PMC2642852_01
Computed tomography. Unenhanced (a) and enhanced (b) CT of pelvis showing diffuse extensive thickening of bladder wall.
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F1
Computerized tomography (CT) of the pelvis indicated diffuse thickening of the bladder wall throughout the organ and obscured fat planes between the bladder and uterus, arousing suspicion of perivesical tissue invasion by a malignancy (Figures 1a and 1b).
Macroscopic appearance of the tumor; (b) shows a horizontal slice taken from the body of bladder.
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F2
It extended from the dome down to the urethra, involving the trigone and bladder neck plus both ureteral orifices, as well as the right lateral and anterior walls distally (Figure 2).
Low (a) and high power (b) pictures of the sarcoma. Highly pleomorphic cellular tumor is seen with areas of osteoid (indicated by arrow) and chondroid (indicated by asterix) formations. Non-neoplastic surface epithelium overlying the tumor is apparent in part (a). Osteoclast-type multinucleated giant cells are seen scattered among malignant cells, seen in part (b). (a: H-E x 40; b: H-E x 200).
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F3
Neoplastic cells formed large areas of malignant cartilage and lacelike osteoid in addition to short interlacing fascicles (Figure 3).
Immunohistochemistry. a) Neoplastic cells do not express cytokeratins. Normal urothelium constitutes the positive intrinsic control of the stain (Primary anti-pancytokeratin Ab, ABC x 100). b) Diffuse and strong p53 positivity by the neoplasm (Primary anti-p53 Ab, ABC x 200).
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F4
Immunohistochemical stains performed on the paraffin-embedded material showed no reaction for pan-cytokeratin, cytokeratin 7, cytokeratin 20, p63 or epithelial membrane antigen (EMA) (Figure 4).