Sarcomatoid urothelial carcinoma with chondrosarcomatous differentiation of the ureter: A case report and review of the literature

  • Authors:
    • Wei Lu
    • Yanjun Wang
    • Yonghong Li
    • Yun Cao
    • Hui Han
    • Fangjian Zhou
  • View Affiliations

  • Published online on: January 5, 2017     https://doi.org/10.3892/ol.2017.5575
  • Pages: 1331-1337
Metrics: Total Views: 0 (Spandidos Publications: | PMC Statistics: )
Total PDF Downloads: 0 (Spandidos Publications: | PMC Statistics: )


Abstract

Sarcomatoid urothelial carcinoma of the urinary tract is associated with poor prognosis. The majority of sarcomatoid urothelial carcinomas are found in the urinary bladder, while a small minority have been shown to arise from the ureter. In the present case, a 72‑year‑old male patient was diagnosed with sarcomatoid urothelial carcinoma with chondrosarcomatous differentiation of the left ureter, and subsequently underwent nephroureterectomy and retroperitoneal lymph node dissection. Two lymph nodes from the renal hilum and one paraaortic lymph node were also found to have metastatic involvement; however, the patient refused to receive chemotherapy or radiotherapy and succumbed to bone and omentum metastasis at 6 months after the initial diagnosis. Sarcomatoid urothelial carcinoma of the ureter is uncommon. Even rarer is the presence of malignant heterologous elements, such as chondrosarcoma. The present study reports a rare case of sarcomatoid urothelial carcinoma with chondrosarcomatous differentiation of the ureter, as well as a review of the literature, in order to demonstrate the aggressive nature of this particular malignancy.

Introduction

Sarcomatoid urothelial carcinoma is an uncommon histological variant of urothelial carcinoma. The majority of sarcomatoid urothelial carcinomas are found in the urinary bladder (1). Generally, >90% of ureteral tumors are urothelial carcinomas; other types of ureteral tumors, including squamous cell carcinoma, adenocarcinoma and small cell carcinoma, are less common (2). To the best of our knowledge, only 24 cases of the ureteral sarcomatoid urothelial carcinoma have been reported in the PubMed database (http://www.ncbi.nlm.nih.gov/pubmed) (Table I) (324), the majority of which were accompanied by a malignant heterologous element (chondrosarcoma). Sarcomatoid carcinoma of the urinary bladder has been associated with a poor prognosis (25). Due to the rarity of this tumor, there is limited information regarding its pathological features, clinical behavior and prognosis.

Table I.

Reported cases of sarcomatoid urothelial carcinoma of the ureter.

Table I.

Reported cases of sarcomatoid urothelial carcinoma of the ureter.

