Carcinosarcoma of the prostate with urothelial and squamous components.

A 51-year-old male smoker presented with gross hematuria and obstructive voiding symptoms. Digital rectal examination was notable for a palpable abnormality of the prostate. Prostate specific antigen (PSA) level was 0.4 g/ml. Basic laboratory values, urinalysis, cytology and cystoscopic examination were within normal limits. Ultrasound guided prostate needle biopsy demonstrated sarcomatoid carcinoma with squamous and urothelial features in the epithelial component. Contrast enhanced magnetic resonance imaging of the pelvis revealed an enlarged prostate with central necrosis consistent with a necrotic neoplasm (fig. 1). Other imaging modalities showed no evidence of metastatic disease. Radical retropubic prostatectomy was attempted but the prostatic mass was found invading the bladder. Therefore, radical cystoprostatectomy with bilateral pelvic lymphadenectomy and ileal conduit diversion were performed. The resected prostate specimen had a grayish-white necrotic tumor located centrally measuring 4.2 cm in greatest dimension. The tumor extended out of the prostate at the base, involving the soft tissue around the seminal vesicles. Histological examination of the prostate demonstrated carcinosarcoma, including areas of urothelial carcinoma and squamous differentiation (fig. 2). No glandular component (ie adenocarcinoma) was identified in the serially sectioned and totally submitted specimen. The bladder specimen was normal on gross and microscopic examination, supporting a prostatic origin of the tumor. Postoperative course was uneventful and the patient was referred for counseling regarding adjuvant treatments.