Sarcomatoid carcinoma of transitional cell origin confined to renal pelvis

doi:10.1016/j.urology.2005.09.026

Urology

Volume 67, Issue 3, March 2006, Pages 622.e9-622.e11

https://doi.org/10.1016/j.urology.2005.09.026 Get rights and content

Abstract

Thirteen reported cases of renal pelvic sarcomatoid carcinoma have been documented since 1961, and all patients presented with metastatic disease or advanced renal parenchyma involvement. The mean survival was shorter than 9 months, and adjuvant therapy appeared to offer no benefit. We present the case of a 61-year-old man with gross hematuria and a large filling defect on computed tomography excretory urography. Surgical pathologic examination after laparoscopic nephroureterectomy was consistent with renal pelvis-confined sarcomatoid carcinoma of transitional cell origin. Adjuvant therapy was not given secondary to the organ-confined nature of disease. The patient was without recurrence for more than 1 year.

Section snippets

Case report

A 61-year-old man presented to our clinic for consultation regarding gross painless hematuria. The patient’s medical history was significant only for hypertension. He had no previous history of stone disease, infection, or radiation. The patient denied past tobacco use or analgesic abuse. His urine culture was negative, and urine cytology showed no signs of malignant or atypical cells. Computed tomography (CT) with excretory urography was performed and demonstrated a large, left-sided renal

Comment

Most renal pelvis malignancies consist of transitional cell carcinoma. Sarcomatoid carcinoma of transitional cell origin in the renal pelvis is rare and only 13 cases have been reported since 1961.¹

The sarcomatoid renal pelvic tumor of transitional cell origin should not be confused with sarcomatoid renal cell carcinoma, a well-described, high-grade malignant variant of renal parenchyma origin.² Sarcomatoid carcinoma is often confused with, and difficult to distinguish from, carcinosarcoma.

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Sarcomatoid transitional cell carcinoma originating from a duplicated renal pelvis
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There are more references available in the full text version of this article.

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Sarcomatoid renal pelvis carcinoma (SRPC) is a rare variant of RPC. We aimed to summarize the clinicopathological features and prognostic factors of SRPC.
In this retrospective study, we collected data from 24 patients with SRPC who were treated at the Department of Urology, Affiliated Hospital of Qingdao University between 2008 and 2021. The clinicopathological features of the patients were obtained from their medical records to evaluate the diagnosis, prognostic factors, and response to systemic therapy.
Immunohistochemical staining revealed that cytokeratin was expressed in 19 patients with SRPC, while vimentin was expressed in all patients. Computer tomography showed these tumors as low-density (n = 12) or mixed-density masses, with or without necrotic areas (n = 12). All patients showed different degrees of enhancement on computed tomography. Lymph node metastasis was present in 6 patients and distant metastasis in 5. The median survival of all patients was 28 months. Patients without metastasis had a median survival of 46 months compared with 18 months in those with metastasis (P < 0.05). Necrosis had no significant influence on prognosis (P > 0.05). The median survival of patients with and without hydronephrosis was 18 and 104 months (P < 0.05). Among patients without metastasis, those without hydronephrosis survived longer than those with hydronephrosis (104 vs 18 months, P < 0.05), and necrosis had no effect on prognosis. In patients with metastasis, necrosis and hydronephrosis had no effect on prognosis (P > 0.05).
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Synchronous squamous cell carcinoma of the kidney, squamous cell carcinoma of the ureter, and sarcomatoid carcinoma of the urinary bladder: A case report
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The author presents a unique case of a synchronous triple carcinoma of kidney, ureter, and urinary bladder. A 73-year-old man was admitted to our hospital because of hematuria and lumbago. Endoscopy and imaging modalities revealed a bladder tumor, a left ureter tumor, and a left kidney tumor. No other tumors were found in the body by imaging modalities. Cystectomy and left nephroureterectomy were performed. The bladder tumor was a large polypoid tumor consisting of pleomorphic sarcomatoid carcinoma (80%) and high-grade papillary urothelial carcinoma (20%), both invading the deep muscle layer. There were gradual merges between the two. The sarcomatous component was composed of malignant spindle, polygonal, and giant cells. Lymphovascular permeation was pronounced. Immunohistochemically, the sarcomatous element was positive for vimentin and various types of cytokeratins (CK), while the urothelial carcinoma element was positive for various types of CK and negative for vimentin. The ureter tumor was small and obstructed the ureter lumen. It was a pure squamous cell carcinoma without a urothelial component. The ureter tumor invaded the adventitia. A mild degree of lymphovascular invasion was recognized. Immunohistochemically, the tumor cells were positive for various types of CK but negative for vimentin. In the kidney, almost the entire kidney parenchyma was replaced by a tumor. The renal pelvis was broadly erosive but was free of apparent tumors. Histologically, the renal tumor was a pure squamous cell carcinoma without a urothelial component. Broad necrosis was present, and lymphovascular permeation was pronounced. The renal pelvis and calices were devoid of apparent tumor cells, but renal squamous cell carcinoma was present just beneath the pelvis and calices. Immunohistochemically, the kidney tumor was positive for various types of CK and negative for vimentin.
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Case reportSarcomatoid carcinoma of transitional cell origin confined to renal pelvis

Abstract

Section snippets

Case report

Comment

J Urol

Pathol Res Pract

Sarcomatoid transitional cell carcinoma originating from a duplicated renal pelvis

Int J Urol

Case report
Sarcomatoid carcinoma of transitional cell origin confined to renal pelvis