Author (year)Age (years)/genderSymptoms/clinical findingsTumor histologyOutcomeReference
Renner (1931)71/MUnknownPapillary carcinoma, SCT, chondrosarcomaUnknown(3)
McDade et al (1974)66/MHematuria, colic-like abdominal painMalignant epithelial and stromal elementsLocal recurrence 4 months later; treatment with diathermy; patient was symptom-free at time of publication(12)
Yano et al (1984)66/MFlank pain, intermittent feverSQCCA, SCT, chondrosarcomaSuccumbed to disease 2 years later; autopsy showed recurrence of sarcomatous component (chondrosarcoma)(4)
Bryard et al (1987)75/F3-week history of urinary frequency, left flank pain and feverUrothelial carcinoma, SQCCA, adenocarcinoma, chondrosarcomaLocal recurrence 6 months later with left iliac paraaortic lymph node metastasis; succumbed to disease 2.5 years later(5)
Fleming et al (1987)68/M6-year history of mild difficulty initiating micturition and urinary frequency; loin pain, single episode of hematuriaPleomorphic carcinoma, SCTPedunculated mass in the bladder measuring 6 cm arising from right ureteral stump 6 months later; succumbed to widespread metastasis(24)
Fukuda et al (1991)69/MHematuria and hydronephrosisUrothelial carcinoma, SQCCA, SCT, chondrosarcomaPatient alive at time of publication(6)
Tsutsumi et al (1993)60/MAsymptomatic gross hematuriaSCCA, urothelial carcinoma, SQCCA, LMS, chondrosarcomaRecurrence of high-grade invasive transitional cell carcinoma on bladder neck 8 months later; radiation and chemotherapy treatment; back pain 4 months later due to thoracic vertebra metastasis; no evidence of metastasis 16 months s/p primary diagnosis and subsequent radiation(7)
Ishikura et al (1994)73/MComputed tomography revealed a solid, cystic mass in the left retroperitoneum and multiple nodules in the liverUndifferentiated carcinoma, blastomatous cells, chondrosarcomaLarge recurrent tumor filling the abdomen s/p surgery and chemotherapy; succumbed to disease 3 months later(8)
Murata et al (1994)80/MEdema in right lower extremitySQCCA, MFH-like SCTSuccumbed to disease 3 months after diagnosis(13)
Murata et al (1994)62/MGross hematuriaUrothelial carcinoma, SQCCA, MFH-like sarcomaNo evidence of disease, patient alive 23 months later(13)
Burt et al (1995)74/MSevere right-sided abdominal pain, vomiting and fever for 24 hUrothelial carcinoma, osteosarcoma, SCT, myxoid areasNo evidence of disease, patient alive 9 months later(14)
Nagayoshi et al (1997)60/FHistory of right flank pain s/p oophorectomy and radiation therapy for ovarian cancer at the age of 40 yearsUrothelial carcinoma, SCTNo evidence of disease, patient alive 5 months later(15)
Ichiniyagi et al (1998)67/FHematuriaUrothelial carcinoma, SQCCA, chondrosarcomaSuccumbed to disease at 10 months s/p adjuvant radiotherapy(9)
Kakoi et al (2002)89/MGross hematuria, left hydronephrosis caused by ureteral tumorCarcinosarcoma of renal pelvis and ureterRecurrent gross hematuria s/p radiation and chemotherapy; cancer-free for 1.5 years s/p left nephroureterectomy(20)
Perimenis et al (2003)68/FHematuria, low back painPD carcinoma, SCTPelvic recurrence at 18 months with liver metastasis 2 months later; succumbed to disease 2 years later(16)
Johnin et al (2003)58/FPainless hematuriaUrothelial carcinoma, osteosarcoma and chondrosarcomaTumor recurrence in bladder 2 months later; succumbed 6 months after presentation, due to local recurrence despite anterior exenteration(23)
Lee et al (2004)90/FLeft iliac fossa painMalignant SCTThe patient refused treatment and succumbed to the disease 3 months after diagnosis(17)
Petsch et al (2004)82/FLeft flank painSCNot stated(19)
Darko et al (2006)81/FGross hematuriaUrothelial carcinoma, SQCCA, mesenchymal chondrosarcomaPositron emission tomography identified new nodules in the lungs and an enlarged paraaortic lymph node compressing the vena cava 4 months later; chemotherapy administered(22)
Busby et al (2006)Not statedUnknownSCRecurrence in tumor bed 3 months later; adjuvant chemotherapy treatment; succumbed to disease 3 months later(18)
Maeda et al (2007)63/MAsymptomatic gross hematuriaBasaloid SQCCA, SCT, chondrosarcomaUneventful postoperative course; no tumor recurrence at 10 months(10)
Völker et al (2008)83/MPainless macrohematuria and hydronephrosisUrothelial carcinoma, SCT, poorly differentiated transitional cell carcinoma, chondrosarcomaNo evidence of the disease; patient alive 36 months later(11)
Völker et al (2008)67/FHydronephrosisUrothelial carcinoma, SCT, RMS, undifferentiated sarcomaNo evidence of the disease; patient alive 18 months later(11)
Nicolas et al (2014)63/MDifficulty of urination for several monthsUrothelial carcinoma, PD carcinoma, adenocarcinoma, SCT, chondrosarcomaRecurrent lesions progressed despite treatment and patient succumbed to disease 16 months after initial diagnosis(21)
Lu et al72/MGross hematuria, urinary irritation, pain in left flank and groinUrothelial carcinoma, SCT, chondrosarcomaPatient refused treatment and succumbed to bone and omentum metastases 6 months laterPresent case

[i] SCT, spindle cell tumor; SQCCA, squamous cell carcinoma; SCCA, small cell carcinoma; LMS, leiomyosarcoma; MFH, malignant fibrous histiocytoma; PD, poorly differentiated; SC, sarcomatoid carcinoma; s/p, status post; RMS, rhabdomyosarcoma.

