Sarcomatoid High Grade Urothelial Carcinoma with Rhabdomyosarcomatous and Other Differentiation: A Case Report with Review of Literature

Authors

  • Shiquan Liu Department of Pathology, Buffalo General Medical Center, State University of New York, Buffalo, NY
  • Minhua Wang Department of Pathology, Buffalo General Medical Center, State University of New York, Buffalo, NY
  • Richard Petrillo Department of Medicine, Montefiore Mount Vernon Hospital, Mount Vernon, NY
  • Frank Chen Department of Pathology, Buffalo General Medical Center, State University of New York, Buffalo, NY

Keywords:

urothelial carcinoma, rhabdomyosarcomatous differentiation, malignant tumor of bladder

Abstract

It is not uncommon for high-grade urothelial carcinoma to show divergent differentiation with the most common being squamous followed by glandular. However, rhabdomyosarcomatous differentiation in urothelial carcinoma, which portends poor prognosis, is very rare. Here we described a case of bladder high grade urothelial carcinoma with rhabdomyosarcomatous as well as other histologic differentiation.  The patient was a 91-year-old female with history of gross hematuria. She was found to have a large tumor protruding into the bladder lumen from the right lateral-posterior wall. The tumor was removed via transurethral resection. The tumor fragments measured 9.1 x 6.5 x 1 cm in aggregate and weighed 23.7 grams. Morphologically, the tumor demonstrated high grade urothelial carcinoma with an area showing abundant eosinophilic cytoplasm, large eccentric hyperchromatic nuclei, and prominent eosinophilic nucleoli, consistent with rhabdomyosarcomatous differentiation.  Immunohistochemically, this area was positive for desmin and muscle-specific actin, supporting the above interpretation. There were also areas showing neuroendocrine, sarcomatoid, glandular and squamous differentiation. Scattered giant cells were also noted. Immunohistochemical stains for vimentin and synaptophysin/chromogranin were positive in the areas with sarcomatoid differentiation and neuroendocrine differentiation, respectively. Based on the overall morphological features and immunohistochemical patterns, this tumor was diagnosed as high grade urothelial carcinoma with rhabdomyosarcomatous, neuroendocrine, sarcomatoid, glandular and squamous differentiation. Similar cases in the literature were reviewed and compared with this case. 

