases of patients with sarcoma-toid bladder cancer who were treated surgically at a single Urology Department be-tween 1999 and 2015. Radiology, pathology and surgical reports were reviewed to determine the pathological staging at the time of cystectomy. These were directly compared with 230 patients having cystectomies for urothelial cell carcinoma. The sarcomatoid patients, were compared to patients with urothelial cell cancers. The other histological sub types, squamous cell (17), neuroendocrine (9), metastatic (7), mixed (4), adenocarcinoma (3), were not included. Results and conclusion Carcinosarcoma of the urinary bladder is often described in the literature as a highly malignant neoplasm that is rapidly lethal. We found that the sarcoma does not offer a worse prognosis than conventional high-grade urothelial car-cinoma. There is no significant difference in grade, stage, positive surgical margin rate, nodal involvement, associated prostate cancer or incidence rates of progression, all cause or disease specific mortality. There was a barely significant difference in carcinoma in-situ. However, carcinosarcomas are three times the volume of urothelial cell tumors which may contribute to its reputation as an aggressive tumour (44cc v 14cc). Sarcomatous elements do not appear, from our small study, to bestow a worse prognosis.

Carcinosarcoma de laringe: reporte de dos casos / Carcinosarcoma of the larynx: report of two cases

El carcinosarcoma de laringe es un tumor bifásico raro que representa menos del 1% de todos los tumores malignos de laringe. Debido a su doble naturaleza epitelial y mesenquimal esta neoplasia ha sido denominada de distintas maneras en la literatura, siendo indispensable el estudio mediante inmunohistoquímica para establecer un diagnóstico correcto. Se presentan 2 casos de carcinosarcoma de laringe, confirmados mediante estudio con inmunohistoquímica, ambos tratados mediante laringectomía total. Se elabora una discusión de los principales aspectos clínicos, histopatológicos y terapéuticos de esta infrecuente neoplasia.

The larynx carcinosarcoma is a rare biphasic tumor that represents less than 1% of all malignant tumors of the larynx. Because of its biphasic epithelial and mesenchymal nature this neoplasm has been called in different ways in the literature being indispensable the study by immunohistochemistry to establish a proper diagnosis. We present 2 cases of larynx carcinosarcoma confirmed by immunohistochemical study, both treated with total laryngectomy. A discussion of the main clinical, histopathological and therapeutic aspects of this rare neoplasm is made.

Cutaneous invasion from sarcomatoid urothelial carcinoma: clinical and dermatopathologic features

Abstract In Brazil, without considering the non-melanoma skin tumors, bladder cancer in men is the eighth most common, and the urothelial carcinoma or transitional cell carcinoma is the most common among these. Cutaneous metastases from urothelial neoplasms appear as single or multiple erythematous, infiltrated nodules or plaques, and like other cases of distant disease, it is indicative of poor prognosis. The invasive urothelial carcinoma is recognized for its ability to present divergent differentiation and morphological variants. The sarcomatoid urothelial carcinoma is a rare cancer that consists of two different components: one composed of epithelial tissue and the other with sarcomatoid features of mesenchymal origin. The authors describe a case of cutaneous metastasis of sarcomatoid urothelial carcinoma in a 63-year-old male patient.

Carcinossarcoma uterino: relato de um caso com invasão da bexiga, mimetizando mullerianose com transformação maligna / Carcinosarcoma of the uterus: report of a case with invasion of the urinary bladder, resembling mullerianosis with malignant transformation

Introdução: Os carcinossarcomas uterinos são neoplasias infrequentes, correspondendo a apenas 3-9 por cento de todas as neoplasias ginecológicas, representam 48 por cento de todos os sarcomas, e possuem incidência de 8,2 por 1 milhão mulheres/ano. As principais manifestações clínicas são o sangramento vaginal anormal em idade pós-menopausa e dor abdominal. Caracterizam-se morfologicamente por elementos epiteliais e estromais. Podem eventualmente invadir estruturas adjacentes, inclusive a bexiga urinária. Relato do caso: Apresentamos um caso de carcinossarcoma uterino com invasão de bexiga mimetizando mullerianose com transformação maligna. A paciente do sexo feminino de 69 anos apresentava hematuria macroscópica como queixa única. Durante a investigação diagnóstica, após cistoscopia com exame anatomopatológico, foi sugerida a hipótese de mullerianose com transformação benigna. A paciente foientão encaminhada para ressecção cirúrgica da neoplasia. Durante o procedimento cirúrgico, notou-se a existência deuma massa tumoral uterina que invadia a bexiga urinária, e, após análise anatomopatológica, mostrou tratar-se de umcarcinossarcoma uterino com invasão vesical. Conclusão: Manifestações incomuns em doenças com grande potencialde malignidade, além de retardar o processo diagnóstico, interferem diretamente no prognóstico do paciente.

