An unusual case of bladder tumour with diagnostic dilemma; A rare case report
Keywords:
Bladder, leiomyosarcoma, nonurothelial neoplasm, ALK 1
Abstract
Urinary bladder tumours rank ninth in the worldwide cancer incidence. Urothelial carcinomas are the fourth most common malignancy in men. It is very rare in younger age group, but it can occur at any age group. We report a case of a 28 yr old male who presented with dysuria and suprapubic pain with Contrast enhanced computerised tomography revealed polypoidal lesion arising from the dome of the urinary bladder. In light microscopy showed, pleomophic spindle tumours cells arranged in fascicles with increased atypical mitosis along with scattered chronic inflammatory cells. The possibility of leiomyosarcoma or inflammatory myofibroblastictumor was considered in differential diagnosis. The immunohistochemistry was positive for Vimentin, Desmin, Smooth muscle actin, Ki 67 and myo D1 and negative for Cytokeratin, ALK 1, H-Caldesmon, S 100 and CD 34. Hence a diagnosis of leiomyosarcoma was made. This case highlights the unusual tumour with its diagnostic dilemma of the case.References
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[8]Cook JR, Dehner LP, Collins MH, Ma Z, Morris SW, Coffin CM, et al. Anaplastic lymphoma kinase (ALK) expression in the inflammatory myofibroblastictumor: A comparative immunohistochemical study. Am J Surg Pathol 2001;25:1364-71.
[9] Spiess PE, Kassouf W, Steinberg JR et al., Review of the M.D. Anderson experience in the treatment of bladder sarcoma.Urologic Oncol 2007:25(1); 38-45.
[10] Ricciardi E, Maniglio P, Schimberni M, Moscarini M. A case of high-grade leiomyosarcoma of the bladder with delayed onset and very poor prognosis. World J Surgical Oncol 2010;8.
[11]. Hamadalla NY, Rifat UN, Safi KC, Mohammed M, Farsakh HA. Leiomyosarcoma of the urinary bladder: A review and a report of two further cases. Arab J Urol 2013;11:159-64.
[12] Yagnik V, Chadha A, Chaudhary S, Patel K. Inflammatory myofibroblastic tumour of the urinary bladder. Uro Ann 2010;2(2):78-9.
[2] Bjergaard JP, Jonsson V, Pedersen M, Jensen KH. “Leiomyosarcoma of the urinary bladder after cyclophosphamide”. J Clin Oncol 1995;13(2):532-3.
[3] Rosser CJ, Slaton JW, Izawa JI, Levy LB, Dinney CPN. Clinical presentation and outcome of high-grade urinary bladder leiomyosarcoma in adults. Urology 2003;61(6):1151-5.
[4] Roth JA. Reactive pseudosarcomatous response in urinary bladder. Urology 1980;16:635-7.
[5] Zones EC, Clement PB, Young RH. Inflammatory pseudotumour of the urinary bladders. A clinicopathologic, immunohistochemical, ultrstructural and flowcytometric study of 13 cases. Am J SurgPathol 1993;17:264-74.
[6] Coffin CM, Fletcher JA. Inflammatory myofibroblastic tumour. In: Fletcher CD, Unni KK, Mertens F, editors. World Health Organization Classification of Tumours: Tumours of Soft Tissue and Bone. Lyons, France: IARC Press; 2002. p. 91-3.
[7].Montgomery EA, Shuster DD, Burkart AL, Esteban JM, Sgrignoli A, Elwood L, et al. Inflammatory myofibroblastictumors of the urinary tract: A clinicopathologic study of 46 cases, including a malignant example of inflammatory fibrosarcoma and a subset associated with high-grade urothelial carcinoma. Am J Surg Pathol 2006;30:1502-12.
[8]Cook JR, Dehner LP, Collins MH, Ma Z, Morris SW, Coffin CM, et al. Anaplastic lymphoma kinase (ALK) expression in the inflammatory myofibroblastictumor: A comparative immunohistochemical study. Am J Surg Pathol 2001;25:1364-71.
[9] Spiess PE, Kassouf W, Steinberg JR et al., Review of the M.D. Anderson experience in the treatment of bladder sarcoma.Urologic Oncol 2007:25(1); 38-45.
[10] Ricciardi E, Maniglio P, Schimberni M, Moscarini M. A case of high-grade leiomyosarcoma of the bladder with delayed onset and very poor prognosis. World J Surgical Oncol 2010;8.
[11]. Hamadalla NY, Rifat UN, Safi KC, Mohammed M, Farsakh HA. Leiomyosarcoma of the urinary bladder: A review and a report of two further cases. Arab J Urol 2013;11:159-64.
[12] Yagnik V, Chadha A, Chaudhary S, Patel K. Inflammatory myofibroblastic tumour of the urinary bladder. Uro Ann 2010;2(2):78-9.
Published
05-11-2016
Section
Case Report
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