Cutaneous invasion from sarcomatoid urothelial carcinoma: clinical and dermatopathologic features

In Brazil, without considering the non-melanoma skin tumors, bladder cancer in men is the eighth most common, and the urothelial carcinoma or transitional cell carcinoma is the most common among these. Cutaneous metastases from urothelial neoplasms appear as single or multiple erythematous, infiltrated nodules or plaques, and like other cases of distant disease, it is indicative of poor prognosis. The invasive urothelial carcinoma is recognized for its ability to present divergent differentiation and morphological variants. The sarcomatoid urothelial carcinoma is a rare cancer that consists of two different components: one composed of epithelial tissue and the other with sarcomatoid features of mesenchymal origin. The authors describe a case of cutaneous metastasis of sarcomatoid urothelial carcinoma in a 63-year-old male patient.

Keywords:
Immunohistochemistry; Urinary bladder Neoplasms; Sarcoma

Authorship

Fred Bernardes FilhoMailing address: Fred Bernardes Filho, Rua Marquês de Caxias, 9, Sobrado, Centro. 24030-050. - Niterói - RJ Brazil.f9filho@gmail.com

Instituto de Dermatologia Professor Rubem David Azulay - Santa Casa de Misericórdia do Rio de Janeiro (IDPRDA-SCMRJ) - Rio de Janeiro (RJ), Brazil.Santa Casa de Misericórdia do Rio de JaneiroBrazilRio de Janeiro, RJ, BrazilInstituto de Dermatologia Professor Rubem David Azulay - Santa Casa de Misericórdia do Rio de Janeiro (IDPRDA-SCMRJ) - Rio de Janeiro (RJ), Brazil.

Alessandro Severo Alves de Melo

Universidade Federal Fluminense (UFF) - Niterói (RJ), Brazil.Universidade Federal FluminenseBrazilNiterói, RJ, BrazilUniversidade Federal Fluminense (UFF) - Niterói (RJ), Brazil.

Andréa Rodriguez Cordovil Pires

Universidade Federal Fluminense (UFF) - Niterói (RJ), Brazil.Universidade Federal FluminenseBrazilNiterói, RJ, BrazilUniversidade Federal Fluminense (UFF) - Niterói (RJ), Brazil.

Omar Lupi

Universidade Federal do Estado do Rio de Janeiro (UNIRIO) - Rio de Janeiro (RJ), Brazil.Universidade Federal do Estado do Rio de JaneiroBrazilRio de Janeiro, RJ, BrazilUniversidade Federal do Estado do Rio de Janeiro (UNIRIO) - Rio de Janeiro (RJ), Brazil.

Universidade Federal do Rio de Janeiro (UFRJ) - Rio de Janeiro (RJ), Brazil.Universidade Federal do Rio de JaneiroBrazilRio de Janeiro, RJ, BrazilUniversidade Federal do Rio de Janeiro (UFRJ) - Rio de Janeiro (RJ), Brazil.

Policlínica Geral do Rio de Janeiro (PGRJ) - Rio de Janeiro (RJ), Brazil.Policlínica Geral do Rio de JaneiroBrazilRio de Janeiro, RJ, BrazilPoliclínica Geral do Rio de Janeiro (PGRJ) - Rio de Janeiro (RJ), Brazil.

Daniel Gama das Neves

Universidade Federal Fluminense (UFF) - Niterói (RJ), Brazil.Universidade Federal FluminenseBrazilNiterói, RJ, BrazilUniversidade Federal Fluminense (UFF) - Niterói (RJ), Brazil.

Margareth Fernandes da Cruz

Hospital Orêncio de Freitas - Niterói (RJ), Brazil.Hospital Orêncio de FreitasBrazilNiterói, RJ, BrazilHospital Orêncio de Freitas - Niterói (RJ), Brazil.

Bernard Kawa Kac

Private clinic - Rio de Janeiro (RJ), Brazil.Private clinic - Rio de Janeiro (RJ), Brazil.BrazilRio de Janeiro, RJ, BrazilPrivate clinic - Rio de Janeiro (RJ), Brazil.

Mailing address: Fred Bernardes Filho, Rua Marquês de Caxias, 9, Sobrado, Centro. 24030-050. - Niterói - RJ Brazil.f9filho@gmail.com

Conflict of Interests: None.

SCIMAGO INSTITUTIONS RANKINGS

Universidade Federal Fluminense (UFF) - Niterói (RJ), Brazil.Universidade Federal FluminenseBrazilNiterói, RJ, BrazilUniversidade Federal Fluminense (UFF) - Niterói (RJ), Brazil.

Hospital Orêncio de Freitas - Niterói (RJ), Brazil.Hospital Orêncio de FreitasBrazilNiterói, RJ, BrazilHospital Orêncio de Freitas - Niterói (RJ), Brazil.

Private clinic - Rio de Janeiro (RJ), Brazil.Private clinic - Rio de Janeiro (RJ), Brazil.BrazilRio de Janeiro, RJ, BrazilPrivate clinic - Rio de Janeiro (RJ), Brazil.

Figures

Figures (7)

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Figure 1
Primary neoplasm invading bladder mucosa and muscles; uncontrolled infiltrative growth with atypical epithelial cells. 2. Dissected collagen bundles; 3. Angiogenesis induced by neoplasm; 4. Undifferentiated atypical epithelioid cells forming cords and irregular aggregates, without a definite architectural pattern.