Carcinosarcoma de la vesícula biliar: caso clínico / Gallbladder carcinosarcoma: case report

Gallbladder Carcinosarcoma corresponds to less than 1 percent of all malignant tumors of the gallbladder. We report an 82 years old female subjected to an open cholecystectomy with the preoperative diagnosis of acute cholecystitis. The pathological study of the surgical piece showed a malignant tumor with epithelial (carcinoma) and stromal (sarcoma) components. A postoperative CAT scan showed multiple nodular lesions in the peritoneum and omentum. The patient died eight months after the operation.

El carcinosarcoma de la vesícula biliar (CSVB) es una neoplasia maligna con diferenciación bifásica (epitelial y estromal) y que representa menos del 1 por ciento de todas las neoplasias malignas de la vesícula biliar. Presentamos el caso de una mujer de 82 años sometida a una colecistectomía abierta de urgencia en Septiembre de 2007 con diagnóstico de colecistitis aguda. El examen histológico de la pieza operatoria describe una lesión neoplásica maligna compuesta por una mezcla de componente epitelial (carcinoma) y estromal (sarcoma), este último con extensas áreas de diferenciación heteróloga de tipo condroide. Estos tumores presentan un comportamiento agresivo con rápida diseminación local y recurrencia siendo generalmente difícil la realización de cirugías con intención curativa (R0), condiciones que explican el pobre pronóstico asociado al CSVB.

Carcinosarcoma / Sarcomatoid carcinoma

El carcinosarcoma es un tumor poco frecuente, bifásico, que ha sido comunicado en diferentes sitios del organismo. Está compuesto por un componente maligno epitelial íntimamente asociado con un componente epitelial sarcomatoide que puede ser homólogo y heterólogo. Existen carcinosarcomas cutáneos y extracutáneos. Los carcinosarcomas extracutáneos muestran un pronóstico pobre. Presentamos un paciente de 75 años, fototipo II, que consulta por presentar un tumor exofítico angiomatoide sangrante de 8 mm, de aspecto botriomicoide, de 2 meses de evolución en piel frontal derecha. Se confirma con biopsia y técnicas de inmunohistoquímica la existencia de 2 morfologías celulares típicas del carcinosarcoma. El tumor fue extirpado con un centímetro de margen de seguridad. El paciente, al año de su intervención, está libre de recurrencias y metástasis. El componente sarcomatoso del tumor es comprendido como una transformación metaplásica del componente carcinomatoso. Estos tumores son potencialmente agresivos.

Carcinosarcoma is an uncommon biphasic neoplasm that has been reported in diverseanatomical sites. This tumor is composed of two malignant epithelial components: onetypical and the other atypical, this one resembling mesenchymal tissue. Both are intimatelyassociated .The latter may be homologous or heterologous. When these tumors are locatedat extracutaneous sites, they are characteristically aggressive.We report a 75-year-old man who developed a solitary reddish bleeding nodule that quicklygrew in a two-months period. It resembled a pyogenic granuloma and was located on hisright frontal skin. Clinical, histologycal and immunohistochemical features were evaluated.The tumor was completely excised with a one-centimeter safety margin, and after a lapse ofone year he is free of local relapses or metastases.The sarcomatous component of the tumor is considered to be a metaplastic transformation ofthe carcinomatous component. These tumors are potentially aggressive if partially removed,thus complete excision is mandatory.

Tumores mesenquimáticos del endometrio / Endometrial mesenchymal tumors. Study of 4 cases

Los tumores mesenquimáticos de la mucosa uterina son un grupo raro, heterogéneo y generalmente agresivo de neoplasias que conduce frecuentemente a una diseminación y muerte temprana. Constituyen menos del 3% de todos los tumores malignos del Tracto Genital Femenino y el 2-7% de las neoplasias malignas uterinas. Presentamos 4 casos de tumores mesenquimáticos diagnosticados en un período de 5 años en el Servicio de Anatomía Patológica del Hospital General de Agudos Carlos G. Durand, analizando su incidencia y haciendo una breve revisión de las características histopatológicas de los mismos

Mesenchymal tumors of the uterine lining are a rare and heterogeneous group of neoplasms, with an agressive behavior leading to an early dissemination and death. They represent less than 3% of all malignant tumors of the Female Genital Tract and 2-7% of uterine malignancies. We report 4 mesenchymal tumors diagnosed throughout a 5 years period at the Department of Pathology Hospital General Carlos G. Durand, analyzing their incidence and making a review of the histopathologic features

Adrenal sarcomatoid carcinoma: A rare case depicted on multi-detector row computed tomography.

