Pseudomalignant spindle cell proliferations of the urinary bladder

Twelve cases of polypoid, nonrecurrent, pseudomalignant spindle cell proliferations of the urinary bladder (eight women and four men) were analyzed. Two patients had a simultaneous urinary bladder carcinoma. The lesions were characterized by proliferating spindle- or strap-shaped cells, which on electron microscopic examination (performed in all 12 cases) revealed characteristics of fibroblasts and myofibroblasts. The cells showed immunoreactivity for vimentin in all cases, for alpha-smooth muscle-specific and muscle-specific actin in six cases, for cytokeratins in five cases, and for CD 34 in one case. No immunoreactivity was observed for desmin, myoglobin, epithelial membrane antigen, S-100 protein, endothelial cell antigen (H and Y), CD 68, or factor VIII RAG. Immunoreactivity for Ki-67 and proliferating cell nuclear antigen was detected in up to 30% of the spindle cell nuclei. The static cytometric DNA analysis revealed a diploid, or in two cases a hyperdiploid, stem cell line. An awareness of this type of spindle cell lesion and its immunophenotypic characteristics and diversity is of importance to avoid an erroneous diagnosis of spindle cell sarcoma (in particular leiomyosarcoma and embryonal rhabdomyosarcoma) or spindle cell carcinoma.