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Figure 2
Erythematous purpuric plaque, infiltrated, located in the infraumbilical midline scar and two erythematous-wine colored nodules in the midline, suprapubic region; the black arrow marks the biopsied nodule. Suprapubic cystostomy with urine leakage

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Figure 3
Tomography of abdomen and pelvis: (a) Cut at bladder level, thickening of right vesical wall associated with densification of adjacent fat and mass of heterogeneous enhancement infiltrating the abdominal wall up to the epidermis (white arrows). Contrast excreted by the kidneys in the interior of the bladder (dotted arrow); (b) Cut below the pubic symphysis, showing extension of the same mass through the subcutaneous tissue and the biopsied nodule (white arrow); (c) Cut at kidney level showing free liquid (*) and peritoneal nodules, of irregular outline and heterogeneous enhancement, suggestive of secondary implants (white arrows).

Thumbnail

Figure 4
Skin – Histopathologic findings: neoplasm composed predominantly of atypical and pleomorphic epithelioid cells, disposed in large compact aggregates, without any characteristic architecture. Presence of numerous mitoses and areas of necrosis. The neoplasm occupies all the dermis (hematoxilin and eosin staining; (A) 4x; (B) 10x; (C) 40x)

Thumbnail

Figure 5
Bladder - Histopathologic findings: neoplasm composed predominantly of atypical and pleomorphic epithelioid cells, disposed in large compact aggregates, without any characteristic architecture. Presence of numerous mitoses and areas of necrosis. The neoplasm reaches the muscular wall [hematoxilin and eosin staining; (A) 4x; (B) 10x; (C) 40x)].

Thumbnail

Figure 6
Bladder – immunomarking profile: immunopositivity with anti vimentin (diffuse) (A, 4x; B, 40x) and cytokeratin AE1/AE3 (rare cells) (C, 4x; D, 40x) antibodies

Thumbnail

Figure 7
Skin – immunomarking profile: immunopositivity with anti vimentin (diffuse) (A, 4x; B, 40x)

Thumbnail

Figure 1 Primary neoplasm invading bladder mucosa and muscles; uncontrolled infiltrative growth with atypical epithelial cells. 2. Dissected collagen bundles; 3. Angiogenesis induced by neoplasm; 4. Undifferentiated atypical epithelioid cells forming cords and irregular aggregates, without a definite architectural pattern.

Figure 2 Erythematous purpuric plaque, infiltrated, located in the infraumbilical midline scar and two erythematous-wine colored nodules in the midline, suprapubic region; the black arrow marks the biopsied nodule. Suprapubic cystostomy with urine leakage

Figure 3 Tomography of abdomen and pelvis: (a) Cut at bladder level, thickening of right vesical wall associated with densification of adjacent fat and mass of heterogeneous enhancement infiltrating the abdominal wall up to the epidermis (white arrows). Contrast excreted by the kidneys in the interior of the bladder (dotted arrow); (b) Cut below the pubic symphysis, showing extension of the same mass through the subcutaneous tissue and the biopsied nodule (white arrow); (c) Cut at kidney level showing free liquid (*) and peritoneal nodules, of irregular outline and heterogeneous enhancement, suggestive of secondary implants (white arrows).

Figure 4 Skin – Histopathologic findings: neoplasm composed predominantly of atypical and pleomorphic epithelioid cells, disposed in large compact aggregates, without any characteristic architecture. Presence of numerous mitoses and areas of necrosis. The neoplasm occupies all the dermis (hematoxilin and eosin staining; (A) 4x; (B) 10x; (C) 40x)

Figure 5 Bladder - Histopathologic findings: neoplasm composed predominantly of atypical and pleomorphic epithelioid cells, disposed in large compact aggregates, without any characteristic architecture. Presence of numerous mitoses and areas of necrosis. The neoplasm reaches the muscular wall [hematoxilin and eosin staining; (A) 4x; (B) 10x; (C) 40x)].

Figure 6 Bladder – immunomarking profile: immunopositivity with anti vimentin (diffuse) (A, 4x; B, 40x) and cytokeratin AE1/AE3 (rare cells) (C, 4x; D, 40x) antibodies

Figure 7 Skin – immunomarking profile: immunopositivity with anti vimentin (diffuse) (A, 4x; B, 40x)

Figure 2 Erythematous purpuric plaque, infiltrated, located in the infraumbilical midline scar and two erythematous-wine colored nodules in the midline, suprapubic region; the black arrow marks the biopsied nodule. Suprapubic cystostomy with urine leakage

Figure 3 Tomography of abdomen and pelvis: (a) Cut at bladder level, thickening of right vesical wall associated with densification of adjacent fat and mass of heterogeneous enhancement infiltrating the abdominal wall up to the epidermis (white arrows). Contrast excreted by the kidneys in the interior of the bladder (dotted arrow); (b) Cut below the pubic symphysis, showing extension of the same mass through the subcutaneous tissue and the biopsied nodule (white arrow); (c) Cut at kidney level showing free liquid (*) and peritoneal nodules, of irregular outline and heterogeneous enhancement, suggestive of secondary implants (white arrows).

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