Ricciardi et al. World Journal of Surgical Oncology 2010, 8:16
Page 4 of 4
A multimodal treatment with CTX settings targeting
mesenchymal cancers (as sarcoma chemotherapy proto-
cols using doxorubicin, ifosfamide, cisplatinum and doc-
etaxel) should be mandatory in the event of metastatic
disease, . With positive margins after surgery, adju-
vant radiotherapy should be advocated for the patient
. Local recurrences should be treated by systemic
CTX and/or external pelvic RT, salvage therapy showed
to be ineffective, with a median survival of 20 months
after surgery .
Sarcomas should be considered as a possible histology at
differential diagnosis, even if they are no frequent com-
pared to other tumors. Unfortunately, obtaining a pre-
operative histological diagnosis does not improve the
prognosis. Rare tumors represent a great challenge for
physicians. They require experienced teams and well-
equipped centers for cancer cure. Bladder sarcomas, as
other genito-urinary sarcomas, require close cooperation
between urologist and gynecologic oncologist, as well as
medical and radiation oncologist. A pathologist expert in
mesenchymal tumors is mandatory.
Nowadays, no statistically relevant evidences on thera-
peutic behavior can be found yet in the literature. There-
fore, treatment should be tailored case-by-case,
preferring a multimodal and/or multidisciplinary
approach to the disease. A decision-making team made
by physicians experienced in managing soft tissues sarco-
mas should be also strictly required.
Written informed consent was obtained from the patient
for publication of this case report and any accompanying
images. A copy of the written consent is available for
review by the Editor-in-Chief of this journal.
The authors report no conflicts of interest. The authors alone are responsible
for the content and writing of the paper.
ER conceived of the study, and participated in its design and coordination and
drafted the manuscript. PM collected clinical data. MS participated in collect-
ing data and read and corrected the manuscript. MM participated in design of
the study and revisions, gave intellectual input and corrected the manuscript.
All authors read and approved the final manuscript.
Special thanks goes out to Prof. Andrea Vecchione for providing the histologi-
cal pictures used in these article.
Department of Gynecology, Perinatology and Child Health. Sapienza University
of Rome. Sant'Andrea Hospital, Via di Grottarossa 1035-1039, 00195, Rome, Italy
1. Pedersen-Bjergaard J, Jonsson V, Pedersen M, Hou-Jensen K:
Leiomyosarcoma of the urinary bladder after cyclophosphamide. J Clin
Oncol 1995, 13:532-3.
2. Parekh DJ, Jung C, O'Conner J, Dutta S, Smith ER Jr: Leiomyosarcoma in
urinary bladder after cyclophosphamide therapy for retinoblastoma
and review of bladder sarcomas. Urology 2002, 60:164.
3. Berkmen F, Celebioglu AS: Adult genitourinary sarcomas: a report of
seventeen cases and review of the literature. J Exp Clin Cancer Res 1997,
4. Dahm P, Gschwend JE: Malignant non-urothelial neoplasms of the
urinary bladder: a review. Eur Urol 2003, 44:672-681.
5. Seo IS, Clark SA, McGovern FD, Clark DL, Johnson EH: Leiomyosarcoma of
the urinary bladder: 13 years after cyclophosphamide therapy for
Hodgkin's disease. Cancer 1985, 55:1597-1603.
6. Rowland RG, Eble JN: Bladder leiomyosarcoma and pelvic fibroblastic
tumor following cyclophosphamide therapy. J Urol 1983, 130:344-346.
7. Venkatraman L, Goepel JR, Steele K, Dobbs SP, Lyness RW, McCluggage
WG: Soft tissue, pelvic, and urinary bladder leiomyosarcoma as second
neoplasm following hereditary retinoblastoma. J Clin Pathol 2003,
8. Kawamura J, Sakurai M, Tsukamoto K, Tochigi H: Leiomyosarcoma of the
bladder eighteen years after cyclophosphamide therapy for
retinoblastoma. Urol Int 1993, 51:49-53.
9. Rosser CJ, Slaton JW, Izawa JI, Levy LB, Dinney CP: Clinical presentation
and outcome of high-grade urinary bladder leiomyosarcoma in adults.
Urology 2003, 61:1151-5.
10. Mackenzie AR, Whitmore WF Jr, Melamed MR: Myosarcomas of the
bladder and prostate. Cancer 1968, 22:833-44.
11. Spiess PE, Kassouf W, Steinberg JR, Tuziak T, Hernandez M, Tibbs RF,
Czerniak B, Kamat AM, Dinney CP, Grossman HB: Review of the M.D.
Anderson experience in the treatment of bladder sarcoma. Urol Oncol
12. De Berardinis E, Giulianelli R, Zarrelli G, De Santis C, Ginepri A, Gentile BC,
Di Silverio F: Leiomyosarcoma of urinary bladder: personal experience
in 3 cases over a 10-year period. Arch Ital Urol Androl 1997, 69:73-80.
13. Strander H, Turesson I, Cavallin-Stahl E: A systematic overview of
radiation therapy effects in soft tissue sarcomas. Acta Oncol (Stockholm,
Sweden) 2003, 42:516-31.
14. Swartz DA, Johnson DE, Ayala AG, Watkins DL: Bladder leiomyosarcoma:
a review of 10 cases with 5-year followup. J Urol 1985, 133:200-2.
15. Martin SA, Sears DL, Sebo TJ, Lohse CM, Cheville JC: Smooth muscle
neoplasms of the urinary bladder: a clinicopathologic comparison of
leiomyoma and leiomyosarcoma. Am J Surg Pathol 2002, 26:292-300.
16. Cody HSIII, Turnbull AD, Fortner JG, Hajdu SI: The continuing challenge of
retroperitoneal sarcomas. Cancer 1981, 47:2147-52.
17. Dotan ZA, Tal R, Golijanin D, Snyder ME, Antonescu C, Brennan MF, Russo
P: Adult genitourinary sarcoma: the 25-year Memorial Sloan-Kettering
experience. J Urol 2006, 176:2033-8.
18. O'Sullivan B, Ward I, Catton C: Recent advances in radiotherapy for soft-
tissue sarcoma. Curr Oncol Rep 2003, 5:274-81.
19. Nelius T, Stevens J, Samathanam C, Filleur S: Leiomyosarcoma of the
urinary bladder presenting as life threatening gross ematuria. Med
Oncol 2009 in press.
Cite this article as: Ricciardi et al., A case of high-grade leiomyosarcoma of
the bladder with delayed onset and very poor prognosis World Journal of Sur-
gical Oncology 2010, 8:16
Received: 22 December 2009 Accepted: 19 March 2010
Published: 19 March 2010
This article is available from: http://www.wjso.com/content/8/1/16© 2010 Ricciardi et al; licensee BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0 ), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.World Journal of Surgical Oncology 2010, 8:16