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Pseudosarcomatous myofibroblastic lesion of the urinary bladder: A rare entity posing a diagnostic challenge and therapeutic dilemma

Alexandros Lekas1, Aikaterini Parasi2, Thomas G Papathomas3*, Athanasios G Papatsoris1, Maria Rozaria Mennonna2, Michail Chrisofos1, Charalambos Deliveliotis1 and Andreas C Lazaris3

Author affiliations

1 2nd Department of Urology, Sismanoglion Hospital, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece

2 Department of Pathology, General Hospital of Nikea, Piraeus, Greece

3 1st Department of Pathology, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece

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Citation and License

Diagnostic Pathology 2008, 3:11  doi:10.1186/1746-1596-3-11

Published: 13 March 2008

Abstract

Background

Pseudosarcomatous myofibroblastic lesions of the urinary bladder are relatively rare entities of an uncertain pathogenesis and benign indolent nature.

Case presentation

We present an extremely rare case of an ALK-1-positive pseudosarcomatous myofibroblastic lesion of the urinary bladder, which was initially misinterpreted as a low-grade leiomyosarcoma of myxoid subtype on histologic examination owing to prominent atypia, high mitotic activity, abnormal mitotic figures and infiltration of the bladder wall. Although the histologic features were suggestive of a sarcoma, the correct diagnosis was finally established and radical surgical treatment was subsequently avoided. The patient is currently free of disease without any evidence of tumor recurrence or metastasis at 3 years post-operatively.

Conclusion

The key differentiating point rests in distinguishing the aforementioned mass forming lesion from the myxoid subtype of low-grade leiomyosarcoma in order to avoid unnecessary radical therapy.