A 26-year-old woman, with no relevant past medical history, presented to the Urology Department complaining of pain suprapuberal, dysuria and total macroscopic hematuria with clots.
Physical examination revealed severe suprapubic pain without defense or other signs of peritoneal irritation.
Both in bimanual fixation and renal percussion wrist presented pain in the right lumbar fossa.
Blood tests and chest X-ray were normal.
Urinary sediment was masked by tapes.
An abdominal ultrasound was performed with the incidental finding of a hemangioma in hepatic segment II, but the rest of the examination was normal.
Finally cystoscopy found a single ulcerated solid lesion of 2.5 cm in maximum diameter located in the bladder dome.
Deep transurethral resection of the tumor was performed.
Anatomopathological study revealed a sarcomatoid bladder carcinoma affecting the muscular layer.
The immunohistochemical study of neoplasia showed diffuse positivity in the vast majority of cells for vimentin, cytokeratins AE1-AE3, CAM 5.2, cytokeratin 7 20% and focal positivity for actin cells (less than reported).
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The extension study of the disease was completed by computed tomography (CT) of the abdomen and pelvis, the bone metastases were the presence of minimal thickening of the anterior wall of the urinary dome, and non-muscle scintigraphy.
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After ruling out extravesical extension, partial cystectomy was performed, with tumor resection in the bladder dome and peritoneum attached to the bladder, as well as bilateral ilioobturator lymphadenectomy.
The anatomopathological review of the surgical specimen confirmed the existence of sarcomatoid carcinoma involving the muscular layer and microscopically the perivesical fat.
None of the 18 lymphadenopathies isolated from the pelvic cavitation pieces were found to be due to tumor.
With the diagnosis of sarcomatoid carcinoma of stage III (pT3N0M0), the patient was referred to the outpatient clinic for evaluation of bladder disease.
We offer the patient the possibility of monitoring or adjuvant treatment with chemotherapy, this last option.
Six weeks after surgery, she was treated with methotrexate, vincristine, adriamycin and cisplatin according to the MVAC regimen.
The patient received four cycles with excellent tolerance, with no delays or reduction in the predicted dose.
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Currently, 13 months after the end of treatment the patient is asymptomatic and without evidence of disease recurrence.