Primary adrenal sarcomatoid carcinoma is rare malignant tumor with the characteristics of carcinoma and sarcoma. To date, only one case of primary sarcomatoid carcinoma in the adrenal gland was reported. We present here computed tomography appearance and pathological features of the case with primary adrenal sarcomatoid carcinoma confirmed by pathology. In addition, a brief review of the relevant literature is presented.

Condrosarcoma mesenquimal sinonasal grado tres y carcinosarcoma de glándula Mamaria de un canino: estudios clínico e histopatológico / Sinunasal mesenchymal chondrosarcoma grade 3 and mammary gland carcinosarcoma of canine: clinical and histopathology study

A la Clínica Veterinaria de la Universidad de los Llanos, llegó un canino hembra de 9 años de edad raza Chow Chow, cuyo motivo de consulta fue epistaxis bilateral 4 meses atrás y una masa en la región nasal. Según lo reportado por el propietario, la masa había comenzado a salir 1 mes atrás del día de la consulta. Al examen clínico presentaba una masa subdérmica en la región nasal superior de 2 cm de diámetro. Se realizó una citología de la misma y se encontraron células inflamatorias sin presencia de células neoplásicas. El paciente volvió al mes y la masa con un diámetro de 5cm, estaba ubicada en la región nasal superior y región zigomática. El can presentaba disnea, anorexia, deshidratación del 6 por ciento, secreción mucopurulenta nasal y ocular, midriasis bilateral, reflejo corneal bilateral negativo, aumento de la presión infraocular del ojo derecho. En la glándula mamaria inguinal derecha presentaba una masa de 2cm de diámetro dura y móvil. Se realizó una citología por aspirado con aguja fina, de distintas zonas de las masas, tanto de la nariz, como de la glándula mamaria. Se valoró la citología permitiéndose definir el origen tumoral del proceso. Se realizó biopsia por incisión de la región sinonasal, diagnosticándose tumor mesenquimal maligno grado tres condrosarcoma sinonasal, conformado por células cartilaginosas pleomórficas con anisocariosis. Se realizaron radiografías de la región nasal y del pulmón, encontrándose una zona radiopaca a nivel del seno maxilar con osteolisis del hueso, se evidenciaba la masa de aproximadamente 4 cm de ancho por 2 cm de largo en el lado derecho. En el pulmón no se evidenció metástasis. Después del diagnóstico de histopatología se decide realizar la eutanasia, encontrándose histopatológicamente metástasis en pulmón, confirmación del condrosarcoma mesenquimal y un carcinosarcoma de glándula mamaria.

To the Veterinary Clinic of the Universidad de los Llanos, come a 9 years old Chow Chow female canine, whose consultation reason was a bilateral epistaxis occurred 4 months ago, sudden loss of the vision and a mass in the nasal region of 2cm of diameter approximately, according to the report of the owner, the mass showed up 1 month the day of the consultation. To the clinical exam they were the following abnormal discoveries. Hirsute hair, opaque, presented a subdermic mass approximately in the nasal region superior of 2 cm. diameter that grew to 5 cm. diameter after 1 month of the consultation, located in the nasal region superior and zigomatic region, of hard consistency, the animal had dysnea, bilateral mydriasis, the bilateral corneal reflection was negative, increase of the infraocular pressure of the right eye, the realized test of obstacles in the clinic was negative, that which showed us a blindness. Besides a complete clinical exploration and taking of the advantages of the cytology, she was carried out an aspired with fine needle of different areas of the masses so much neoplastic of the nose and of the region of the mammary gland, being obtained two types of samples. The cytology was evaluated to define origin of the tumors of the process. She was carried out biopsy for incision of the sinunosal region being diagnosed wicked tumor mesenchymal Chondrosarcoma sinunasal that commits bone. After having carried out the autopsy they took samples for histopathology. Being diagnosed mesenchymal chondrosarcoma sinunasal grade 3, with metastasis to lung, and a carcinosarcoma of mammary gland.

