J Med Cases

Journal of Medical Cases, ISSN 1923-4155 print, 1923-4163 online, Open Access

Article copyright, the authors; Journal compilation copyright, J Med Cases and Elmer Press Inc

Journal website http://www.journalmc.org

Case Report

Volume 5, Number 2, February 2014, pages 116-119

Sarcomatoid Carcinoma of the Urinary Bladder: A Case Report and Review of the Literature

Figures

Figure 1. A). CT revealed a large mass occupying almost the entire bladder at an advanced stage disease (T2 or higher) and no metastatic lesions. B). Sarcomatoid carcinoma mostly composed of undifferentiated malignant spindle cells. Tumor infiltrates through adventitial adipose tissue.

Figure 2. Sarcomatoid carcinoma composed entirely of sarcomatous appearing cells.

Figure 3. Higher magnification of Fig. 2 with vimentin and EMA positivity documenting epithelial differentiation.

Table

**Table 1.** Differential Diagnosis of Urinary Bladder Sarcomatoid Carcinoma According to Morphological and Immunohistochemical Features
	Sarcomatoid Carcinoma	Leiomyosarcoma	High grade urothelial carcinoma with metaplastic changes	Inflammatory myofibroblastic tumor	Post-operative spindle cell nodule
EMA: epithelial membrane antigen; MSA: muscle-specific actin;* Rare aberrant expression. ** Regarding the specific mesenchymal differentiation.
Cytologic atipia in spindle cells	Yes (High grade)	Yes	No	No	No
Concurrent neoplastic epithelial elements	Yes	No	Yes	No	No
AE1/AE3	+	*	+	*	-
CK 5/6	+		+
P63	+		+
EMA	+	-	+	-	-
Vimentin	+	+	+	+	+
MSA	*	+	**	-	+
Desmin	-	+	**	-	+