ANGIOSARCOMA OF THE BLADDER - A REVIEW

Objectives. To present a new case of angiosarcoma of the bladder, revi ew 9 other previously reported cases, and discuss the unique features of our case with regard to presentation, treatment, and clinical cours e of patients with this exceedingly rare tumor. The utility of multimo dality therapy is emphasized. Methods. We report the latest case of an giosarcoma of the bladder. We also reviewed the world literature (MEDL INE) and discovered 9 previously reported cases of angiosarcoma of the bladder. Presentation, treatment, and clinical course were analyzed. Results. Of the 10 cases, 2 were considered to have arisen from a pree xisting bladder hemangioma. Two patients had a history of prior gyneco logic malignancies treated with external beam radiotherapy, with subse quent sarcoma formation within the past treatment field. Two other pat ients presented with skin lesions that predated the discovery of bladd er lesions. Only 4 patients presented with primary bladder lesions and no preexisting disease or previous carcinogenic exposure (except for tobacco use). Hematuria was a universal presentation, and treatment wa s widely variant. Of the 10 patients, 8 died during a period of follow -up of 23 months. Five patients died of tumor-related causes. Mean sur vival of these 5 was 10.6 months. The 2 most recent patients (includin g ours) were alive and tumor free at 8 and 32 months, respectively. Bo th of these patients underwent multimodality oncologic approaches as p art of their treatment regimen. Conclusions. Angiosarcoma of the bladd er is exceedingly rare and usually fatal. Prognosis is poorer than tha t of angiosarcomas in more traditional sites. Regional lymph nodes are typically spared, but local recurrence with eventual distant metastas is is the rule. Optimal therapy has not been determined, but it most l ikely should involve a multimodal approach combining radical surgery w ith chemotherapy and radiotherapy. (C) 1998, Elsevier Science Inc. All rights reserved.