Leiomyosarcoma of the bladder: A review and a report of four further cases

• Published in: International journal of surgery case reports Vol. 110; p. 108735
• Main Authors: Saidani, Bilel, Saadi, Ahmed, Bedoui, Mohamed Ali, Zaghbib, Selim, Chakroun, Marouene, Slama, Riadh Ben
• Format: Journal Article
• Language: English
• Published: Elsevier Ltd 01.09.2023; Elsevier
• Subjects: Bladder cancer; Case Report; Chemotherapy; Cystectomy; Leiomyosarcoma; Cystectomy; Chemotherapy; Bladder cancer; Leiomyosarcoma
• ISSN: 2210-2612; 2210-2612
• DOI: 10.1016/j.ijscr.2023.108735

Our study aims to expose the experience of our department in dealing with bladder leiomyosarcomas and illustrate the management tools of this rare pathology. We present a retrospective study of 4 cases of bladder leiomyosarcoma, gathered in the Department of Urology during the period of 1996–2022. All our patients were exclusively male and aged between 35 and 73 years. No history of pelvic irradiation nor chemotherapy was found in our patients. Three patients had high-grade leiomyosarcoma and pT2 stage whereas only one had a low-grade tumour. Three patients underwent radical treatment by cystoprostatectomy with extensive bilateral pelvic lymph node dissection and one patient was treated by endoscopic re-resection and endoscopic monitoring. We noticed 2 lymph nodes and liver metastasis recurrences in 2 patients treated by radical surgery while 2 patients didn't present recurrences at two years of follow-up. To date, there is no clear and precise therapeutic approach for the treatment of bladder leiomyosarcoma. Little is known about the long term survival associated with these tumours. All studies agree that the prognosis for bladder leiomyosarcoma is poor, if not diagnosed early, especially those presenting with an undifferentiated tumour grade, distant metastatis and treated without surgical therapy. Bladder leiomyosarcoma is a rare and highly aggressive tumour. The anatomopathological examination provides diagnosis and prognosis assessment. Radical surgery remains the most suitable therapeutic approach. •Bladder leiomyosarcoma is rare and highly malignant. Diagnosis and prognosis are based on pathological examination.•The FNCLCC system seems to have the best performance in terms of objectivity and assessment of differentiation, mitotic activity and necrosis.•There is no consensus on management.•Radical surgery is the most suitable treatment option.•Chemotherapy and radiotherapy are promoted by some teams.