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.