病程迅速惡化的罕見肉瘤樣變異型膀胱癌

范子宣¹、陳鴻毅

基隆長庚紀念醫院 泌尿部

A Rare Case of Sarcomatoid Variant Bladder Cancer Presenting with Rapid Disease Progression

Tzu-Hsuan Fan¹、Hung-Yi Chen

Keelung Chang Gung Memorial Hospital, Department of Urology

Abstract

Background:

Sarcomatoid variant of urothelial carcinoma (SV-UC) is a rare and highly aggressive subtype of bladder cancer, often presenting with high-grade, deeper invasion (often ≥pT2 at diagnosis)and poor response to systemic therapy. Median overall survival is reported at 12–18 months, significantly shorter than in typical high-grade UC.

Case presentation:

     An 84-year-old man presented with painless gross hematuria for two weeks in May 2025.. Intravenous pyelography revealed a 4.3 cm bladder filling defect with non-opacification of the left pelvocalyceal system, highly suggestive of left ureteric orifice obstruction by a bladder tumor. Due to persistent hematuria, he underwent TURBT on May 20, which resected a large tumor from the left ureteric orifice. Pathology showed invasive urothelial carcinoma, sarcomatoid variant, high grade, pT2, positive for GATA3, p63, and vimentin. Staging CT revealed no residual or metastatic disease but a small lesion at the left UVJ. He received four cycles of gemcitabine, carboplatin plus avelumab, with carboplatin omitted in the last cycle due to AKI. Despite therapy, MRU on September 18 showed a 7.5 × 5 cm recurrent mass with full-thickness invasion and distal ureter involvement. Given rapid progression and chemo-immunotherapy resistance, the patient underwent robot-assisted radical cystoprostatectomy with ileal conduit diversion. Final pathology revealed high-grade urothelial carcinoma, ypT3aN0, with microscopic perivesical invasion but negative margins

Conslusion:

    Compared with conventional urothelial carcinoma (UC), Radical cystectomy remains the mainstay of treatment for localized disease, often combined with cisplatin-based chemotherapy when feasible. However, due to frequent renal impairment or advanced age, carboplatin-based regimens are sometimes substituted. In addition, radical cystectomy (RC) significantly reduced cancer-specific mortality (CSM) compared with no-RC in both organ-confined and non-organ-confined SV-UC, with an even stronger protective effect than in UC. This case demonstrates rapid progression and chemo-immunotherapy resistance, emphasizing the importance of early radical surgery for disease control in elderly, comorbid patients.