Abstract
Around 0.3 percent of all primary tumors of the urinary bladder are sarcomatoid carcinomas, a rare aggressive tumor with a poor prognosis. Histological diagnosis for urothelialcarcinoma plays a significant role but is challenging in several ways. Making a foundational diagnosis relies heavily on immunohistochemistry. We present a case of high-grade urothelial cancer with sarcomatoid characteristics and having components of giant cells. The case discusses an 80-year-old male who had been referred because of painless intermittent hematuria. A 32 m mass at the posterior and lateral walls of the urinary bladder without perivesical fat infiltration was detected during a computed tomography urography. Histopathology results from the transurethral resection of the patient showed pTa high-grade malignant giant urothelial carcinoma with spindle cell tumor. Due to recurrence, the patient underwent Re-TURBT twice in our institution and had a BCG re-induction intravenously. Given that it contained mesenchymal markers such as EMA, IHC corroborated the final diagnosis of sarcomatoid cancer. It is crucial to recognize the unusual variations of urinary bladder urothelial tumors because they have an impact on prognosis and general care. The diagnosis is largely determined by immunohistochemistry. For aggressive variants, radical cystectomy is the standard treatment however, intravenous BCG may be beneficial for patients who are not fit for surgery.
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