Inflammatory pseudotumor and sarcoma of urinary bladder: differential diagnosis and outcome in thirty-eight spindle cell neoplasms. Mod Pathol 2001 Oct;14(10):1043-51
Date
10/13/2001Pubmed ID
11598176DOI
10.1038/modpathol.3880434Scopus ID
2-s2.0-0034775813 (requires institutional sign-in at Scopus site) 128 CitationsAbstract
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.
Author List
Iczkowski KA, Shanks JH, Gadaleanu V, Cheng L, Jones EC, Neumann R, Nascimento AG, Bostwick DGMESH terms used to index this publication - Major topics in bold
ActinsAdolescent
Adult
Aged
Aged, 80 and over
Child
Child, Preschool
Cystectomy
Desmin
Diagnosis, Differential
Female
Follow-Up Studies
Granuloma, Plasma Cell
Humans
Immunohistochemistry
Infant
Keratins
Male
Middle Aged
Mucin-1
Muscle, Smooth
S100 Proteins
Sarcoma
Treatment Outcome
Tumor Suppressor Protein p53
Urinary Bladder
Urinary Bladder Diseases
Urinary Bladder Neoplasms
Vimentin