Abstract
IntroductionThe association of systemic lupus erythematosus with malignancies is an uncommon occurrence. We present the case of an osteosarcoma of the urinary bladder developing in a patient with a prolonged history of active systemic lupus erythematosus. This is a previously unreported association. Primary osteosarcoma is an extremely rare disease in the urinary bladder.Case presentationA 24-year-old Caucasian woman with a 13-year history of systemic lupus erythematosus, who had been treated with high dose immunosuppressive agents, presented with pain and hematuria. A deeply invasive high-grade tumor was detected in the urinary bladder and the patient underwent radical surgery. A diagnosis of osteosarcoma was made based on the characteristic histology.ConclusionPredisposing factors for primary sarcomas in the urinary bladder are mostly unknown; however, in our case, long-term administration of immunosuppressive agents, as well as long standing systemic lupus erythematosus, may both be of significance.
Highlights
The association of systemic lupus erythematosus with malignancies is an uncommon occurrence
Predisposing factors for primary sarcomas in the urinary bladder are mostly unknown; in our case, long-term administration of immunosuppressive agents, as well as long standing systemic lupus erythematosus, may both be of significance
We present the case of a 24-year-old woman with a primary osteosarcoma of the urinary bladder
Summary
We present the case of a 24-year-old woman with a primary osteosarcoma of the urinary bladder. Laboratory investigations at that time revealed elevated antinuclear antibody titer (1/1000) and anti-dsDNA levels (124 IU/mL), anemia, decreased C3 (14.3) and C4 (8.1) and SLE was diagnosed She was treated with azathioprine 100 mg for 3 months, hydroxychloroquine 400 mg for 9 months and prednisolone 10–32 mg daily. Thereafter, there was no complete remission and she was continuously on immunosuppressive medications, with the dose regulations depending on her white blood cell count, and she needed pulse methylprednisolone administration once a month She had frequent urinary tract infections with Gram negative bacteria which were treated with several antibiotics. On macroscopic examination of the radical cystectomy specimen, a large ulcerating exophytic polypoid nodular tumor, mainly located on the left lateral and posterior walls of the urinary bladder, was observed. Osteoclast-type multinucleated giant cells are seen scattered among malignant cells, seen in part (b). (a: H-E × 40; b: H-E × 200)
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