| A 75-year-old male with a history of moderate COPD without other relevant medical history. | |
| Among the toxic habits, the patient smoked 20 packs/year and did not drink. | |
| No environmental risk factors or family history. | |
| The patient debuts with urethrorrhagia and impossibility of voiding, reason why he comes to the Emergency Department. | |
| Once the urinary catheter was not possible, suprapubic size was placed and the patient was then studied. | |
| An ultrasound showed a large bladder balloon with apparent single diverticulum size similar to bladder voiding cyst (with maximum diameter 13 cm) with several parietal polypoid images less than 2-3 cm suggestive of bladder neoplasia. | |
| The residual stenosis was diagnosed and treated with cystoscopy. A solid tumor measuring approximately 7 cm was found in the lateral aspect. A transurethral resection was performed in the same act. | |
| The anatomopathological result was not conclusive, but when performing the immunohistochemical analysis of the sample, it was observed a negativity for epithelial markers and positivity for fibroblast markers: vimentin and actin fibrotic tumor, all of which were reactive. | |
| With the result obtained, it was decided to complete the surgery, and at that time, it was decided to perform a partial cystectomy and grand resection, with the following anatomopathological result: low grade leiomyosarcoma (mitosis = 3). | |
| Marked cellular pleomorphism. | |
| Focus of intratumoral necrosis and multiple images of isolated cellular necrosis. | |
| Extensive areas of myxoid change. | |
| Intensifies intra and peritumoral inflammation. | |
| Peritumoral fibrous reaction is defined as the thickness of the diverticular wall up to the periadrenal adipose tissue. | |
| Surgical margins were tumor free. | |
| Immunohistochemistry | |
| Tumor cells were positive for muscle differentiation markers (vimentin and actin) and were negative for desmin and epithelial markers (EMA and high molecular weight cytokeratins). | |
| With the result of a low-grade leiomyosarcoma with non-existent layer, the case was raised in a clinical committee. The patient was treated due to the high risk of the patient. | |
| The extension study was completed by performing an extension TAC, a bone scintigraphy and a pelvic MRI that showed no distant disease. | |
| It was decided to administer locoregional radiotherapy and complementary chemotherapy. | |
| The patient received locoregional radiotherapy at a dose of 57 Gy. | |
| The chemotherapy administered consisted of the combination of ifosfamide-adriamycin at usual doses, and the patient received three cycles of this treatment. | |
| Once the treatment has been completed, the patient continues to receive revisions through periodic cystoscopy, urinary cytology and TAC-non-pelvic consolidations. | |
| After a period of 22 months, the patient remains disease-free and in periodic reviews he is asymptomatic and has an excellent quality of life. | |