Diagnosis and treatment analysis of 5 cases of primary sarcomatoid carcinoma of the bladder
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摘要: 目的 探讨膀胱肉瘤样癌的诊断和治疗方法，以提高这种特殊疾病患者的临床管理水平和治疗效果。方法 回顾性分析2010年2月—2021年1月徐州市中心医院收治的5例膀胱原发性肉瘤样癌患者的临床资料。患者均为男性，中位年龄78岁。4例行腹腔镜下膀胱癌根治术，1例行膀胱部分切除术。全切患者中1例术前、术后行吉西他滨+奈达铂静脉化疗，部分切患者术后行吉西他滨膀胱灌注。结果 5例患者术后病理均确诊为膀胱肉瘤样癌。术后随访6~37个月，4例死亡，1例存活；其中2例发生术后淋巴结或肠转移。全切患者中，2例为T1N0M0，1例为T2N0M0，1例为T3N0M0。膀胱部分切患者为T2N0M0。免疫组化显示波形蛋白(Vim)及细胞角蛋白(CK)均为阳性。结论 膀胱肉瘤样癌是在临床实践中遇到的一种相对罕见的情况，其临床表现类似于典型的尿上皮癌。诊断困难，且大多数病例在最初发现时有肌层浸润，恶性程度高，有复发和转移的倾向，预后不良。手术干预是肉瘤样癌的主要治疗方法，通过术后化疗和其他辅助措施，有改善患者生存期的潜力。Abstract: Objective To examine the diagnostic and therapeutic approaches utilized for sarcomatoid carcinoma of the bladder, with the aim of enhancing the clinical management and treatment outcomes for patients afflicted with this particular disease.Methods The clinical data of 5 patients with primary sarcomatoid carcinoma of the bladder admitted to Xuzhou Central Hospital from February 2010 to January 2021 were retrospectively analyzed. The patients were all male, with an average age of 78 years old. Four cases underwent laparoscopic radical cystectomy for bladder cancer and 1 case underwent partial cystectomy. One of the total resection patients underwent preoperative and postoperative gemcitabine + nedaplatin intravenous chemotherapy, and the partial resection patient underwent postoperative gemcitabine bladder instillation.Results Postoperative pathology confirmed the diagnosis of sarcomatoid carcinoma of the bladder in all 5 patients. After 6-37 months of postoperative follow-up, 4 cases died and 1 case survived. Two of them developed postoperative lymph node or intestinal metastases. Among the patients with total resection, there were 2 cases of stage T1N0M0, 1 case of stage T2N0M0, 1 case of stage T3N0M0, and the patient with partial cystotomy was staged as T2N0M0. Immunohistochemistry showed that both Vim and CK were positive.Conclusion Sarcomatoid carcinoma of the bladder is an infrequent occurrence in clinical practice, sharing clinical manifestations akin to typical uroepithelial carcinoma. Its diagnosis poses challenges, and the majority of cases exhibit an unfavorable prognosis due to early detection being hindered by muscular infiltration, a high level of malignancy, and a tendency for recurrence and metastasis. Surgical intervention serves as the primary treatment modality for sarcomatoid carcinoma, offering the potential to enhance patient survival rates when combined with postoperative chemotherapy and other supplementary approaches.
