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Int J Clin Exp Pathol 2012;5(1):83-88

Case Report
Spindle cell carcinoma progressed from transitional cell carcinoma of the urinary bladder

Tadashi Terada

Department of Pathology, Shizuoka City Shimizu Hospital, Shizuoka, Japan

Received August 13, 2011; accepted November 25, 2011; Epub January 1, 2012; Published January 15, 2012

Abstract: The author reports a very rare case of spindle cell carcinoma (SpCC) of the urinary bladder progressed from ordinary papillary
transitional cell carcinoma (TCC). A 63-year-old man complained of hematuria. A transurethral endoscopic examination revealed a papillary
tumor, and transuthetral resection of bladder tumor (TUR-BT) was performed and was diagnosed as ordinary papillary urothelial TCC. Since
then, he was treated with TUR-BT eight times. Chemotherapy, radiation, radical cystectomy and lymph nodes dissection were performed 16
years after the first TUR-BT. However, he developed rectal mucosal metastasis. He is now alive 17 years after the first presentation. All the
TUR-BT specimens were ordinary papillary TCCs without invasion (pTa). Immunohistochemically, the TUR-BT specimens were positive for
pancytokeratin, high molecular weight cytokeratin (CK), CK 5/6, CK 7, CK 18, CK 19, CK 20, p53, p63, Ki-67 (10%), and negative for other
antigens examined including vimentin. The cystectomy bladder specimens show broad ulcers and polypoid lesions, and malignant spindle
cells (SpCC) invading into muscular layer were present. No TCC elements were recognized. The tumor cells were positive strongly for
vimentin, and less strongly for pancytokeratin, high molecular weight cytokeratin, CK 5/6, CK 14, CK 18, p53, p63 and Ki-67 (95%), and negative
for other antigens examined. The rectal metastatic lesion showed SpCC without TCC elements, and were strongly positive for vimentin, and
weakly positive for pancytokeratin, S100 protein, p53, p63, Ki-67 (90%), neuron-specific enolase, CD56, KIT and PDGFRA. It was negative for
other antigen examined. It is strongly suggested that the present SpCC were progressed from ordinary TCC.

Keywords: spindle cell carcinoma, urinary bladder, immunohistochemistry

Address all correspondence to:
Tadashi Terada, MD, PhD
Department of Pathology
Shizuoka City Shimizu Hospital
Miyakami 1231 Shimizu-Ku
Shizuoka 424-8636, Japan.
Tel: 81-54-336-1111
Fax: 81-54-336-1315
E-mail: piyo0111jp@yahoo.co.jp