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      Complete Response of Rare Sarcomatoid Upper Tract Urothelial Carcinoma Variant: Case Report and Literature Review

      case-report

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          Abstract

          Infiltrating urothelial carcinoma sarcomatoid variant is a rare variant of urothelial carcinoma. We report a case of a 68-year-old female with a history of hematuria. CT scan with contrast showed a mass in the 1/3 distal of the right ureter. The biopsy result showed a high-grade infiltrating urothelial carcinoma. A radical nephroureterectomy was performed but at the follow-up after 3 months, there was a recurrent mass and gemcitabine-cisplatin chemotherapy was given. Since a high-grade infiltrating urothelial carcinoma sarcomatoid variant was an aggressive tumor, we need to give more attention to evaluating this tumor.

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          Most cited references13

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          What Is the Significance of Variant Histology in Urothelial Carcinoma?

          Urothelial carcinoma can exhibit a wide range of variant morphologies. Many variants present diagnostic challenges and carry clinical implications that inform prognosis and treatment decisions.
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            Sarcomatoid carcinoma of the urinary bladder: the final common pathway of urothelial carcinoma dedifferentiation.

            Sarcomatoid carcinoma of the urinary bladder is an unusual malignancy composed of both carcinomatous and sarcomatous components. It is an aggressive tumor that presents at an advanced stage and confers a much poorer prognosis than conventional urothelial carcinoma. The proper nomenclature and histogenesis of these tumors have been subjects of debate for some time. There is an emerging consensus that sarcomatoid carcinoma is the most appropriate term for these neoplasms. The recent World Health Organization classification has applied this term to all tumors showing morphologic and/or immunologic evidence of both malignant epithelial and mesenchymal differentiation. Such tumors have been postulated to represent either multiclonal collision tumors or monoclonal cancers with divergent differentiation; recent molecular studies favor the latter theory. In this study, we discuss the nomenclature, clinical features, pathology, differential diagnosis, molecular genetics, and histogenesis of sarcomatoid carcinoma. We emphasize the importance of molecular genetic studies in providing insight into the histogenesis of this neoplasm. Sarcomatoid carcinoma seems to represent the final common pathway of urothelial carcinoma dedifferentiation.
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              Sarcomatoid Variant of Urothelial Carcinoma (Carcinosarcoma, Spindle Cell Carcinoma): A Review of the Literature

              Background. Sarcomatoid variant of urothelial carcinoma (SVUC) was added to the WHO classification in 2004. Aims. To review the literature. Materials and Method. Various internet databases were used. Result. SVUCs are rare biphasic malignant neoplasms exhibiting morphologic/immunohistochemical evidence of epithelial and mesenchymal differentiation with the presence or absence of heterologous elements. Some cases of SVUC have been associated with radiation therapy and cyclophosphamide treatment. Patients' ages range from 50 to 77 years (mean age 66). Patients tend to be younger and they more commonly presented with high-grade histology and advanced stage disease, in comparison with patients who had conventional urothelial carcinoma (CUC). Results of molecular/genetic studies strongly argue for a common monoclonal cell origin of both the epithelial and mesenchymal components in SUVC. The cancer specific survival of SVUC is poor in comparison with CUC. Radical surgical excision and chemoradiation may be associated with improved prognosis; chemoradiation as an organ preserving alternative to radical excision may be associated with improved outcome. There is no consensus opinion on the best treatment modalities for SUVC. Conclusions. SVUC is rare and is associated with inferior outcome compared with CUC. A multicentre trial of various treatment options is required. Cases of SVUC should be reported.
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                Author and article information

                Journal
                Case Rep Oncol
                Case Rep Oncol
                CRO
                CRO
                Case Reports in Oncology
                S. Karger AG (Basel, Switzerland )
                1662-6575
                12 May 2023
                Jan-Dec 2023
                12 May 2023
                : 16
                : 1
                : 325-330
                Affiliations
                [a ]Division of Urology, Department of Surgery, Faculty of Medicine, Universitas Sumatera Utara – Haji Adam Malik General Hospital, Medan, Indonesia
                [b ]Department of Urology, Universitas Sumatera Utara Hospital, Universitas Sumatera Utara, Medan, Indonesia
                [c ]Department of Anatomical Pathology, Faculty of Medicine, Universitas Sumatera Utara, Medan, Indonesia
                [d ]Department of Urology, Faculty of Medicine, Universitas Indonesia ‒ Haji Adam Malik General Hospital, Medan, Indonesia
                Author notes
                Correspondence to: Syah Mirsya Warli, warli@ 123456usu.ac.id
                Article
                530264
                10.1159/000530264
                10176196
                37187682
                872d434e-20b6-4397-8bbd-7cb5e6fe286b
                © 2023 The Author(s). Published by S. Karger AG, Basel

                This article is licensed under the Creative Commons Attribution-NonCommercial 4.0 International License (CC BY-NC) ( http://www.karger.com/Services/OpenAccessLicense). Usage and distribution for commercial purposes requires written permission.

                History
                : 8 November 2022
                : 3 March 2023
                : 2023
                Page count
                Figures: 4, References: 13, Pages: 6
                Funding
                This research did not receive any funding from public, commercial, or non-for-profit sectors.
                Categories
                Case Report

                Oncology & Radiotherapy
                urothelial carcinoma variant,urothelial carcinoma,sarcomatoid variant

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