Sarcomatoid Urothelial Carcinoma with Chondrosarcomatous Differentiation of the Ureter A Case Report

BACKGROUND: Sarcomatoid urothelial cell carcinoma of the urinary tract has a poor prognosis. Most of the reported cases of sarcomatoid urothelial cell carcinomas are those from the urinary bladder. A limited number of these tumors originate from the ureter. CASE: We describe a ureteral sarcomatoid urothelial carcinoma in a 63-year-old man who underwent nephroureterectomy with bladder cuff. The malignant epithelial elements consisted of undifferentiated polygonal cells and areas of glandular formation. Urothelial carcinoma in situ was present in the overlying mucosa. The mesenchymal components were pleomorphic spindle cells and atypical chondrocytes within lacunae with multi-nucleation and mitoses. The tumor extended beyond the muscularis into the periureteral adipose tissue. The tumor recurred after 6 months in the retroperitoneum and presacral area. The patient received chemotherapy and radiotherapy but died 16 months after the initial diagnosis. CONCLUSION: Sarcomatoid urothelial carcinoma of the ureter is uncommon. Even rarer is the presence of malignant heterologous elements such as chondrosarcoma. The case described here underscores the aggressive nature of these neoplasms.