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Key words:
- sarcomatoid carcinoma /
- bladder cancer /
- diagnosis /
- treatment
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表 1 5例患者的临床资料
患者编号 年龄/岁 性别 临床表现 手术方式 肿瘤直径/cm 药物治疗 TNM分期 是否存活 总生存期/月 复发/转移 1 99 男 无痛血尿 腹腔镜膀胱全切术 2 无 T1N0M0 否 10 无 2 66 男 无痛血尿 腹腔镜膀胱全切术 2 吉西他滨+奈达铂a) T2N0M0 否 37 无 3 66 男 血尿伴膀胱刺激症状 腹腔镜膀胱全切术 3 无 T1N0M0 否 12 无 4 82 男 血尿伴膀胱刺激症状 腹腔镜膀胱全切术 6 无 T3N0M0 否 6 术后淋巴结转移 5 78 男 膀胱刺激症状 部分膀胱切除术+电切 10 吉西他滨b) T2N0M0 是 30 术后肠转移 注：a)术前术后均予以GC静脉治疗；b)术后予以膀胱灌注。 
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[1] Liu S, Yao Y, Wang ZK, et al. Prognostic value of the sarcomatoid component in bladder cancer: A propensity score matching study[J]. Oncol Lett, 2023, 25(3): 103. doi: 10.3892/ol.2023.13690
[2] Daga G, Kerkar P. Sarcomatoid Carcinoma of Urinary Bladder: a Case Report[J]. Indian J Surg Oncol, 2018, 9(4): 644-646. doi: 10.1007/s13193-018-0769-z
[3] Malla M, Wang JF, Trepeta R, et al. Sarcomatoid Carcinoma of the Urinary Bladder[J]. Clin Genitourin Cancer, 2016, 14(5): 366-372. doi: 10.1016/j.clgc.2016.03.004
[4] Robinson SP, Farooq A, Laniado M, et al. The demographic features, clinical outcomes, prognosis and treatment options for patients with sarcomatoid carcinoma of the urinary bladder: a single centre experience[J]. Int Braz J Urol, 2018, 44(1): 45-52. doi: 10.1590/s1677-5538.ibju.2016.0347
[5] Siegel RL, Miller KD, Fuchs HE, et al. Cancer statistics, 2022[J]. CA Cancer J Clin, 2022, 72(1): 7-33. doi: 10.3322/caac.21708
[6] Taseer R, Ahmed TT. Sarcomatoid Urothelial Carcinoma With Myxoid Stroma: A Case Report and Diagnostic Approach[J]. Cureus, 2021, 13(3): e14007.
[7] Bansal A, Kumar N, Sharma SC. Sarcomatoid variant of urothelial carcinoma of the urinary bladder[J]. J Cancer Res Ther, 2013, 9(4): 571-573. doi: 10.4103/0973-1482.126449
[8] Baio R, Spiezia N, Marani C, et al. Potential contribution of benzodiazepine abuse in the development of a bladder sarcomatoid carcinoma: A case report[J]. Mol Clin Oncol, 2021, 15(5): 231. doi: 10.3892/mco.2021.2394
[9] Lobo N, Shariat SF, Guo CC, et al. What Is the Significance of Variant Histology in Urothelial Carcinoma?[J]. Eur Urol Focus, 2020, 6(4): 653-663. doi: 10.1016/j.euf.2019.09.003
[10] Freedman ND, Silverman DT, Hollenbeck AR, et al. Association between smoking and risk of bladder cancer among men and women[J]. JAMA, 2011, 306(7): 737-745. doi: 10.1001/jama.2011.1142
[11] Witjes JA, Compérat E, Cowan NC, et al. EAU guidelines on muscle-invasive and metastatic bladder cancer: summary of the 2013 guidelines[J]. Eur Urol, 2014, 65(4): 778-792. doi: 10.1016/j.eururo.2013.11.046
[12] Miyawaki I, Moriyasu M, Funabashi H, et al. Mechanism of clobazam-induced thyroidal oncogenesis in male rats[J]. Toxicol Lett, 2003, 145(3): 291-301. doi: 10.1016/j.toxlet.2003.08.002
[13] Karmali RA, Volkman A, Muse P, et al. The influence of diazepam administration in rats bearing the R3230AC mammary carcinoma[J]. Prostaglandins Med, 1979, 3(3): 193-198. doi: 10.1016/0161-4630(79)90103-4
[14] Iida M, Anna CH, Hartis J, et al. Changes in global gene and protein expression during early mouse liver carcinogenesis induced by non-genotoxic model carcinogens oxazepam and Wyeth-14, 643[J]. Carcinogenesis, 2003, 24(4): 757-770. doi: 10.1093/carcin/bgg011
[15] Yoo Y, Choi E, Lee DH, et al. Diagnostic value of urine cytology in detecting histologic variants of urothelial carcinomas in the urinary bladder: Cytopathologic correlation of 72 cases[J]. Diagn Cytopathol, 2021, 49(3): 367-373. doi: 10.1002/dc.24660
[16] Moschini M, Shariat SF, Freschi M, et al. Is transurethral resection alone enough for the diagnosis of histological variants? A single-center study[J]. Urol Oncol, 2017, 35(8): 528. e1-528. e5.