The present study reports a rare case of sarcomatoid urothelial carcinoma with chondrosarcomatous differentiation of the ureter. In addition, the clinical and pathological features of ureteral sarcomatoid carcinomas, with particular emphasis on the differential diagnosis and prognosis of the disease, are discussed based on a review of the existing literature. Written informed consent was obtained from the patient.

Case report

A 72-year-old male patient presenting with hematuria, urinary irritation and pain in the left flank and groin was referred to Sun Yat-Sen University Cancer Center (Guangzhou, China) on March 5, 2013. The patient had undergone a cystoureteroscopy at Jieyang People's Hospital (Jieyang, China) on February 27, 2013, and poorly differentiated urothelial carcinoma had been detected on the ureteral biopsy. He subsequently presented to our hospital. The patient had a history of kidney calculi for ~10 years, tobacco smoking for ~40 years and unknown drug allergies. His family had no notable medical history. Laboratory examinations showed the following: White blood cell count, 6.7×109/l (normal range, 3.5–9.5×109/l); neutrophils, 56.5% (normal range, 0.40–0.75%); red blood cell count, 4.34×1012/l (normal range, 3.8–5.8×1012/l); hemoglobin level, 140 g/l (normal range, 110–160 g/l); platelet count, 158×109/l (normal range, 100–300×109/l); red blood cells in urine, 37/µl; occult blood, 2+. The left and right renal glomerular filtration rates were 7.16 ml/min and 51 ml/min (normal range, 80–125 ml/min), respectively, and the levels of the tumor markers serum creatinine, urea nitrogen and cystatin C were found to be within the normal ranges. Ultrasonography of the urinary tract detected that the tumor was located in the middle-lower ureter, and that the lumen was obstructed by 70×15×15 mm mass, which led to the dilatation of the proximal ureter and renal pelvis (Fig. 1A and B). Sonography led to suspicion of upper tract urothelial carcinoma. Chest X-ray and ultrasonography of the urinary tract indicated no signs of metastasis.

The patient underwent left nephroureterectomy and lymphadenectomy. Macroscopically, the surgical specimen revealed a tumor located in the distal ureter. In addition, no obvious abnormalities in the renal pelvis were observed. On the cut section of the tumor, fragile areas were found on the grayish-yellow cut surface. Microscopic examination revealed that the tumor cells were arranged in sheets or tubes, or had a ‘cracked’ appearance (Fig. 2A and B). Atypia and pathological mitosis of cancer cells was distinct. Immunohistochemical analysis indicated positivity of the tumor cells for vimentin (monoclonal mouse antibody; cat. no. ZM-0260; ZSGB-BIO, Beijing, China; Fig. 3A), epithelial membrane antigen (monoclonal mouse antibody; cat. no. ZM-0095; ZSGB-BIO; Fig. 3B), CD10 (monoclonal rabbit antibody; cat. no. NCL-CD10-270; Quanhui Imp & Exp Int'l Co., Ltd., Macao, China; Fig. 3C), CD99 (monoclonal rabbit antibody; cat. no. ZA-0577; ZSGB-BIO; Fig. 3D) and CD56 (monoclonal mouse antibody; cat. no. ZM-0057; ZSGB-BIO), and negativity for low molecular weight cytokeratin (CK) (monoclonal mouse antibody; cat. no. Z2061; ZSGB-BIO), CK-7 (monoclonal mouse antibody; cat. no. 180234; ZSGB-BIO), carcinoembryonic antigen (monoclonal mouse antibody; cat. no. ZM-0061; ZSGB-BIO), CK5/6 (monoclonal mouse antibody; cat. no. ZM-0313; ZSGB-BIO), leukocyte common antigen (monoclonal mouse antibody; cat. no. ZM-0183; ZSGB-BIO), S100 (monoclonal rabbit antibody; cat. no. ZA-0225; ZSGB-BIO), CD34 (monoclonal mouse antibody; cat. no. ZM-0046; ZSGB-BIO), CD31 (monoclonal rabbit antibody; cat. no. ZA-0568; ZSGB-BIO), synaptophysin (monoclonal rabbit antibody; cat. no. ZA-0506; ZSGB-BIO), chromogranin A (polyclonal rabbit antibody; cat. no. ZA-0066; ZSGB-BIO) and low molecular weight CK (monoclonal mouse antibody; cat. no. ZM-0329; ZSGB-BIO). A high cell proliferation rate (>60% immunoreactive cells) was revealed by Ki-67 staining, indicating the malignant nature of the lesion. Reticular fiber staining showed that the cells had a nest-like distribution; therefore, a diagnosis of invasive sarcomatoid urothelial carcinoma interspersed with chondrosarcomatous differentiation of the ureter was proposed. The retroperitoneal lymph nodes on the left side of the renal hilum and paraaortic nodes were also involved. The patient refused to undergo chemotherapy and succumbed to bone and omentum metastases 6 months later.

