PMC7268166_01
CT and MRI findings. (a) CT reveals no abnormal findings in July 2017. (b) CT reveals the contrast-enhanced wall thickening near the left ureteral orifice in December 2017 (arrow). (c) T2-weighted image of MRI reveals that the tumor in the vicinity of the left ureteral orifice is a low signal lesion without obvious muscle invasion in January 2018 (arrow). (d) On dynamic contrast enhancement imaging, the lesion demonstrates early uptake at the same lesion as the T2-weighted image (arrow). (e) CT findings suspect metastasis in the left lower lobe of the lung in July 2018 (arrow). (f) CT findings reveal a decrease in the size of the nodules in the left lower lobe in September 2018 (arrow).
10.1177_2050313X20927615-fig1.jpg
PMC7268166_01_10.1177_2050313X20927615-fig1.jpg
fig1-2050313X20927615
Computed tomography (CT) revealed no abnormal findings (Figure 1(a)). Class III. CT revealed contrast-enhanced wall thickening near the left ureteral orifice (Figure 1(b)). Magnetic resonance imaging (MRI) did not reveal obvious muscle invasion of the tumor in the vicinity of the left ureteral orifice (Figure 1(c) and (d)). Three months after the operation, CT findings suggested metastasis in the left lower lobe of the lungs in July 2018 (Figure 1(e)). The patient underwent four courses of chemotherapy with doxorubicin, and the nodule in the left lower lobe decreased in size (Figure 1(f)).
Cystoscopic findings and histopathological findings of excised specimen by TURBO. Cystoscopy revealed a papillary broad-base tumor in the upper left lateral side of the bladder ((a), left side of (c)) and a non-papillary tumor in the upper lateral side of the left ureteral orifice ((b), right side of (c)) in December 2017. (d) and (e) The pathological findings of a non-papillary tumor in the upper lateral side of the left ureteral orifice obtained by TURBO (right side of (c)) reveal invasive urothelial carcinoma with sarcomatous/osteosarcoma variant with vascular invasion (pT2a) in January 2018. (f) The tumor cells located in CD31-positive blood vessels. The immunohistochemical findings of this case are consistent with the sarcomatoid variant of urothelial carcinoma based on both an associated basal-type urothelial carcinoma components: (g) CK5/6-positive, (h) CK20-negative, and (i) GATA3-positive; and a sarcomatoid component: (j) vimentin-positive. The sarcomatoid variant lesion also retains the elements of basal-type urothelial carcinoma: (g) CK5/6 positive, (h) CK20-negative, and (i) GATA3 positive.
10.1177_2050313X20927615-fig2.jpg
PMC7268166_01_10.1177_2050313X20927615-fig2.jpg
fig2-2050313X20927615
Cystoscopy revealed a papillary broad-base tumor on the upper left lateral side of the bladder and a non-papillary tumor on the upper lateral side of the left ureteral orifice in December 2017 (Figure 2(a) and (b)). TUR-BT in one piece (TURBO) for two lesions in January 2018 (Figure 2(c)). The non-papillary tumor showed invasive basal-type urothelial carcinoma with sarcomatous/osteosarcoma variant with vascular invasion (pT2a) (Figure 2(d)-(j)). The patient underwent laparoscopic radical cystoprostatectomy and orthotopic neobladder reconstruction using ileum in March 2018.