Inflammatory pseudotumor and sarcoma of urinary bladder: differential diagnosis and outcome in thirty-eight spindle cell neoplasms.

2.50
Hdl Handle:
http://hdl.handle.net/10541/83239
Title:
Inflammatory pseudotumor and sarcoma of urinary bladder: differential diagnosis and outcome in thirty-eight spindle cell neoplasms.
Authors:
Iczkowski, Kenneth A; Shanks, Jonathan H; Gadaleanu, V; Cheng, L; Jones, E C; Neumann, R; Nascimento, A G; Bostwick, David G
Abstract:
We assessed diagnostic criteria among 38 spindle cell tumors of the urinary bladder and obtained follow-up in 36 patients. Patients comprised 28 males and 10 females aged 2.5 months to 87 years. Hematuria was the commonest presenting symptom (27 patients). After review and immunohistochemical workup, 17 patients had inflammatory pseudotumor (myofibroblastic tumor), 4 postoperative spindle cell nodule, 1 leiomyoma, 13 sarcoma (7 low-grade; 6 high-grade), and 3 carcinoma. Mean age was 38 years for pseudotumor (range 15 to 74), 65 for postoperative spindle cell nodule, 51 for sarcoma, and 76 for carcinoma. Size of pseudotumor averaged 4.4 +/- 0.7 cm (range 1.5 to 13.0), similar to sarcoma, 4.0 +/- 0.6 cm (range 0.5 to 7.0). Similar proportions of benign tumors and sarcomas had muscularis propria invasion. The criteria that best differentiated sarcoma from inflammatory pseudotumor were presence of necrosis at the tumor-detrusor muscle interface in muscle-invasive cases, and nuclear atypia. Sarcoma also had less prominent microvasculature, less variable cellularity, consistently > or =1 mitotic figure per 10 high-power fields, and predominant acute inflammation without plasma cells. p53 protein nuclear immunostaining was moderate, unlike the rare to absent staining in pseudotumors. Because all 12 sarcomas were desmin-negative, we did not call them leiomyosarcoma; they overlapped with benign tumor in epithelial, mesenchymal, and actin immunostaining. Among 12 sarcoma patients, 2 died of tumor (at 3 months). Two of four experienced tumor recurrence after partial cystectomy (2 and 26 months). No pseudotumors recurred after transurethral resection or partial cystectomy, although one patient, 5 months after transurethral resection, had histologically identical pseudotumor that the surgeon considered residual. Another patient with pseudotumor, not a candidate for tumor ablation after transurethral resection, had continued tumor growth and he died of urosepsis. In conclusion, inflammatory pseudotumor, although overlapping with sarcoma in presentation, age range, and size, does not metastasize and remains histologically distinct from low-grade sarcoma.
Affiliation:
Department of Pathology and Laboratory Medicine, University of Florida and Veterans Administration Medical Center, Gainesville, Florida 32608-1197, USA. iczkoka@pathology.ufl.edu
Citation:
Inflammatory pseudotumor and sarcoma of urinary bladder: differential diagnosis and outcome in thirty-eight spindle cell neoplasms. 2001, 14 (10):1043-51 Mod. Pathol.
Journal:
Modern Pathology
Issue Date:
Oct-2001
URI:
http://hdl.handle.net/10541/83239
DOI:
10.1038/modpathol.3880434
PubMed ID:
11598176
Type:
Article
Language:
en
ISSN:
0893-3952
Appears in Collections:
All Christie Publications

