CARCINOSARCOMA AND SARCOMATOID CARCINOMA OF THE BLADDER - CLINICOPATHOLOGICAL STUDY OF 41 CASES

Purpose: Carcinosarcoma of the bladder is a rare neoplasm characterize d by an intimate admixture of carcinoma and malignant soft tissue neop lasm. The clinical usefulness of separating carcinosarcoma (carcinoma with sarcomatous component) from sarcomatoid carcinoma (carcinoma with spindle cell carcinomatous component) is uncertain, and it comprises the subject of this report. Materials and Methods: We reviewed the cli nical and pathological records of 10 men and 5 women a mean of 66 year s old with carcinosarcoma, and 21 men and 5 women a mean of 66.5 years old with sarcomatoid carcinoma of the bladder, as documented in the f iles of the Mayo Clinic between 1936 and 1995. Results: Of the 15 pati ents in the carcinosarcoma group 9 had urothelial carcinoma, small cel l carcinoma, 3 had squamous cell carcinoma and 2 had more than 1 type. The sarcomatous component included chondrosarcoma in 3 cases, leiomyo sarcoma in 3, malignant fibrous histiocytoma in 3, osteosarcoma in 2, fibrosarcoma in 1, rhabdomyosarcoma in 1 and more than 1 type in 2. Al l disease was high stage at presentation. Treatment included cystectom y in 11 patients with (4) and without (7) radiation therapy, and trans urethral resection in 4 with (1) and without (3) radiation therapy. Me an followup available in 14 cases was 34 months (range 1 to 144). A to tal of 11 patients died of cancer at 1 to 48 months (mean 17.2) and 2 survived for 8 to 131 months. Of the 26 patients in the sarcomatoid ca rcinoma group 18 had urothelial carcinoma, 1 had squamous carcinoma, 2 had urothelial carcinoma combined with squamous cell carcinoma and 5 had spindle cells only with no recognizable epithelium. All but 1 case was high stage at diagnosis. Treatment included transurethral resecti on in 17 patients with (7) and without (10) radiation therapy, includi ng 1 who also received chemotherapy, and only cystectomy in 5, includi ng 2 who also underwent radiation therapy and 1 who also received chem otherapy. Mean followup available in 21 cases was 49 months (range 1 t o 420). A total of 17 patients died of cancer at 1 to 73 months (mean 9.8), 1 was alive at 140 months and 3 died of unrelated causes. Conclu sions: Carcinosarcoma and sarcomatoid carcinoma of the bladder are hig hly aggressive malignancies with a similar outcome regardless of histo logical findings and treatment. Pathological stage is the best predict or of survival.