Discussion

Urothelial carcinoma is the most common histological subtype of urothelial cancer, followed by squamous cell carcinoma, adenocarcinoma and small cell carcinoma. Over 90% of urothelial carcinomas derive from the urinary bladder, 8% from the renal pelvis, and the remaining 2% from the ureter and urethra (26). Urothelial carcinoma has an uncommon sarcomatoid variant with a distinctive histological appearance. ‘Invasive urothelial carcinoma, sarcomatoid variant’, was the term preferred by the 2004 World Health Organization Classification Tumors of the Urinary System (27). It is generally believed that sarcomatoid carcinoma is a rare type of cancer. Furthermore, the sarcomatoid component may be a metaplastic part of the cancer, and the heterologous sarcomatoid component of the tumor (such as chondrosarcoma and osteosarcoma) derives from a special type of mesenchyma (22).

With regard to the overlapping histology and immunophenotype, as well as the aggressive biological behavior of these tumors, a hypothesis was presented by the researchers that both carcinomatous and sarcomatous elements have a common cell of origin (27). This hypothesis was validated by a series of studies. Sung et al (28) performed a study on the loss of heterozygosity and X-chromosome inactivation, the results of which demonstrated a considerable overlapping loss of heterozygosity between the sarcomatoid and carcinomatous components, and the uniform, non-random X-chromosome inactivation is consistent with the hypothesis that sarcomatoid urothelial carcinoma of the urinary bladder is monoclonal in origin. Subsequently, Völker et al (11) further demonstrated considerable, but not complete, overlapping of the genetic alterations by comparative genomic hybridization of the two sarcomatoid carcinomas in their unusual location, the ureter. It was also demonstrated that the epithelial and mesenchymal components shared similar chromosomal gains and losses. These findings are consistent with the hypothesis that sarcomatoid carcinoma is developed from a common pluripotent progenitor cell, which has a potential for epithelial and mesenchymal differentiation.

Due to the aggressive nature of this neoplasm, sarcomatoid urothelial carcinoma has a considerably poor prognosis compared with the other types of ureteral cancer (21). The presence of a sarcomatoid component has been associated with a dismal prognosis and an increased risk of metastasis (21,29,30). Previously reported cases of urothelial carcinoma with sarcomatoid differentiation exhibited systemic metastasis to sites including the bone, liver, lung and lymph nodes (23,24,30). The majority of these tumors are high-grade in histology (16). Other more common and less aggressive types of tumors that occur in the ureter and differ from carcinosarcoma include carcinomas with osseous or chondroid metaplasia, carcinoma with pseudosarcomatous stroma, and sarcomatoid carcinoma (21). The histological features of the metaplastic part differ from those of the primary tumor. The epithelial component consists of transitional cell carcinoma, carcinoma in situ, small cell carcinoma, adenocarcinoma and squamous cell carcinoma, while the stromal component consists of chondrosarcoma, osteosarcoma and leiomyosarcoma (27). Furthermore, the spindle cells of sarcomatoid carcinoma are demonstrated by immunohistochemistry. Pseudosarcomatous stromal reactions may be distinguished from carcinosarcoma by their pathological features, including lack of malignant characteristics, and display of minimal atypia and mitotic activity (31). Lichtenstein and Bernstein first described extraskeletal mesenchymal chondrosarcoma as an occurrence of the bone in 1959 (32); it was defined as a subtype of chondrosarcoma believed to arise from remnants of the metaplasia of meningeal fibroblasts or embryonic cartilage (33). Mesenchymal chondrosarcoma accounts for <1% of all sarcomas, and predominantly affects children and young adults aged 15–35 years (34). One third of cases occur outside the bone; other common sites of mesenchymal chondrosarcoma include the central nervous system, maxilla, sinuses, meninges, eyelids and thyroid (35).

