Abstract
Introduction
Non-urothelial neoplasms of the bladder account for fewer than 5% of all bladder tumors. Sarcoma constitutes the most usual mesenchymal malignancy of the bladder, with leiomyosarcomas being the most common type of sarcoma in adults.
Patients and methods
The records of seven patients presenting to two different institutions with bladder leiomyosarcomas between 2003 and 2007 and between 2000 and 2007, respectively, were examined. Cystoscopy, with transurethral resection of the bladder tumor was initially performed in all patients, with leiomyosarcoma being initially diagnosed on the basis of examination of the transurethral specimen.
Results
There were N = 5 men and N = 2 women with a median age of 64.8 years at presentation. All seven patients underwent a definitive surgical procedure. Complete resection with negative surgical margins was achieved in all seven patients (100%). MSKCC stage included 86% of patients with stage 3 (N = 6) and 14% with stage 2 (N = 1). A low-grade tumor was evident in one patient only, with the remaining 86% exhibiting a high-grade tumor.
Discussion
Leiomyosarcomas of the bladder have always been considered as a highly aggressive entity and little is known about their origin, clinicopathologic presentation, and the survival factors associated with them. Contemporary studies suggest that these tumors may have a better prognosis than once believed. Leiomyosarcomas require aggressive surgical extirpation and, when surgical resection is possible, radical cystectomy with wide margins is the rule and should be performed. Strict adherence to standard surgical technique has resulted in low rates of positive surgical margins and low rates of local tumor recurrence.
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References
Dahm P, Gschwend JE (2003) Malignant non-urothelial neoplasms of the urinary bladder: a review. Eur Urol 44:672–681
Berkmen F, Celebioglu AS (1997) Adult genitourinary sarcomas: a report of seventeen cases and review of the literature. J Exp Clin Cancer Res 16:45–48
Bergman RT, Kugel AI (1950) Leiomyosarcoma of the urinary bladder. Urol Cutaneous Rev. 54(2):65–67
Sobin LH, Wittekind C (eds) (1997) International union against cancer: TNM classification of malignant tumors. Wiley–Liss, New York, pp 165–194
Hajdu SI (1979) Pathology of soft tissue tumors. Lea and Febiger, Philadelphia
Martin SA, Sears DL, Sebo TJ et al (2002) Smooth muscle neoplasms of the urinary bladder. Am J Surg Pathol 26:292–300
Morton DL, Eilber FR (1982) In: Holland JT, Fire E (eds) Soft Tissue Sarcomas. Lea and Febiger, Philadelphia, pp 21–41
Rosenberg SA, Suit HD, Baker LH (1985) Sarcomas soft tissues. In: Devita VT Jr, Hellman S, Rosenberg SA (eds) Cancer: principles and practices of oncology, 2nd edn. JB Lippincott, Philadelphia, pp 1243–1291
Cody HS III, Turnbull AD, Fortner JG et al (1981) The continuing challenge of retroperitoneal sarcomas. Cancer 47:2147–2153
Helpab B (2001) Nonepithelial neoplasms of the urinary bladder. Virchows Arch 439:497–503
Sigal SH, Tomaszewski JE, Brooks JJ, Wein A, Li Volsi VA (1991) Carcinosarcoma of bladder following long-term cyclophosphamide therapy. Arch Pathol Lab Med 115:1049–1051
Kawamura J, Sakurai M, Tsukamoto K, Tochigi H (1993) Leiomyosarcoma of the bladder eighteen years after cyclophosphamide therapy for retinoblastoma. Urol Int 51:49–53
Pedersen-Bjergaard J, Jonsson V, Pedersen M, Hou-Jensen K (1995) Leiomyosarcoma of the urinary bladder after cyclophosphamide. J Clin Oncol 13:532–533
Thrasher JB, Miller GJ, Wettlaufer JN (1990) Bladder leiomyosarcoma following cyclophosphamide therapy for lupus nephritis. J Urol 143:119–121
Rowland RG, Eble JN (1983) Bladder leiomyosarcoma and pelvic fibroblastic tumor following cyclophosphamide therapy. J Urol 130:344–346
Parekh DJ, Jung C, O’Conner J et al (2002) Leiomyosarcoma in urinary bladder after cyclophosphamide therapy for retinoblastoma and review of bladder sarcomas. Urology 60:164–166
Mackenzie AR, Whitmore WF Jr, Melamed MR (1968) Myosarcomas of the bladder and prostate. Cancer 22(4):833–844
Russo P, Brady MS, Conlon K et al (1992) Adult urological sarcoma. J Urol 147:1032–1036
Rosser CJ, Slaton JW, Izawa JI et al (2003) Clinical presentation and outcome of high grade urinary bladder leiomyosarcoma in adults. Urology 61:1151–1155
Bitterman P, Chun B, Kurman RJ (1990) The significance of epithelial differentiation in mixed mesodermal tumors of the uterus: a clinicopathologic and immunohistochemical study. Am J Surg Pathol 14:317–328
Froehner M, Lossnitzer A, Manseck A et al (2000) Favorable long-term outcome in adult genitourinary low grade sarcoma. Urology 56:373–377
McCrea LE, Post E (1955) Sarcoma of the bladder. Urol Surv 5:30
Seo IS, Clark SA, McGovern FD, Clark DL, Johnson EH (1985) Leiomyosarcoma of the urinary bladder: 13 years after cyclophosphamide therapy for Hodgkin’s disease. Cancer 55:1597–1603
Spiess PE, Kassouf W, Steinberg JR, Tuziak T, Hernandez M, Tibbs RF, Czerniak B, Kamat AM, Dinney CP, Grossman HB (2007) Review of the M.D. Anderson experience in the treatment of bladder sarcoma. Urol Oncol 25(1):38–45
Swartz DA, Johnson DE, Ayala AG, Watkins DL (1985) Bladder leiomyosarcoma: a review of 10 cases with 5 year follow-up. J Urol 133:200–202
De Berardinis E, Giulianelli R, Zarrelli G, De Santis C, Ginepri A, Gentile BC et al (1997) Leiomyosarcoma of urinary bladder: personal experience in 3 cases over a 10-year period. Arch It Urol 69(Suppl 1):73–80
Strander H, Turesson I, Cavallin-Stahl E (2003) A systematic overview of radiation therapy effects in soft tissue sarcomas. Acta Oncol 42:516 –31
O’Sullivan B, Ward I, Catton C (2003) Recent advances in radiotherapy for soft tissue sarcoma. Curr Oncol Rep 5:274–81
Harrell FE Jr, Lee KL, Matchar DB et al (1985) Regression models for prognostic prediction: Advantages, problems, and suggested solutions. Cancer Treat Rep 69:1071–1077
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Labanaris, A.P., Zugor, V., Meyer, B. et al. Urinary bladder leiomyosarcoma in adults. Int Urol Nephrol 40, 311–316 (2008). https://doi.org/10.1007/s11255-007-9288-5
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DOI: https://doi.org/10.1007/s11255-007-9288-5