Spindle and giant cell carcinoma of the urinary bladder: a clinicopathological light microscopic and immunohistochemical study.

OBJECTIVE

To evaluate the cellular nature and biological behaviour of spindle and giant cell carcinoma (SGCC) of the urinary bladder. The clinicopathological, light microscopic and immunohistochemical features of seven patients are reported.

PATIENTS AND METHODS

Paraffin-embedded tissue was available from each patient for microscopic and immunohistochemical studies. There were five men and two women, ranging in age from 48 to 79 years. Clinical histories and follow-up information were obtained by review of the patients' charts. The clinical outcome was compared with that of transitional cell carcinoma (TCC) and small cell carcinoma (SCC).

RESULTS

The tumours were large, polypoid and frequently ulcerated. They diffusely permeated the bladder musculature or the perivesical fat. On microscopic examination five tumours were composed mainly of interlacing sheets of spindle cells and occasional giant cells; two comprised giant cells only. Foci of identifiable TCC (papillary or in situ) were present in four tumours. Immunohistochemistry demonstrated that SGCCs exhibit a phenotype indicative of an epithelial nature.

CONCLUSIONS

The median survival (11 months) of the seven patients indicates that SGCCs have a poor prognosis and they are more aggressive than TCCs of the same stage. The unfavourable clinical course is similar to the rapidly fatal outcome of small cell carcinomas of the bladder. The prolonged survival periods of three patients who received additional chemotherapy suggest that this treatment may be profitable.