References

1. Parwani AV, Herawi M, Volmar K, Tsay SH, Epstein JI. Urothelial carcinoma with rhabdoid features: report of 6 cases. Hum Pathol. 2006;37:168-172.
2. Pasricha S, Hafiz A, Gandhi JS, Mehta A. Urothelial carcinoma of bladder having rhabdoid differentiation with isolated scapular metastasis. J Cancer Res Ther. 2011;7:486-488.
3. Duvdevani M, Nass D, Neumann Y, Leibovitch I, Ramon J, Mor Y. Pure rhabdoidtumor of the bladder. J Urol. 2001;166:2337.
4. Inagaki T, Nagata M, Kaneko M, Amagai T, Iwakawa M, Watanabe T. Carcinosarcomawith rhabdoid features of the urinary bladder in a 2-year-old girl: possible histogenesis of stem cell origin. Pathol Int. 2000;50:973-978.
5. Harris M, Eyden BP, Joglekar VM. Rhabdoid tumour of the bladder: a histological, ultrastructural and immunohistochemical study. Histopathology. 1987;11:1083-1092.
6. Kagotani A, Ishida M, Yoshida K, Iwai M, Okabe H. High-grade urothelial carcinoma of the bladder with rhabdoid features: cytological and histological report of two cases. Cytopathology. 2014;19:1-3.
7. Perez-Montiel D, Wakely PE, Hes O, Michal M, Suster S. High-grade urothelial carcinoma of the renal pelvis: clinicopathologic study of 108 cases with emphasis on unusual morphologic variants. Mod Pathol. 2006;19:494-503.
8. Guillou L1, Wadden C, Coindre JM, Krausz T, Fletcher CD. "Proximal-type" epithelioid sarcoma, a distinctive aggressive neoplasm showing rhabdoid features. Clinicopathologic, immunohistochemical, and ultrastructural study of a series. Am J Surg Pathol. 1997;21:130-146.
9. Fukumura Y1, Fujii H, Mitani K, et al. Urothelial carcinoma of the renal pelvis with rhabdoid features. Pathol Int. 2009;59:322-325.
10. Mahul B Amin. Histological variants of urothelial carcinoma: diagnostic, therapeutic and prognostic implications. Modern Pathology. 2009;22:S96-S118.
11. Black PC, Brown GA, Dinney CP. The impact of variant histology on the outcome of bladder cancer treated with curative intent. Urol Oncol. 2009;27:3-7.
12. Sung MT, Wang M, MacLennan GT, et al. Histogenesis of sarcomatoid urothelial carcinoma of the urinary bladder: evidence for a common clonal origin with divergent differentiation. J Pathol. 2007;211:420-430.
13. Wright JL, Black PC, Brown GA, et al. Differences in survival among patients with sarcomatoid carcinoma, carcinosarcoma and urothelial carcinoma of the bladder. J Urol 2007;178:2302-2306; discussion 2307.
14. Hoot AC, Russo P, Judkins AR, et al. Immunohistochemical analysis of hSNF5/INI1 distinguishes renal and extra-renal malignant rhabdoid tumors from other pediatric soft tissue tumors. Am J Surg Pathol. 2004;28:1485–1491.
15. Gururangan S1, Bowman LC, Parham DM, et al. Primary extracranial rhabdoid tumors. Clinicopathologic features and response to ifosfamide. Cancer. 1993;71:2653-2659.
16. Nadal R, Bellmunt J. New treatments for bladder cancer: when will we make progress? Curr Treat Options Oncol. 2014;15:99-114.
17. Feng C, Wang L, Ding G, et al. Predictive value of 265clinicopathological markers for the metachronous bladder cancer and prognosis of upper tract urothelial carcinoma. Sci Rep. 2014;4:1-6.
18. Sapre N, Herle P, Anderson PD, Corcoran NM, Hovens CM. Molecular biomarkers for predicting outcomes in urothelial carcinoma of the bladder. Pathology. 2014;46:274-282.
19. Wu XR. Urothelial tumorigenesis: a tale of divergent pathways. Nat Rev Cancer. 2005;5:713-725.
20. Mitra AP, Cote RJ. Molecular screening for bladder cancer: progress and potential. Nat Rev Urol. 2010;7:11-20.
21. Liu S, Liu W, Jakubczak JL, et al. Genetic instability favoring transversions associated with ErbB2-induced mammary tumorigenesis. Proc Natl Acad Sci U S A. 2002;99:3770-3775.
22. Czerniak B, Cohen GL, Etkind P, et al. Concurrent mutations of coding and regulatory sequences of the Ha-ras gene in urinary bladder carcinomas. Hum Pathol. 1992;23:1199-1204.
23. van Rhijn BW, Lurkin I, Radvanyi F, et al. The fibroblast growth factor receptor 3 (FGFR3) mutation is a strongindicator of superficial bladder cancer with low recurrence rate. Cancer Res. 2001;15:1265-1268.
24. Egger G, Liang G, Aparicio A, Jones PA. Epigenetics in human disease and prospects for epigenetic therapy. Nature. 2004;429:457-463.
25. Gschwind A, Fischer OM, Ullrich A. The discovery of receptor tyrosine kinases: targets for cancer therapy. Nature Rev Cancer. 2004;4:361-370.

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Published

2015-01-25

How to Cite

Liu, S., Wang, M., Petrillo, R., & Chen, F. (2015). Sarcomatoid High Grade Urothelial Carcinoma with Rhabdomyosarcomatous and Other Differentiation: A Case Report with Review of Literature. North American Journal of Medicine and Science, 8(1). Retrieved from https://najms.com/index.php/najms/article/view/34

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Case Report