Primary Urinary Bladder Angiosarcoma with Osteoclast-Like Multinucleated Giant Cells: A Case Report and Literature Review.
BACKGROUND Angiosarcomas are rare vascular neoplasms, and visceral involvement is quite uncommon. Predisposing factors that are thought to contribute to the development of angiosarcomas include ionizing radiation and chemical agents. Particularly, the association of angiosarcomas with therapeutic radiation has been previously emphasized. Nonurothelial bladder tumors are quite rare, too. Sarcomas represent the most common mesenchymal tumors of the bladder and generally share an extremely aggressive biologic behavior. CASE A 67-year-old, white woman presented with primary angiosarcoma of the bladder and with no apparent risk factors or previous exposure to the carcinogens typically related to such neoplasms. A biopsy performed due to gross hematuria by endoscopic resection revealed an infiltrative, poorly differentiated neoplasm that was interpreted as high grade papillary urothelial carcinoma. A radical cystectomy, with regional lymphadenectomy and bilateral hysterosalpingo-oophorectomy, was performed. The pathological examination revealed a voluminous and extensively necrotic mass, histologically compatible with an angiosarcoma of the bladder. Despite a multimodal therapeutic approach, the patient died within a short time. This report summarizes the clinical course and highlights the histological features of this tumor. CONCLUSION This case falls within the limited group of primary angiosarcoma of the bladder with very aggressive clinical features in a patient without recognized risk factors.