2020-14 / APRIL 05

A middle-aged man with no prior medical history presents with hematuria. A TURBT was performed.


1. What is the correct diagnosis?

a. Clear cell adenocarcinoma

b. Sarcomatoid urothelial carcinoma

c. Angiosarcoma

d. Pseudoangiosarcomatous pattern of urothelial carcinoma

e. Pseudocarcinomatous epithelial hyperplasia

1. Pseudoangiosarcomatous pattern of urothelial carcinoma

Although not an official urothelial carcinoma variant listed in the WHO, recognition of pseudoangiosarcomatous pattern of urothelial carcinoma (so-called “angiosarcoma-like”, “acantholytic”, “pseudovascular” urothelial carcinoma) is important so as to avoid misdiagnosis, especially on limited tissue biopsies. The key differential diagnoses include angiosarcoma (can be keratin positive; positive for vascular markers, usually negative for p63/GATA3), sarcomatoid urothelial carcinoma (unequivocal spindle cell morphology; often decreased/negative keratin expression), and clear cell adenocarcinoma (admixed tubular/papillary patterns, endometriosis in females; PAX8+, usually CK20/GATA3 negative). Although data are somewhat limited by the paucity of reported cases, one series showed an association with higher tumor stage at cystectomy and poor outcome.

Paner GP, Cox RM, Richards K, Akki A, Gokden N, Lopez-Beltran A, Krausz T, McKenney JK, Steinberg GD. Pseudoangiosarcomatous urothelial carcinoma of the urinary bladder. Am J Surg Pathol. 2014 Sep;38(9):1251-9.

Ankur Sangoi, MD
El Camino Hospital, Mountain View, CA

Urinary Bladder

urinary bladder, pseudoangiosarcomatous, angiosarcoma