Primary chondrosarcoma of the urothelial carcinoma presents a diagnostic challenge, due to its rarity, unusual location and nonspecific symptoms. Highly malignant, radiation-resistant tumors with a dismal prognosis (36) also include carcinosarcomas of the ureter, for which the optimal treatment option upon diagnosis is surgical resection; no significant improvement on the prognosis for this tumor type has been achieved by adjuvant radiotherapy or chemotherapy (16). In the present case, the patient underwent radical nephroureterectomy; however, he and his family refused to receive chemotherapy and radiotherapy to improve his general condition. Five months after surgery and 6 months after initial diagnosis, the patient succumbed to extensive bone and omentum metastases.

In conclusion, the pathological features, prognosis and treatment options for the histological variants of urothelial carcinoma differ from those of traditional urothelial carcinoma. It is important for urologists and pathologists to fully understand the features of each variant in order to improve the process of clinical diagnosis, assessment of prognosis, and, most importantly, treatment of these types of tumors.

References

1 

Beltran A Lopez, Sauter G, Gasser T, et al: Infiltrating urothelial carcinoma. World Health Organization Classification of Tumors. Pathology And GeneticsTumours of the Urinary System and Male Genital Organs. Eble JN, Sauter G, Epstein JI and Sesterhenn IA: IARC Press; Lyon: pp. 93–109. 2004

2 

Tanaka MF and Sonpavde G: Diagnosis and management of urothelial carcinoma of the bladder. Postgrad Med. 123:43–55. 2011. View Article : Google Scholar : PubMed/NCBI

3 

Renner MJ: Primary malignant tumors of the ureter. Surg Gynecol Obstet. 52:793–803. 1931.

4 

Yano S, Arita M, Ueno F, Yoshida M, Ikegami K and Fukuda S: Carcinosarcoma of the ureter. Eur Urol. 10:711984.PubMed/NCBI

5 

Byard RW, Bell ME and Alkan MK: Primary carcinosarcoma: A rare cause of unilateral ureteral obstruction. J Urol. 137:732–733. 1987.PubMed/NCBI

6 

Fukuda T, Ohnishi Y, Sato K, Tachikawa S, Tamura T, Uehara T and Emura I: Transitional cell carcinoma with sarcomatous elements in the urinary tract. Six cases examined by immunohistochemistry. Acta Pathol Jpn. 41:143–149. 1991.PubMed/NCBI

7 

Tsutsumi M, Kamiya M, Sakamoto M, Tobisu K and Kakizoe T: A ureteral small cell carcinoma mixed with malignant mesodermal and ectodermal elements: A clinicopathological, morphological and immunohistochemical study. Jpn J Clin Oncol. 23:325–329. 1993.PubMed/NCBI

8 

Ishikura H, Kumagai F and Yoshiki T: Carcinosarcoma of the ureter with unusual histologic features. Jpn J Clin Oncol. 24:175–180. 1994.PubMed/NCBI

9 

Ichiyanagi N, Yamada T and Sakai Y: Carcinosarcoma of the ureter: A case report. (Abstract). Rinsho Hinyokika. 52:965–967. 1998.

