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

Shiquan Liu, Minhua Wang, Richard Petrillo, Frank Chen


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. 


urothelial carcinoma, rhabdomyosarcomatous differentiation, malignant tumor of bladder

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