Teratocarcinosarcoma rinosinusal: reporte de un caso / Rhinosinusal teratocarcinosarcoma: a case report

Teratocarcinosarcoma rinosinusal es una neoplasia maligna infrecuente y rara, que combina elementos de teratoma y carcinosarcoma. Se compone de epitelio benigno o maligno (fibroblastos), mesénquima (cartílago, hueso o músculo liso) y elementos neurales. Hasta el año 2008 se han reportado un total de 63 casos de ubicación rinosinusal. Presentamos el caso de un teratocarcinosarcoma de fosa nasal, en un hombre de 67 años de edad, que consultó por obstrucción nasal rápidamente progresiva. La lesión se resecó completamente por abordaje endoscópico. El diagnóstico fue confirmado por histopatología e inmunohistoquímica. Se realizó tratamiento complementario con radioterapia, sin evidencia de recidiva al año después de la cirugía.

Rhinosinusal teratocarcinosarcoma is a rare malignant neoplasm, which combines teratoma and carcinoma elements. It is composed of benign or malignant epithelium (fibroblasts), mesenchymatic (cartilage, bone or smooth muscle) and neural elements. Until 2008, a total of 63 cases of rhinosinusal location have been reponed. We present the case of a nasal cavity teratocarcinosarcoma ín a 67 year old man that presented with rapidly progressing nasal obstruction. The lesion was completely resected by endoscopic approach. Diagnosis was confirmed by histological pathology and immunohistochemistry Additional treatment by radiotherapy was administered, with no evidence of recurrences a year after surgery.

Metaplastic carcinoma of the breast (carcinosarcoma variant): a case report.

A case of a female patient aged 60 yrs, with metaplastic carcinoma of the breast which is a rare neoplasm is presented. Although it is a tumor of the ductal type, the predominant component of the neoplasm has an appearance other than glandular pattern and more in keeping with other cell types. Metaplastic carcinoma runs a very aggressive course and bears an unfavourable prognosis.

Carcinosarcoma of the Liver: A Case Report

Primary hepatic carcinosarcoma is a rare tumor comprised of a mixture of carcinomatous and sarcomatous elements. Less than 20 adequately documented cases have been reported, however the imaging features of two cases were briefly described. We present here a case of carcinosarcoma of the liver in a 46-year-old woman, which was confirmed based on pathology. Imaging showed a large mass with large necrotic portions, small cystic portions, calcifications and bone formations.

Influence of diets varying in lipid and protein content on the histopathologic variety of murine salivary gland tumors induced by 9, 10-dimethyl-1, 2-benzanthracene (DMBA) / Influencia de dietas de diferente contenido lipídico y proteico sobre variantes histopatológicas de tumores de glándulas salivares murinos inducidos con 9, 10-dimethyl-1, 2-benzathraceno (DMBA)

The purpose of this study was to analyze the influence of diets varying in lipids and proteins on the histopathologic variety of murine salivary tumors induced by DMBA. 117 BALB/c mice were assigned to experiments one (E1: lipids, males) and two (E2: proteins, males and females), E1 comprising Soy oil (SO); Corn oil (CO, control); Fish oil (FO) and Olein (O) groups and E2, soy protein (SP) and casein (C) groups. Tumors were induced by DMBA and the animals were sacrificed at week 13- post-induction. Tumor volume was calculated. Tumor sections were stained with H-E for histopathologic evaluation. No significant association was found between tumor volume and dietary condition (p > 0.05). In E1, FO animals developed mainly carcinomas (C) (58.8%), the sarcomas (S) and carcinosarcomas (CS) being especially of high-grade type (tumors < 600 mm3). In E2, SP animals developed mainly C (55.6%). Although no significantly different (p > 0.05), S and C were more frequent in female and male mice, respectively. In both E1 and E2, the biggest tumors (> 600 mm3) were mainly high-grade S (87.5%-80%). Dietary fat and soy protein appear to influence the tumor histopathology and thus its prognosis.

