Synchronous primary tumors of the bladder: Successfully managed case

The coexistence of 2 primary bladder tumors of different histogenesis is very rare. Synchronous leiomyosarcoma LMS of the bladder and urothelial carcinoma are even rarer. We report here the case of a 48-year-old patient who presented with hematuria and symptoms of bladder irritation. Cystoscopy showed a superficial bladder tumor which occupies the entire bladder lumen. Transurethral resection of bladder tumor (TURBT) was performed and revealed a noninvasive low-grade papillary urothelial carcinoma pTa with nonvisualized muscularis. A second TURBT could not remove any muscle. The decision for a radical cystectomy was performed with Bricker derivation and pelvic lymph node dissection to control bleeding. The final pathology demonstrated concurrent urothelial carcinoma and leiomyosarcoma LMS. In this report, we presented a unique case of urinary bladder leiomyosarcoma with noninvasive urothelial carcinoma. The rarity of this association and its clinical similarity to other common tumors, including infiltrative urothelial tumors, leading to misdiagnosis, are also described.