The clinical course of advanced urothelial cancer is generally characterized by a more aggressive biological behavior over time. This is typically accompanied by phenotypic evolution patterns is readily recognized to reflect the more aggressive biological behavior. In this context, recognition of areas with spindled histomorphology is fairly common. When this pattern becomes dominant, cancers are often described as sarcomatoid carcinomas. These cases have long recognized, and many series of cases and fixes are available.
There remain several reports of sporadic cases each year. Almost always, recognizable as Highgrade nonspindled TCC areas are also present, suggesting that this pattern of results of evolution from a common ancestor. Indeed, by immunohistochemistry, the spindle areas are generally positive for keratin, epithelial membrane antigen and vimentin. (When the epithelial markers are lost in a significant fraction of tumor cells, the term carcinosarcoma is adequate, but the literature makes no systematic distinction between these two terms.) Clonality analysis based on loss of heterozygosity (LOH) of microsatellite markers5, 6 provides strong evidence that despite the various components can and should evolve independently once they diverge, they do, in fact, derive from a common precursor.
While it is clear that we can define a subset of sarcomatoid appearance, which is more important to know what such an important biological morphology portends. Although there appear to be particular risk factors or clinically distinctive features at initial presentation, a recurrent theme in the clinical experience with sarcomatoid urothelial cancer is having an aggressive natural history and poor outcome in relation to the classics of TCC . This is confirmed by the registration of MD Anderson in both locally advanced and metastatic settings. In view of this, we believe that the presence of a sarcomatoid component in bladder cancer minimally invasive otherwise be a strong indicator of early cystectomy. We know of no data to recommend a specific therapeutic approach of systemic therapy. Although we have investigated more intensive chemotherapy in this subgroup, who have no sense that this is justified by better results and does not endorse this approach in the absence of a clinical trial. It is very important to realize that not everything that appears spindle is dangerous.
In particular, the post-resection of sarcomatous nodules and inflammatory pseudotumor should not be confused with aggressive cancers that have some resemblance. In addition to the clinical context, it is reported that the presence of necrosis at the interface of muscle and nuclear atypia are the most useful features that distinguish true sarcomas or sarcomatoid carcinomas of these benign conditions. Although extremely rare, true sarcomas without an epithelial component occur in the bladder, and listed in the section of "sarcoma".
There remain several reports of sporadic cases each year. Almost always, recognizable as Highgrade nonspindled TCC areas are also present, suggesting that this pattern of results of evolution from a common ancestor. Indeed, by immunohistochemistry, the spindle areas are generally positive for keratin, epithelial membrane antigen and vimentin. (When the epithelial markers are lost in a significant fraction of tumor cells, the term carcinosarcoma is adequate, but the literature makes no systematic distinction between these two terms.) Clonality analysis based on loss of heterozygosity (LOH) of microsatellite markers5, 6 provides strong evidence that despite the various components can and should evolve independently once they diverge, they do, in fact, derive from a common precursor.
While it is clear that we can define a subset of sarcomatoid appearance, which is more important to know what such an important biological morphology portends. Although there appear to be particular risk factors or clinically distinctive features at initial presentation, a recurrent theme in the clinical experience with sarcomatoid urothelial cancer is having an aggressive natural history and poor outcome in relation to the classics of TCC . This is confirmed by the registration of MD Anderson in both locally advanced and metastatic settings. In view of this, we believe that the presence of a sarcomatoid component in bladder cancer minimally invasive otherwise be a strong indicator of early cystectomy. We know of no data to recommend a specific therapeutic approach of systemic therapy. Although we have investigated more intensive chemotherapy in this subgroup, who have no sense that this is justified by better results and does not endorse this approach in the absence of a clinical trial. It is very important to realize that not everything that appears spindle is dangerous.
In particular, the post-resection of sarcomatous nodules and inflammatory pseudotumor should not be confused with aggressive cancers that have some resemblance. In addition to the clinical context, it is reported that the presence of necrosis at the interface of muscle and nuclear atypia are the most useful features that distinguish true sarcomas or sarcomatoid carcinomas of these benign conditions. Although extremely rare, true sarcomas without an epithelial component occur in the bladder, and listed in the section of "sarcoma".