Carcinosarcoma of the ureter with a small cell component: report of a rare pathologic entity and potential for diagnostic error on biopsy.

Kent Newsom,William Hamilton,Bayo Tojuola,Lizette Vila Duckworth,Samer Al-Quran,Sijo Parekattil

doi:10.1155/2014/391615

Kent Newsom, William Hamilton + Show 4 more

Open Access

https://doi.org/10.1155/2014/391615

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Abstract

Carcinosarcomas of the ureter are rare biphasic neoplasms, composed of both malignant epithelial (carcinomatous) and malignant mesenchymal (sarcomatous) components. Carcinosarcomas of the urinary tract are exceedingly rare. We report a unique case of a carcinosarcoma of the ureter with a chondrosarcoma and small cell tumor component arising in a 68-year-old male who presented with microscopic hematuria. CT intravenous pyelogram revealed right-sided hydroureter and hydronephrosis with thickening and narrowing of the right ureter. The patient underwent robot-assisted ureterectomy with bladder cuff excision and subsequent adjuvant chemotherapy. The patient is disease-free at 32 months after treatment. We provide a brief synoptic review of carcinosarcoma of the ureter and bladder with utilization of immunohistochemical (IHC) stains and potential diagnostic pitfalls.

Highlights

Carcinosarcomas of the ureter are rare malignant neoplasms with only around a dozen case reports within the literature [1,2,3,4,5,6,7,8,9,10,11,12,13,14]
They are biphasic neoplasms composed of both malignant epithelial and mesenchymal components. These aggressive tumors are more commonly found within the uterus, where they are known within the gynecologic pathology nomenclature as malignant mixed mesodermal tumors (MMMT)
Of reported cases of ureteral carcinosarcoma, the epithelial components most often are comprised of urothelial carcinoma, carcinoma in situ, adenocarcinoma, squamous cell carcinoma, or small cell carcinoma

Summary

Introduction

Carcinosarcomas of the ureter are rare malignant neoplasms with only around a dozen case reports within the literature [1,2,3,4,5,6,7,8,9,10,11,12,13,14] They are biphasic neoplasms composed of both malignant epithelial and mesenchymal components. These aggressive tumors are more commonly found within the uterus, where they are known within the gynecologic pathology nomenclature as malignant mixed mesodermal tumors (MMMT). We present a rare case of carcinosarcoma of the ureter and review the histopathogenesis and immunohistochemical staining profile and discuss current treatment strategies and prognosis

Case Presentation

Discussion