Urinary bladder carcinoma with triplicate differentiations into giant cell sarcomatoid carcinoma, squamous cell carcinoma, and papillary urothelial transitional cell carcinoma: a case report
Abstract
The author reports a very rare and very unique urinary bladder carcinoma. This carcinoma occurred in a 68-year-old Japanese patient who underwent cystectomy for bladder tumor. The tumor was large polypoid and ulcerated one. Histologically, the tumor consisted of the following three elements: giant cell sarcomatoid carcinoma (70% in area), squamous cell carcinoma (20% in area), and papillary urothelial transitional cell carcinoma (10% in area). The former two elements were invasive into the peribladder fat tissue, while the latter one element invaded into the submucosa. There were gradual merges between the giant cell sarcomatoid element and squamous cell carcinoma element. Apparent transitions were not seen between the transitional cell carcinoma element and the giant cell sarcomatoid element or the squamous cell carcinoma element. Immunohistochemically, the giant cell sarcomatoid element was positive for various kinds of cytokeratins and vimentin while the squamous and transitional cell carcinoma elements were positive for various kinds of cytokeratins and negative for vimentin. The giant cell sarcomatoid element was free of other specific antigens. The author speculates that giant cell sarcomatoid carcinoma transdifferentiates into squamous cell carcinoma, and vice versa. The relationship between transitional cell carcinoma and the other two elements is unclear in the present case
Key Questions
1. What is the primary objective of the study?
The study aims to report a unique case of urinary bladder carcinoma exhibiting triplicate differentiations into giant cell sarcomatoid carcinoma, squamous cell carcinoma, and papillary urothelial transitional cell carcinoma.
2. What methodology was employed in the research?
A 68-year-old Japanese male patient underwent cystectomy for a bladder tumor. Histological examination of the tumor revealed three components:
- Giant cell sarcomatoid carcinoma (70% of the tumor)
- Squamous cell carcinoma (20% of the tumor)
- Papillary urothelial transitional cell carcinoma (10% of the tumor)
3. What were the main findings of the study?
The giant cell sarcomatoid carcinoma and squamous cell carcinoma components were invasive into the peribladder fat tissue. The papillary urothelial transitional cell carcinoma component invaded the submucosa. Immunohistochemically, the giant cell sarcomatoid carcinoma was positive for various cytokeratins and vimentin, while the squamous and transitional cell carcinoma components were positive for various cytokeratins and negative for vimentin.
Summary
Terada (2009) reports a rare case of urinary bladder carcinoma exhibiting triplicate differentiations into giant cell sarcomatoid carcinoma, squamous cell carcinoma, and papillary urothelial transitional cell carcinoma. This case highlights the diverse histological presentations that bladder carcinomas can exhibit and underscores the importance of comprehensive histopathological and immunohistochemical evaluations in diagnosing complex carcinoma cases.
