The twenty-ninth case of a carcinosarcoma of the urinary bladder is reported, although the diagnosis in 8 of the cases previously reported has been questioned by other authors. The microscopic features and pitfalls in histologic diagnosis are discussed. The tumor occurs predominantly i n elderly men, and aggressive surgical treatment is indicated because of the poor prognosis. ARCINOSARCOMA IS A WELL-RECOGNIZED TU-C mor in the uterus and has been reported as occurring in other organs, but it is rare in the urinary bladder. Twenty-eight cases have been listed in the literature as carcinosarcomas of the.bladder. Gabe recorded 6 cases in 1932,s Saphir and Vass reviewed 4 cases in 1941 (including Gabe's one case),l3 and Pang added 7 cases in 1958.11 A survey of the literature reveals 12 other case reports.l-49 6p *, 149 16tI9
The case reported here brings the total to 29 cases.
Although 28 cases have been reported previously, some of these have been questioned. Saphir and Vass2 discarded the cases reported by Tanton, Leuenberger, Gabe, and Bosenberg. The case of Wright-Smith19 was excluded by Pang11 because no definite epithelial elements were discernible. Renner's case is included by Pang, but apparently arose in the ureter rather than the bladder." Dent's case was admittedly a collision tumor and, therefore, should not be considered a true carcinosarcoma.3 Hej tmancik and Klatt's case showed good demarcation between the carcinoma and sarcoma and it metastasized as a pure leiomyosarcoma.6 Thus, there are 20 acceptable cases recorded in the literature.
CASE REPORT
A 50-year-old Caucasian man was admitted to the Long Beach Veterans Administration Hospital with a history of gross, total, painless hematuria for 4 days. There was no other significant urologic history. The pa-
From the