10 

Maeda D, Fujii A, Yamaguchi K, Tominaga T, Fukayama M and Mori M: Sarcomatoid carcinoma with a predominant basaloid squamous carcinoma component: The first report of an unusual biphasic tumor of the ureter. Jpn J Clin Oncol. 37:878–883. 2007. View Article : Google Scholar : PubMed/NCBI

11 

Völker HU, Zettl A, Schön G, Heller V, Heinrich E, Rosenwald A, Handwerker M, Müller-Hermelink HK, Marx A and Ströbel P: Molecular genetic findings in two cases of sarcomatoid carcinoma of the ureter: Evidence for evolution from a common pluripotent progenitor cell? Virchows Arch. 452:457–463. 2008. View Article : Google Scholar : PubMed/NCBI

12 

McDade HB, Armstrong EM and Graham AG: Proceedings: A case of carcinosarcoma of ureter. J Clin Pathol. 27:5141974. View Article : Google Scholar : PubMed/NCBI

13 

Murata T, Soga T, Tajima K, Saito K, Komeda Y, Ioshii SO, Shiraishi T, Sakakura T and Yatani R: Sarcomatoid carcinoma of the urinary tract. Pathol Int. 44:138–144. 1994. View Article : Google Scholar : PubMed/NCBI

14 

Burt JD, Murphy D and Heffernan EB: Carcinosarcoma of the ureter presenting as biliary colic. Aust N Z J Surg. 65:63–64. 1995. View Article : Google Scholar : PubMed/NCBI

15 

Nagayoshi J, Kawakami T and Maruyama Y: Sarcomatoid carcinoma of the ureter: A case report. Int J Urol. 4:618–620. 1997. View Article : Google Scholar : PubMed/NCBI

16 

Perimenis P, Athanasopoulos A, Geragthy J and Speakman M: Carcinosarcoma of the ureter: A rare, pleomorphic, aggressive malignancy. Int Urol Nephrol. 35:491–493. 2003. View Article : Google Scholar : PubMed/NCBI

17 

Lee G, Rankin A, Williamson M and Pope A: Case report: Sarcomatoid carcinoma arising from the ureter: A rare case and a treatment dilemma. Int Urol Nephrol. 36:153–154. 2004. View Article : Google Scholar : PubMed/NCBI

18 

Busby JE, Brown GA, Tamboli P, Kamat AM, Dinney CP, Grossman HB and Matin SF: Upper urinary tract tumors with nontransitional histology: A single-center experience. Urology. 67:518–523. 2006. View Article : Google Scholar : PubMed/NCBI

19 

Petsch MJ, Planz B, Tschahargane C and Caspers HP: Primary sarcomatoid carcinoma of the ureter. Aktuelle Urol. 35:137–139. 2004.(In German). View Article : Google Scholar : PubMed/NCBI

20 

Kakoi N, Miyajima A, Motizuku T, Mizuguchi Y, Asano T and Hayakawa M: Carcinosarcoma of the renal pelvis and ureter: A case report. Hinyokika Kiyo. 48:29–32. 2002.(In Japanese). PubMed/NCBI

21 

Nicolas MM, Nazarullah A and Guo CC: Sarcomatoid urothelial carcinoma with chondrosarcomatous differentiation of the ureter: A case report. Anal Quant Cytopathol Histpathol. 36:111–116. 2014.PubMed/NCBI

22 

Darko A, Das K, Bhalla RS and Heller D: Carcinosarcoma of the ureter: Report of a case with unusual histology and review of the literature. Int J Urol. 13:1528–1531. 2006. View Article : Google Scholar : PubMed/NCBI

23 

Johnin K, Kadowaki T, Kushima M, Ushida H, Koizumi S and Okada Y: Primary heterologous carcinosarcoma of the ureter with necrotic malignant polyps. Report of a case and review of the literature. Urol Int. 70:232–235. 2003. View Article : Google Scholar : PubMed/NCBI

24 

Fleming S: Carcinosarcoma (mixed mesodermal tumor) of the ureter. J Urol. 138:1234–1235. 1987.PubMed/NCBI

25 

Lopez-Beltran A, Pacelli A, Rothenberg HJ, Wollan PC, Zincke H, Blute ML and Bostwick DG: Carcinosarcoma and sarcomatoid carcinoma of the bladder: Clinicopathological study of 41 cases. J Urol. 159:1497–1503. 1998. View Article : Google Scholar : PubMed/NCBI

26 

Clark PE, Agarwal N, Biagioli MC, Eisenberger MA, Greenberg RE, Herr HW, Inman BA, Kuban DA, Kuzel TM, Lele SM, et al: Bladder cancer. J Natl Compr Canc Netw. 11:446–475. 2013.PubMed/NCBI

