Pseudosarcomatous and sarcomatous proliferations of the bladder

Department of Urologic Oncology, The University of Texas M. D. Anderson Cancer Center, Houston, TX 77030, USA.
Human Pathlogy (Impact Factor: 2.77). 06/2007; 38(5):753-61. DOI: 10.1016/j.humpath.2006.11.014
Source: PubMed


Pseudosarcomatous fibromyxoid tumor (PFT), postoperative spindle cell nodule (PSN), sarcoma, and sarcomatoid carcinoma of the bladder are frequently difficult to distinguish histopathologically with significant differences in disease-related outcomes. A retrospective review of our pathology registry over the last 25 years identified 7 PFT, 10 PSN, 18 primary bladder sarcomas, and 17 sarcomatoid carcinomas. Most patients with PFT, PSN, sarcoma, and sarcomatoid carcinoma were diagnosed between the ages of 50 to 60 years with PFT and PSN most commonly detected in women. A previous history of urological instrumentation and bladder cancer was present in all patients with PSN but none of the patients with PFT. Pseudosarcomatous fibromyxoid tumors were characterized by a tissue culture-like proliferation of myofibroblastic cells with focal atypia and overall cytoarchitectural features mimicking nodular fasciitis. Sarcomas and sarcomatoid carcinomas exhibited cellular atypia, mitotic activity with atypical mitosis, and the presence of necrosis. Transurethral resection was sufficient to control all PFT and PSN with no evidence of distant metastatic spread. In contrast, local recurrences and distant metastases frequently occurred in patients with primary sarcoma and sarcomatoid carcinoma despite aggressive surgical management, which was often combined with neoadjuvant chemotherapy (50% and 65% disease-specific mortality, respectively). Pseudosarcomatous fibromyxoid tumor and PSN have unique clinical and pathologic features that allow their distinction from primary bladder sarcoma and sarcomatoid carcinoma.

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Available from: Philippe Spiess, May 13, 2014
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    • "Au plan thérapeutique, la PMP peut être prise en charge par une résection endoscopique complète. Certaines équipes optent pour la cystectomie partielle [2] [3]. Notre patient a eu une résection endoscopique complète de la tumeur avec une évolution favorable après un recul d'un an. "
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    ABSTRACT: Myofibroblastic proliferations of the bladder in adults are unusual lesions with a benign course. These proliferations, whether spontaneous or secondary to instrumentation, have identical morphology and behaviour. Histologically, similar lesions have been reported in the literature using different names, such as inflammatory pseudotumour, pseudosarcomatous fibromyxoid tumour, nodular fasciitis, postoperative spindle cell nodule... Recently, some authors proposed that these lesions are similar enough to be considered the same entity, designated as "pseudosarcomatous myofibroblastic proliferation" and insisted on the necessity to distinguish them from the inflammatory myofibroblastic tumour of the childhood. The latter, recently recognized as tumour, has a malignant potential and is capable of giving metastases. We describe the case of a 17-year-old man who presented a vesical mass. The histopathological study concluded to a pseudosarcomatous myofibroblastic proliferation. We discuss, through a literature review, the relationship of this lesion with inflammatory myofibroblastic tumour and its main differential diagnoses.
    Progrès en Urologie 04/2010; 20(4):307-10. DOI:10.1016/j.purol.2009.05.007 · 0.66 Impact Factor
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    Journal of the Indian Medical Association 02/1993; 91(1):18-9.
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    ABSTRACT: Los tumores no epiteliales de la vejiga sólo representan el 2-5% de las neoplasias de este órgano. Se trata de un grupo heterogéneo de tumores, cuya sintomatología clínica es variable e inespecífica, que puede asociar signos de irritación vesical, infecciones urinarias de repetición y hematuria. Su tratamiento y su pronóstico difieren según la extensión tumoral y el tipo histológico. Los tumores no epiteliales benignos de la vejiga engloban los tumores conjuntivos benignos (sobre todo los leiomiomas, los hemangiomas y los neurofibromas), las lesiones miofibroblásticas y los feocromocitomas. Su tratamiento consiste en la cirugía conservadora (endoscopia e incluso cistectomía parcial) y su pronóstico es favorable. Los tumores no epiteliales malignos de la vejiga están representados principalmente por los sarcomas, que, con excepción del rabdomiosarcoma infantil, tienen mal pronóstico. Su tratamiento consiste en una cirugía radical asociada a medidas adyuvantes. Los linfomas tienen un buen pronóstico y se tratan sobre todo con estrategias terapéuticas combinadas. Los melanomas vesicales son excepcionales y su pronóstico es malo. En conclusión, los tumores no epiteliales de la vejiga engloban tumores benignos y malignos relativamente infrecuentes en esta localización, que se distinguen del carcinoma urotelial sobre todo por su evolución y su pronóstico.
    01/2008; 40(3):1–10. DOI:10.1016/S1761-3310(08)70038-0
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