El objetivo de este estudio fue analizar la influencia de dietas con diferente contenido de lípidos y proteínas sobre la variedad histopatológica de tumores salivares murinos inducidos por DMBA. Se asignaron 117 ratones BALB/c a los experimentos uno (E1: lípidos, machos) y dos (E2: proteínas, machos y hembras). E1 comprendió a los grupos aceite de soja (AS), aceite de maíz (AM, control), aceite de pescado (AP) y oleína (O), en tanto E2 incluyó a los grupos preteína de soja (PS) y caseína (C). Los tumores fueron inducidos por DMBA y los animales fueron sacrificados a la 13ª semana post-inducción. Se calculó el volumen tumoral. Los cortes de tumor fueron coloreados con Hematoxilina-Eosina para su evaluación histopatológica. No se encontró asociación entre volumen tumoral y condición dietaria (p>0.05). En E1, los animales del grupo AP desarrollaron principales carcinomas (C) (58,8%), en tanto que los sarcomas (S) y carcinosarcomas (CS) fueron de alto grado (tumores<600 mm³). En el E2, los animales del grupo PS desarrollaron principalmente C (55.6%). Aunque la diferencia no fue significativa (p>0.05), S y C fueron más frecuentes en ratones hembras y machos, respectivamente. Tanto el E1 com en E2, los tumores más voluminosos (> 600 mm³) fueron principalmente de alto grado (87.5%-80%) Los lípidos y la proteína de soja de la dieta parecen influenciar la histopatología de los tumores y, en consecuencia, su pronóstico.

Sarcomatoid differentiation in renal cell carcinoma: prognostic implications

INTRODUCTION: Renal cell carcinoma with sarcomatoid differentiation is a tumor with aggressive behavior that is poorly responsive to immunotherapy. The objective of this study is to report our experience in the treatment of 15 patients with this tumor. MATERIALS AND METHODS: We retrospectively analyzed 15 consecutive cases of renal cell carcinoma with sarcomatoid differentiation diagnosed between 1991 and 2003. The clinical presentation and the pathological stage were assessed, as were the tumor's pathological features, use of adjuvant immunotherapy and survival. The study's primary end-point was to assess survival of these individuals. RESULTS: The sample included 8 women and 7 men with mean age of 63 years (44 - 80); follow-up ranged from 1 to 100 months (mean 34). Upon presentation, 87 percent were symptomatic and 4 individuals had metastatic disease. Mean tumor size was 9.5 cm (4 - 24) with the following pathological stages: 7 percent pT1, 7 percent pT2, 33 percent pT3, and 53 percent pT4. The pathological features showed high-grade tumors with tumoral necrosis in 87 percent of the lesions and 80 percent of intratumoral microvascular invasion. Disease-free and cancer-specific survival rates were 40 and 46 percent respectively, with 2 cases responding to adjuvant immunotherapy. CONCLUSIONS: Patients with sarcomatoid tumors of the kidney have a low life expectancy, and sometimes surgical resection associated with immunotherapy can lead to a long-lasting therapeutic response.

True malignant mixed tumor (carcinosarcoma) of parotid gland : a case report.

The malignant mixed tumor (carcinosarcoma) of the salivary gland is an extremely rare tumor. By definition, it is composed of both malignant epithelial and malignant mesenchymal components. We report a case of carcinosarcoma in the parotid gland of a 59 year old man, that arose "de novo" and contained ductal adenocarcinoma as the epithelial component and osteosarcoma and chondrosarcoma as mesenchymal components. The etiologic and histologic features are presented and in addition, the literature is reviewed.

Sarcomatoid carcinoma (carcinosarcoma) of the esophagus with extensive areas of osseous differentiation: a case report.

A 46 year old male presented with progressively increasing dysphagia and weight loss. Esophagoscopy showed a large polypoidal growth involving the middle segment of esophagus. Histologically bulk of the tumour had a sarcoma-like appearance composed of spindly pleomorphic cells along with extensive areas of bone formation. The epithelial element was represented by a small area of squamous cell carcinoma. One of the draining lymph nodes also showed small islands of squamous cell carcinoma. A diagnosis of sarcomatoid carcinoma was made. Sarcomatoid carcinoma of the esophagus, also termed carcinosarcoma, pseudosarcoma, and spindle cell carcinoma is an unusual malignant tumour of the esophagus. The proportion of carcinomatous and sarcomatous component may vary from case to case. Rarely, the sarcomatous component may exhibit osseous differentiation as in our case.

Carcinosarcoma renal: informe de un caso con estudios de inmunohistoquímica y ultraestructura / Renal carcinoma: report of a case with immunohystochemical and ultrastructural studies

Los carcinosarcomas renales son tumores bifásicos raros (1.5 por ciento) compuestos por áreas epitelioides y fusocelulares sarcomatosas. El diagnóstico diferencial incluye lesiones primarias y metastásicas en el riñón. En este artículo se informan los hallazgos histopatológicos de inmunohistoquímica y ultraestructura, así como los criterios de diagnóstico descritos en la bibliografía