Full metadata record

DC FieldValue Language
dc.contributor.authorIczkowski, Kenneth A-
dc.contributor.authorShanks, Jonathan H-
dc.contributor.authorGadaleanu, V-
dc.contributor.authorCheng, L-
dc.contributor.authorJones, E C-
dc.contributor.authorNeumann, R-
dc.contributor.authorNascimento, A G-
dc.contributor.authorBostwick, David G-
dc.date.accessioned2009-10-01T14:06:25Z-
dc.date.available2009-10-01T14:06:25Z-
dc.date.issued2001-10-
dc.identifier.citationInflammatory pseudotumor and sarcoma of urinary bladder: differential diagnosis and outcome in thirty-eight spindle cell neoplasms. 2001, 14 (10):1043-51 Mod. Pathol.en
dc.identifier.issn0893-3952-
dc.identifier.pmid11598176-
dc.identifier.doi10.1038/modpathol.3880434-
dc.identifier.urihttp://hdl.handle.net/10541/83239-
dc.description.abstractWe assessed diagnostic criteria among 38 spindle cell tumors of the urinary bladder and obtained follow-up in 36 patients. Patients comprised 28 males and 10 females aged 2.5 months to 87 years. Hematuria was the commonest presenting symptom (27 patients). After review and immunohistochemical workup, 17 patients had inflammatory pseudotumor (myofibroblastic tumor), 4 postoperative spindle cell nodule, 1 leiomyoma, 13 sarcoma (7 low-grade; 6 high-grade), and 3 carcinoma. Mean age was 38 years for pseudotumor (range 15 to 74), 65 for postoperative spindle cell nodule, 51 for sarcoma, and 76 for carcinoma. Size of pseudotumor averaged 4.4 +/- 0.7 cm (range 1.5 to 13.0), similar to sarcoma, 4.0 +/- 0.6 cm (range 0.5 to 7.0). Similar proportions of benign tumors and sarcomas had muscularis propria invasion. The criteria that best differentiated sarcoma from inflammatory pseudotumor were presence of necrosis at the tumor-detrusor muscle interface in muscle-invasive cases, and nuclear atypia. Sarcoma also had less prominent microvasculature, less variable cellularity, consistently > or =1 mitotic figure per 10 high-power fields, and predominant acute inflammation without plasma cells. p53 protein nuclear immunostaining was moderate, unlike the rare to absent staining in pseudotumors. Because all 12 sarcomas were desmin-negative, we did not call them leiomyosarcoma; they overlapped with benign tumor in epithelial, mesenchymal, and actin immunostaining. Among 12 sarcoma patients, 2 died of tumor (at 3 months). Two of four experienced tumor recurrence after partial cystectomy (2 and 26 months). No pseudotumors recurred after transurethral resection or partial cystectomy, although one patient, 5 months after transurethral resection, had histologically identical pseudotumor that the surgeon considered residual. Another patient with pseudotumor, not a candidate for tumor ablation after transurethral resection, had continued tumor growth and he died of urosepsis. In conclusion, inflammatory pseudotumor, although overlapping with sarcoma in presentation, age range, and size, does not metastasize and remains histologically distinct from low-grade sarcoma.en
dc.language.isoenen
dc.subjectUrinary Bladder Canceren
dc.subjectTumour Suppressor Protein p53en
dc.subject.meshActins-
dc.subject.meshAdolescent-
dc.subject.meshAdult-
dc.subject.meshAged-
dc.subject.meshAged, 80 and over-
dc.subject.meshChild-
dc.subject.meshChild, Preschool-
dc.subject.meshCystectomy-
dc.subject.meshDesmin-
dc.subject.meshDiagnosis, Differential-
dc.subject.meshFemale-
dc.subject.meshFollow-Up Studies-
dc.subject.meshGranuloma, Plasma Cell-
dc.subject.meshHumans-
dc.subject.meshImmunohistochemistry-
dc.subject.meshInfant-
dc.subject.meshKeratins-
dc.subject.meshMale-
dc.subject.meshMiddle Aged-
dc.subject.meshMucin-1-
dc.subject.meshMuscle, Smooth-
dc.subject.meshS100 Proteins-
dc.subject.meshSarcoma-
dc.subject.meshTreatment Outcome-
dc.subject.meshTumor Suppressor Protein p53-
dc.subject.meshUrinary Bladder-
dc.subject.meshUrinary Bladder Diseases-
dc.subject.meshUrinary Bladder Neoplasms-
dc.subject.meshVimentin-
dc.titleInflammatory pseudotumor and sarcoma of urinary bladder: differential diagnosis and outcome in thirty-eight spindle cell neoplasms.en
dc.typeArticleen
dc.contributor.departmentDepartment of Pathology and Laboratory Medicine, University of Florida and Veterans Administration Medical Center, Gainesville, Florida 32608-1197, USA. iczkoka@pathology.ufl.eduen
dc.identifier.journalModern Pathologyen

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