Vol. 44 (1): 45-52, January – February, 2018

doi: 10.1590/S1677-5538.IBJU.2016.0347

ORIGINAL ARTICLE
Simon Paul Robinson 1, Assad Farooq 2, Marc Laniado 3, Hanif Motiwala 3
1 Frimley Health Foundation Trust – Urologia, Wexham Street, Slough, United Kingdom, UK; 2 Heatherwood and Wexham Park Hospitals NHS Trust, Wexham Park Hospital Wexham Slough, Slough, United Kingdom, UK; 3 Department of Urology, Heatherwood and Wexham Park Hospitals NHS Trust – Slough, Berkshire, United Kingdom, UK

ABSTRACT

Introduction: Carcinosarcoma of the bladder is a very rare neoplasm. The pathogenesis of carcinosarcomas is not clearly understood and remains a subject of debate. Whilst there is some research conceptualizing the histopathological findings of bladder car­cinosarcomas, the demographic features, clinical outcomes, prognosis and treatment options remain unclear.

Materials and Methods: We analyzed 12 consecutive cases of patients with sarco­ma-toid bladder cancer who were treated surgically at a single Urology Department be-tween 1999 and 2015. Radiology, pathology and surgical reports were reviewed to determine the pathological staging at the time of cystectomy. These were directly compared with 230 patients having cystectomies for urothelial cell carcinoma. The sarcomatoid patients, were compared to patients with urothelial cell cancers. The other histological sub types, squamous cell (17), neuroendocrine (9), metastatic (7), mixed (4), adenocarcinoma (3), were not included.

Results and conclusion: Carcinosarcoma of the urinary bladder is often described in the literature as a highly malignant neoplasm that is rapidly lethal. We found that the sarcoma does not offer a worse prognosis than conventional high-grade urothelial car-cinoma. There is no significant difference in grade, stage, positive surgical margin rate, nodal involvement, associated prostate cancer or incidence rates of progression, all cause or disease specific mortality. There was a barely significant difference in car­cinoma in-situ. However, carcinosarcomas are three times the volume of urothelial cell tumors which may contribute to its reputation as an aggressive tumour (44cc v 14cc). Sarcomatous elements do not appear, from our small study, to bestow a worse prognosis.

Keywords: Urinary Bladder; Sarcoma; Carcinoma

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