CARCINOSARCOMA OF THE PROSTATE WITH UROTHELIAL AND SQUAMOUS COMPONENTS CRAIG G. ROGERS, ANIL PARWANI, AYLIN TEKES, MARK P. SCHOENBERG* AND JONATHAN I. EPSTEIN From the Brady Urological Institute (CGR, MPS, JIE), Department of Pathology (AP, JIE) and Department of Radiology (AT), Johns Hopkins University School of Medicine, Baltimore, Maryland KEY WORDS: prostate, carcinosarcoma, neoplasms Carcinosarcoma of the prostate is a rare neoplasm with malignant epithelial and mesenchymal components. Most contain adenocarcinoma as the epithelial component. 1, 2 To our knowledge this is the first report of carcinosarcoma of the prostate with urothelial and squamous epithelial elements and without a glandular component. CASE REPORT A 51-year-old male smoker presented with gross hematu- ria and obstructive voiding symptoms. Digital rectal exami- nation was notable for a palpable abnormality of the pros- tate. 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 fea- tures in the epithelial component. Contrast enhanced mag- netic resonance imaging of the pelvis revealed an enlarged prostate with central necrosis consistent with a necrotic neo- plasm (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 ne- crotic 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 carci- nosarcoma, 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 nor- mal on gross and microscopic examination, supporting a prostatic origin of the tumor. Postoperative course was un- eventful and the patient was referred for counseling regard- ing adjuvant treatments. Submitted for publication June 21, 2004. * Correspondence: James Buchanan Brady Urological Institute, Johns Hopkins Medical Institutions, 600 N. Wolfe St., Marburg 150, Baltimore, Maryland 21287-2101 (telephone: 410-502-3803; FAX: 410-955-0833; e-mail: mschoenberg@jhmi.edu). FIG. 1. Axial arterial phase gadolinium enhanced magnetic reso- nance imaging reveals focal enlargement in central zone of basal prostate. Note peripheral nodular enhancement with low signal in- tensity, suggesting necrosis (arrows). Lesion extended from apex to base (not shown) abutting almost whole organ. FIG. 2. Microscopic view of surgically resected prostate mass dem- onstrates carcinosarcoma of prostate with urothelial (A) and squa- mous components (B). H & E, reduced from 20. 0022-5347/05/1732-0439/0 Vol. 173, 439 – 440, February 2005 THE JOURNAL OF UROLOGY ® Printed in U.S.A. Copyright © 2005 by AMERICAN UROLOGICAL ASSOCIATION DOI: 10.1097/01.ju.0000149969.76999.7c 439