Papandreou et al. Journal of Medical Case Reports 2010, 4:70 http://www.jmedicalcasereports.com/content/4/1/70 C A S E R E P O R T JOURNAL OF MEDICAL CASE REPORTS Open Access Primary osteosarcoma of the urinary bladder treated with external radiotherapy in a patient with a history of transitional cell carcinoma: a case report Christos Papandreou1*, Antigoni Skopelitou2, George Kappes3, Housam Daouaher1 Abstract Introduction: Primary osteosarcoma is one of the rare tumors affecting the urinary bladder. The occurrence of osteosarcoma in a patient with a long history of transitional cell carcinoma of the bladder is even more uncommon. Case presentation: We present the case of a 74-year-old Greek man who was diagnosed with osteosarcoma 10 years after he had been diagnosed with transitional cell carcinoma of the bladder from which he had been free from recurrences for the past three years. Our patient was treated for the osteosarcoma with transurethral resection of bladder tumor and external beam radiation therapy. He died eight months after the diagnosis, suffering poor quality of life in the last months. Conclusion: Osteosarcoma of the bladder has a dismal prognosis. External beam radiation therapy as an adjunct to transurethral resection of bladder tumor not only provides no benefit to patients with primary osteosarcoma of urinary bladder, but also may be associated with poor quality of life. Introduction Osteosarcoma of the urinary bladder is a rare tumor. To date, only 32 cases have been reported using several treatment modalities [1-3]. We present another case of this neoplasm, which was managed with transurethral resection and external beam radiation therapy. Case presentation A 74-year-old Greek man presented in June 2008 with gross hematuria. Our patient had been previously trea- ted for non-muscle invasive pTa, G2 transitional cell carcinoma of the bladder (TCC). The first transurethral resection of bladder tumour (TURBT) had been per- formed ten years before, while the last was performed three years before. The last follow up cystoscopy had been performed twelve months before. Our patient was asymptomatic thereafter, until June 2008. * Correspondence: cpapas@otenet.gr 1Department of Urology, General Hospital of Arta, Greece Then, at cystoscopy, a large solitary polypoid, yellow- white tumor was found on the superior surface of the bladder. A computed tomography (CT) scan revealed a heterogeneous mass arising from the bladder dome with evidence of invasion of the bladder wall (figure 1). There was no evidence of pelvic or abdominal lympha- denopathy. Subsequent transurethral resection was extremely difficult and incomplete because of hardness of the tissue. Pathological examination of retrieved spe- cimen revealed a highly pleomorphic and hypercellular neoplasm composed of spindled sarcomatous cells with characteristic formation of malignant osteoid, as well as an abundant chondroid matrix. Immunohistochemical analysis performed on paraffin- embedded tissue sections was negative for pan-cytokera- tin 7 and 20, epithelial membrane antigen (EMA), as well as a smooth muscle actin, desmin, CD34 and CD68. Vimentin and p53 were strongly expressed in more than 95% of the neoplasmatic cells. No transitional cell carcinoma or carcinosarcoma elements were evident (figures 2 and 3). These findings supported the diagnosis © 2010 Papandreou et al; licensee BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.