Pleomorphic undifferentiated sarcoma of urinary bladder with calcified pulmonary metastasis: A rare entity
A 29-year-old male presented with history of hematuria, dysuria, and bilateral flank pain of 2 months duration. He had undergone right ureteroscopy and double J stent (DJ stent) insertion for right ureteric calculus and bladder biopsy for bladder tumor 1 month earlier at another hospital (operative details not available). Bladder biopsy had revealed necrotic material. He had also undergone an open cysto-lithotomy 20 years earlier, i.e., at the age of nine years. He was of a low socio-economic status from a rural background, hailing from North Karnataka, where primary bladder calculus is still common. The patient did not give history of recurrent urolithiasis. So he was asymptomatic for the last 20 years.\nGeneral and systemic examinations were unremarkable. Per-rectal examination revealed a hard, nodular, bimanually palpable mass felt just above the prostate. Computerized tomography showed a heterogeneously enhancing mass with calcification, involving bladder base and lateral walls (70 mm × 52 mm) with bilateral hydro-ureteronephrosis (left < right) with right DJ stent in situ [] and with calcified pulmonary metastases [].\nCystoscopy revealed broad-based solid tumor, with necrotic material on the surface, occupying almost the whole of the urinary bladder except for the anterior wall and bladder dome. Both ureteric orifices were not seen. The lower end of the right DJ stent was almost completely engulfed by the tumor. The stent was seen just peeping out of the bladder mass on the right side and the right ureteric orifice could not be visualized inspite of the presence of the DJ stent. Transurethral resection of a part of the tumor was performed. The biopsy was reported as sarcomatoid variant of urothelial carcinoma with heterologous (osteosarcoma) differentiation []. Immunohistochemistry [] supports the diagnosis of undifferentiated pleomorphic sarcoma with osteoid formation.\nBone scan showed focal radio tracer concentration in the chest not conforming to any rib. Single-photon emission computed tomography showed uptake in lung parenchyma representing metastatic pulmonary lesions.\nThe patient was explained about the disease and the need for multimodality treatment. He refused any form of treatment and succumbed to his disease 3 months later.