J Pathol Transl Med.  2021 Jul;55(4):298-302. 10.4132/jptm.2021.04.23.

Sarcomatoid urothelial carcinoma arising in the female urethral diverticulum

• Park HS

• KMID: 2518430
• DOI: http://doi.org/10.4132/jptm.2021.04.23

Abstract

A sarcomatoid variant of urothelial carcinoma in the female urethral diverticulum has not been reported previously. A 66-year-old woman suffering from dysuria presented with a huge urethral mass invading the urinary bladder and vagina. Histopathological examination of the resected specimen revealed predominantly undifferentiated pleomorphic sarcoma with sclerosis. Only a small portion of conventional urothelial carcinoma was identified around the urethral diverticulum, which contained glandular epithelium and villous adenoma. The patient showed rapid systemic recurrence and resistance to immune checkpoint inhibitor therapy despite high expression of programmed cell death ligand-1. We report the first case of urethral diverticular carcinoma with sarcomatoid features.

Keyword

Sarcomatoid carcinoma; Urothelial carcinoma; Urethral diverticulum

Figure

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  Fig. 1. Enhanced abdominopelvic computed tomography. (A) Axial image taken 7 months prior to presentation showed a urethral diverticulum (asterisk) at the level of the symphysis pubis. (B) Preoperative image revealed a large urethral mass (UB, urinary bladder; arrow, urinary catheter within the urethra).

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  Fig. 2. Histopathological findings. (A) Gross examination revealed a 10-cm-sized, hard white urethral mass invading the uterus, vagina, urinary bladder, and perivesical fat. The cut surface showed necrosis and cystic space (arrowheads). (B) Microscopically, the majority of the tumor was composed of pleomorphic spindle cells with occasional collagen deposition. Intratumoral lymphoplasmacytic infiltration was noted. (C, D) The cystic space was lined focally by glandular epithelium (C) and associated villous adenoma (D). (E) A conventional urothelial carcinoma component was minimally present, and areas of epithelial-to-mesenchymal transition were noted.

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  Fig. 3. Results of immunohistochemical staining. (A) Immunostaining for cytokeratin 7 highlighted the glandular epithelium (left side) and urothelial carcinoma component, whereas there was no staining of the sarcoma component. (B) Programmed death ligand-1 SP142 (Ventana Medical Systems, Tucson, AZ, USA) immunostaining showed diffuse positivity (90%) in tumor-infiltrating immune cells (ICs) of the sarcoma component, while ICs of the carcinoma component were negative.

Reference

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