[17] Abd El-Latif A, Watts KE, Elson P, et al. The sensitivity of initial transurethral resection or biopsy of bladder tumor(s)for detecting bladder cancer variants on radical cystectomy[J]. J Urol, 2013, 189(4): 1263-1267. doi: 10.1016/j.juro.2012.10.054
[18] Acosta AM, Barletta J, Sonpavde G, et al. p-120 Catenin is a Useful Diagnostic Biomarker for Distinguishing Plasmacytoid and Sarcomatoid Variants From Conventional Urothelial Carcinoma[J]. Arch Pathol Lab Med, 2021, 145(8): 1000-1008. doi: 10.5858/arpa.2020-0262-OA
[19] Sanfrancesco J, McKenney JK, Leivo MZ, et al. Sarcomatoid Urothelial Carcinoma of the Bladder: Analysis of 28 Cases With Emphasis on Clinicopathologic Features and Markers of Epithelial-to-Mesenchymal Transition[J]. Arch Pathol Lab Med, 2016, 140(6): 543-551. doi: 10.5858/arpa.2015-0085-OA
[20] Dursun F, Elshabrawy A, Wang H, et al. Histological variants of non-muscle invasive bladder cancer: Survival outcomes of radical cystectomy vs. bladder preservation therapy[J]. Urol Oncol, 2022, 40(6): 275e1-275e10. doi: 10.1016/j.urolonc.2022.02.004
[21] García González J, Pérez Fentes D, Aliste Santos C, et al. Use of M-VAC in the adjuvant treatment of sarcomatoid carcinoma of the bladder[J]. Actas Urol Esp, 2009, 33(4): 447-449. doi: 10.1016/S0210-4806(09)74175-0
[22] Almassi N, Vertosick EA, Sjoberg DD, et al. Pathological and oncological outcomes in patients with sarcomatoid differentiation undergoing cystectomy[J]. BJU Int, 2022, 129(4): 463-469. doi: 10.1111/bju.15428
[23] Chakiryan NH, Jiang DD, Gillis KA, et al. Pathological Downstaging and Survival Outcomes Associated with Neoadjuvant Chemotherapy for Variant Histology Muscle Invasive Bladder Cancer[J]. J Urol, 2021, 206(4): 924-932. doi: 10.1097/JU.0000000000001855
[24] Compérat E, Amin MB, Epstein JI, et al. The Genitourinary Pathology Society Update on Classification of Variant Histologies, T1 Substaging, Molecular Taxonomy, and Immunotherapy and PD-L1 Testing Implications of Urothelial Cancers[J]. Adv Anat Pathol, 2021, 28(4): 196-208. doi: 10.1097/PAP.0000000000000309
[25] Mori K, Abufaraj M, Mostafaei H, et al. A Systematic Review and Meta-Analysis of Variant Histology in Urothelial Carcinoma of the Bladder Treated with Radical Cystectomy[J]. J Urol, 2020, 204(6): 1129-1140. doi: 10.1097/JU.0000000000001305
[26] Wang X, MacLennan GT, Zhang S, et al. Sarcomatoid carcinoma of the upper urinary tract: clinical outcome and molecular characterization[J]. Hum Pathol, 2009, 40(2): 211-217. doi: 10.1016/j.humpath.2008.07.003
[27] 朱将, 王沈阳. 尿路上皮肉瘤样癌的临床特征及诊疗进展[J]. 现代泌尿生殖肿瘤杂志, 2022, 14(1): 57-59, 63. https://www.cnki.com.cn/Article/CJFDTOTAL-PXDM202201013.htm
[28] Wright JL, Black PC, Brown GA, et al. Differences in survival among patients with sarcomatoid carcinoma, carcinosarcoma and urothelial carcinoma of the bladder[J]. J Urol, 2007, 178(6): 2302-6;discussion 2307. doi: 10.1016/j.juro.2007.08.038
[29] Veenboer PW, de Kort LM. Bladder carcinoma in a 31-year-old female spina bifida patient with an auto-augmented bladder[J]. Int Urol Nephrol, 2012, 44(4): 1027-1030. doi: 10.1007/s11255-011-0046-3
[30] Wang Z, Xiong W, Pan C, et al. Aggressive muscle-invasive bladder cancer with sarcomatoid differentiation in a 10-year-old girl: A case report[J]. Exp Ther Med, 2016, 11(3): 985-987. doi: 10.3892/etm.2016.3012
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