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Inicio Actas Urológicas Españolas (English Edition) Sarcomatoid urothelial bladder carcinoma in adults: Histology, symptomatology, t...
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Vol. 43. Issue 2.
Pages 106-110 (March 2019)
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Vol. 43. Issue 2.
Pages 106-110 (March 2019)
Review article
Sarcomatoid urothelial bladder carcinoma in adults: Histology, symptomatology, treatments and survival
Carcinoma urotelial sarcomatoide de vejiga en el adulto: histología, sintomatología, tratamientos y supervivencia
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X.A. Sabaté Arroyoa,
Corresponding author
sabate.arnau@gmail.com

Corresponding author.
, H. Rodrigo Larab, P. Carrillo Garcíab, J. Brugarolas Rossellóa, P. Pizá Reusa
a Servicio Urologia, Hospital Universitari Son Espases, Palma de Mallorca, Spain
b Servicio de Anatomía Patológica, Hospital Universitari Son Espases, Palma de Mallorca, Spain
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Abstract
Objective

Sarcomatoid urothelial bladder carcinoma comprises 3% of the tumours of the bladder and is considered one of the most aggressive tumours of the urinary tract. Our aim is to analyze the characteristics of sarcomatoid urothelial bladder carcinoma in adults, its treatments and survival.

Method

A retrospective study performed between 2000 and 2017 of all the patients with a sarcomatoid urothelial bladder carcinoma in a single centre. We studied the anatomopathological characteristics, symptoms at time of diagnosis, treatment given and survival according to the treatment given.

Results

Sixteen patients were diagnosed with sarcomatoid carcinoma, 11 with no heterologous component, one with rhabdomyosarcomatous components, 2 with chondrosarcomatous components and 2 with osteosarcomatous components. The mean age was 74 years (±20) and 88% were smokers. The primary symptom was haematuria, and the least well-tolerated was dysuria together with hypogastric pain. Ninety-four percent of the patients had muscle layer infiltration and 18% had metastases at the time of diagnosis. Thirty-seven percent of the patients were treated by radical cystectomy, thirteen percent by radical cystectomy plus adjuvant chemotherapy, and 50% were treated by palliative transurethral resection to control their symptoms. A survival curve was made with the different treatments given, which showed a mean global survival of 7 months and no statistically significant differences in terms of survival according to the treatment given.

Conclusions

Sarcomatoid urothelial carcinoma is an aggressive disease, of rapid and torpid onset which occurs in patients of advanced age and smokers. There are no established treatment guidelines, and it appears that no treatment influences increased survival. Cystectomy should be evaluated as a treatment alternative for patients whose symptoms are difficult to control. The various heterologous components do not appear to influence the progression of the disease or patient survival.

Keywords:
Sarcomatoid urothelial carcinoma
Radical cystectomy
Rhabdomyosarcoma
Osteosarcoma
Chondrosarcoma
Resumen
Objetivo

El carcinoma urotelial sarcomatoide vesical representa el 0,3% de los tumores de vejiga y es considerado unos de los tumores más agresivos del tracto urinario. Nuestro objetivo es analizar las características del carcinoma urotelial sarcomatoide de vejiga en la edad adulta, tratamientos realizados y supervivencia.

Método

Estudio retrospectivo entre el año 2000 y el 2017 de todos los pacientes con diagnóstico de carcinoma urotelial sarcomatoide de vejiga en un solo centro. Se analizan características anatomopatológicas, sintomatología en el momento del diagnóstico, tratamiento realizado y supervivencia según tratamiento llevado a cabo.

Resultados

Dieciséis pacientes fueron diagnosticados de carcinoma sarcomatoide, 11 sin componente heterólogo, uno con componente rabdomiosarcoma, 2 con componente condrosarcoma y 2 con componente osteosarcoma. La edad media fue de 74 años (±20) y el 88% eran fumadores. El síntoma principal fue la hematuria y el peor tolerado la disuria conjuntamente con el dolor hipogástrico. El 94% de los pacientes presentaron infiltración de la capa muscular y el 18% metástasis en el momento del diagnóstico. En el 37% de los pacientes se realizó tratamiento mediante cistectomía radical, en el 13% mediante cistectomía radical más quimioterapia adyuvante y en el 50% mediante resección transuretral de forma paliativa para conseguir el control de los síntomas. Se realizó una curva de supervivencia con los diferentes tratamientos realizados, presentando una supervivencia media global de 7 meses y sin observar diferencias estadísticamente significativas en cuanto a la supervivencia según el tratamiento realizado.

Conclusiones

El carcinoma urotelial sarcomatoide es una enfermedad agresiva, de evolución rápida y tórpida que se produce en pacientes de edad avanzada y fumadores. No existen pautas de tratamiento establecidas y no parece que ningún tratamiento influya en un aumento de la supervivencia de los pacientes. Se debe de valorar la cistectomía como alternativa de tratamiento en aquellos pacientes de difícil control sintomatológico. Los diferentes componentes heterólogos no parecen influir en la evolución de la enfermedad ni en la supervivencia del paciente.

Palabras clave:
Carcinoma urotelial sarcomatoide
Cistectomía radical
Rabdomiosarcoma
Osteosarcoma
Condrosarcoma

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