27 

Eble JN, Sauter G, Epstein J and Sesterhenn I: World Health Organiztion Classification of Tumours: Pathology and Genetics of Tumours of the Urinary System and Male Genital Organs. 7. 3rd. IARC Press; Lyon: 2004

28 

Sung MT, Wang M, MacLennan GT, Eble JN, Tan PH, Lopez-Beltran A, Montironi R, Harris JJ, Kuhar M and Cheng L: Histogenesis of sarcomatoid urothelial carcinoma of the urinary bladder: Evidence for a common clonal origin with divergent differentiation. J Pathol. 211:420–430. 2007. View Article : Google Scholar : PubMed/NCBI

29 

Gira FA, Barbieri A, Fellegara G, Zompatori M and Corradi D: Dedifferentiated chromophobe renal cell carcinoma with massive osteosarcoma-like divergent differentiation: A singular entity in the spectrum of retroperitoneal calcifying tumors. Int J Surg Pathol. 18:419–423. 2010.PubMed/NCBI

30 

Cserni G, Kovács BR, Tarján M, Sápi Z, Domján Z and Szabó Z: Sarcomatoid renal cell carcinoma with foci of chromophobe carcinoma. Pathol Oncol Res. 8:142–144. 2002. View Article : Google Scholar : PubMed/NCBI

31 

Wang X, MacLennan GT, Zhang S, Montironi R, Lopez-Beltran A, Tan PH, Foster S, Baldridge LA and Cheng L: Sarcomatoid carcinoma of the upper urinary tract: Clinical outcome and molecular characterization. Hum Pathol. 40:211–217. 2009. View Article : Google Scholar : PubMed/NCBI

32 

Lichtenstein L and Bernstein D: Unusual benign and malignant chondroid tumors of bone. A survey of some mesenchymal cartilage tumors and malignant chondroblastic tumors, including a few multicentric ones, as well as many atypical benign chondroblastomas and chondromyxoid fibromas. Cancer. 12:1142–1157. 1959. View Article : Google Scholar : PubMed/NCBI

33 

Bahr AL and Gayler BW: Cranial chondrosarcomas. Report of four cases and review of the literature. Radiology. 124:151–156. 1977. View Article : Google Scholar : PubMed/NCBI

34 

Huvos AG, Rosen G, Dabska M and Marcove RC: Mesenchymal chondrosarcoma. A clinicopathologic analysis of 35 patients with emphasis on treatment. Cancer. 51:1230–1237. 1983. View Article : Google Scholar : PubMed/NCBI

35 

Shapeero LG, Vanel D, Couanet D, Contesso G and Ackerman LV: Extraskeletal mesenchymal chondrosarcoma. Radiology. 186:819–826. 1993. View Article : Google Scholar : PubMed/NCBI

36 

Yilmaz E, Birlik B, Arican Z and Guney S: Carcinosarcoma of the renal pelvis and urinary bladder: A case report. Korean J Radiol. 4:255–259. 2003. View Article : Google Scholar : PubMed/NCBI

Related Articles

Journal Cover

March 2017
Volume 13 Issue 3

Print ISSN: 1792-1074
Online ISSN:1792-1082

Sign up for eToc alerts

Recommend to Library

Copy and paste a formatted citation
APA
Lu, W., Wang, Y., Li, Y., Cao, Y., Han, H., & Zhou, F. (2017). Sarcomatoid urothelial carcinoma with chondrosarcomatous differentiation of the ureter: A case report and review of the literature. Oncology Letters, 13, 1331-1337. https://doi.org/10.3892/ol.2017.5575
MLA
Lu, W., Wang, Y., Li, Y., Cao, Y., Han, H., Zhou, F."Sarcomatoid urothelial carcinoma with chondrosarcomatous differentiation of the ureter: A case report and review of the literature". Oncology Letters 13.3 (2017): 1331-1337.
Chicago
Lu, W., Wang, Y., Li, Y., Cao, Y., Han, H., Zhou, F."Sarcomatoid urothelial carcinoma with chondrosarcomatous differentiation of the ureter: A case report and review of the literature". Oncology Letters 13, no. 3 (2017): 1331-1337. https://doi.org/10.3892/ol.2017.5575