Inflammatory pseudotumor and sarcoma of urinary bladder: Differential diagnosis and outcome in thirty-eight spindle cell neoplasms

Kenneth A. Iczkowski, Jonathan H. Shanks, Virgil Gadaleanu, Liang Cheng, Edward C. Jones, Roxann Neumann, Antonio G. Nascimento, David G. Bostwick

Research output: Contribution to journalArticle

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Abstract

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 tumordetrusor muscle interface in muscle-invasive cases, and nuclear atypia. Sarcoma also had less prominent microvasculature, less variable cellularity, consistently ≥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.

Original languageEnglish
Pages (from-to)1043-1051
Number of pages9
JournalModern Pathology
Volume14
Issue number10
DOIs
StatePublished - 2001

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Plasma Cell Granuloma
Sarcoma
Urinary Bladder
Differential Diagnosis
Neoplasms
Cystectomy
Carcinoma
Muscles
Desmin
Leiomyosarcoma
Leiomyoma
Hematuria
Nuclear Proteins
Microvessels
Plasma Cells
Actins
Necrosis
Staining and Labeling

Keywords

  • Inflammatory pseudotumor
  • Leiomyosarcoma
  • Myofibroblastic tumor
  • Postoperative spindle cell nodule
  • Spindle cell tumor
  • Urinary bladder

ASJC Scopus subject areas

  • Pathology and Forensic Medicine

Cite this

Inflammatory pseudotumor and sarcoma of urinary bladder : Differential diagnosis and outcome in thirty-eight spindle cell neoplasms. / Iczkowski, Kenneth A.; Shanks, Jonathan H.; Gadaleanu, Virgil; Cheng, Liang; Jones, Edward C.; Neumann, Roxann; Nascimento, Antonio G.; Bostwick, David G.

In: Modern Pathology, Vol. 14, No. 10, 2001, p. 1043-1051.

Research output: Contribution to journalArticle

Iczkowski, KA, Shanks, JH, Gadaleanu, V, Cheng, L, Jones, EC, Neumann, R, Nascimento, AG & Bostwick, DG 2001, 'Inflammatory pseudotumor and sarcoma of urinary bladder: Differential diagnosis and outcome in thirty-eight spindle cell neoplasms', Modern Pathology, vol. 14, no. 10, pp. 1043-1051. https://doi.org/10.1038/modpathol.3880434
Iczkowski, Kenneth A. ; Shanks, Jonathan H. ; Gadaleanu, Virgil ; Cheng, Liang ; Jones, Edward C. ; Neumann, Roxann ; Nascimento, Antonio G. ; Bostwick, David G. / Inflammatory pseudotumor and sarcoma of urinary bladder : Differential diagnosis and outcome in thirty-eight spindle cell neoplasms. In: Modern Pathology. 2001 ; Vol. 14, No. 10. pp. 1043-1051.
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N2 - 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 tumordetrusor muscle interface in muscle-invasive cases, and nuclear atypia. Sarcoma also had less prominent microvasculature, less variable cellularity, consistently ≥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.

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