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Carcinosarcoma of the Urinary Bladder: Dynamic Contrast-Enhanced MR Imaging with Clinical and Pathologic Correlation

Aylin Tekes1, Ihab R. Kamel1, Gilberto Szarf1, Theresa Y. Chan2, Mark P. Schoenberg3 and David A. Bluemke1

1 Russell H. Morgan Department of Radiology and Radiological Sciences, Johns Hopkins Hospital, Rm. 100, 600 N. Wolfe St., Baltimore, MD 21287.
2 Department of Pathology, Weinberg Bldg., Johns Hopkins Hospital, Baltimore, MD 21287.
3 James Buchanan Brady Urological Institute, Johns Hopkins University Medical Institutions, Marburg 150, Baltimore, MD 21287.



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  		Fig. 1A. —70-year-old man with multiple carcinosarcomas (stage T2b) in bladder diverticulum. Oblique coronal T2-weighted MR image (TR/TE, 5967/96) shows large diverticulum arising from left lateral bladder wall. Note 2.5-cm tumor that originates from dome (black arrow) and three additional papillary tumor foci (white arrows). Large mass is heterogeneous in signal intensity, which is uncommon for transitional cell carcinoma. Bladder wall appears irregular due to incomplete distention.

 


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  		Fig. 1B. —70-year-old man with multiple carcinosarcomas (stage T2b) in bladder diverticulum. Oblique coronal fat-suppressed arterial phase contrast-enhanced fast spoiled gradient-echo MR image (295/4.2) shows heterogeneous enhancement of large mass (large arrow) and homogeneously enhancing small tumor foci (small arrows). No evidence of bladder wall invasion is present.

 


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  		Fig. 1C. —70-year-old man with multiple carcinosarcomas (stage T2b) in bladder diverticulum. Photomicrograph obtained from cystectomy specimen shows rhabdomyosarcoma component of carcinosarcoma. Tumor shows spindle and plump cells with eosinophlic cytoplasm and high mitotic activity. (H and E, x400)

 


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  		Fig. 2A. —79-year-old woman with stage T3b carcinosarcoma of urinary bladder. Axial unenhanced fast spoiled gradient-echo MR image (TR/TE, 237/4.2) shows large intraluminal bladder mass (arrow). Mass is isointense to bladder wall muscle.

 


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  		Fig. 2B. —79-year-old woman with stage T3b carcinosarcoma of urinary bladder. Axial arterial phase contrast-enhanced fast spoiled gradient-echo MR image (220/2.2) shows large heterogeneously enhancing mass arising from left lateral bladder wall. Peripheral portion (straight arrows) does not enhance, probably because of adherent thrombus. At site of tumor origin, tumor invades bladder wall with perivesical fat (curved arrow).

 


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  		Fig. 2C. —79-year-old woman with stage T3b carcinosarcoma of urinary bladder. Photomicrograph obtained from cystectomy specimen shows adenocarcinoma component (arrows) of carcinosarcoma infiltrating adipose tissue. (H and E, x400)

 


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  		Fig. 3A. —74-year-old man with stage T2b carcinosarcoma of urinary bladder. Axial T2-weighted MR image (TR/TE, 3500/120) shows sessile mass (straight arrow) arising from right lateral bladder wall with associated thickening of dome and anterolateral walls (curved arrow). Enlarged prostate is present at bladder base.

 


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  		Fig. 3B. —74-year-old man with stage T2b carcinosarcoma of urinary bladder. Axial arterial phase contrast-enhanced fast spoiled gradient-echo MR image with fat suppression (250/2.5) shows wall thickening (curved arrow) and no contrast enhancement of mass (straight arrow).

 


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  		Fig. 3C. —74-year-old man with stage T2b carcinosarcoma of urinary bladder. Axial 2-min delayed phase fast spoiled gradient-echo MR image (250/2.5) shows only submucosal enhancement (arrow) of sessile mass without any evidence of extravesical tumor invasion. This enhancement pattern is unusual for transitional cell carcinomas, which usually show bright early arterial enhancement. Pathologic examination found that entire bladder was invaded by carcinosarcoma.

 


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  		Fig. 3D. —74-year-old man with stage T2b carcinosarcoma of urinary bladder. Photomicrograph of cystectomy specimen shows squamous component of carcinosarcoma with keratin formation (arrows) and rhabdomyosarcoma component with spindle and plump cells. (H and E, x200)

 

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