Leiomyosarcoma, a Nonurothelial Bladder Tumor: A Rare Entity With Therapeutic Diversity
A 22-year-old young woman presented with dysuria and lower urinary tract symptoms (American Urological Association, 12) for 6 months. The results of her general physical examination were unremarkable. Her results on renal function tests, urinalysis, and urine culture sensitivity were within the normal limits. The bladder ultrasound revealed a single bladder mass approximately 2.9 cm×2.7 cm×3 cm in size near the bladder neck. The results of urine cytology for malignant cells were negative. A contrast-enhanced computed tomography (CT) scan showed a well-defined, homogeneous, enhancing endophytic soft tissue lesion near the bladder neck (). Transurethral resection of the bladder mass was done with the patient under general anaesthesia. The histopathological examination revealed a tumor composed of proliferated elongated or spindle-shaped cells disposed in bundles or fascicles or an interlacing pattern (). The cells enclosed ovoid nuclei and fair amounts of lightly stained cytoplasm. There were 3 to 4 mitoses per 10 high-power fields. The immunohistochemical staining showed that the whole specimen was strongly positive for muscle actin, strongly positive for desmin, and negative for pancytokeratin (). The results of the histopathology with immunohistochemical staining were consistent with a low-grade leiomyosarcoma. After consultation with medical and radiation oncologists, adjuvant sequential chemoradiation was done. Six cycles (21 days for each cycle) of ifosfamide and doxorubicin were administered. The therapeutic response was monitored by contrast-enhanced CT and cystoscopic examination, which showed a partial response. Next, external beam fractionated radiotherapy was given (total 60 Grays, 2 Grays/d, 5 days/wk). Postradiation contrast CT scan and cystoscopy revealed no evidence of local disease. The patient has been doing well for 12 months of follow-up, with no evidence of either local or distant recurrences.