K. T., a 27-year-old male had started with asymptomatic gross hamaturia in August 1964 and was diagnosed as the bladder tumor. Papillary tumors, mainly locating around the left ureteral orifice, were excised repeatedly through transurethral route. On July 6, 1965, the bladder was opened and 10 mCi/h of radon seeds were implanted in the bladder neck after the tumor resection. After repeated unsuccessful tumor resections, supplemented with the use of radon seeds, total cystectomy was performed on April 20, 1966. The distal lower half of the prostate including the seminal collide was not removed. Megalovoltage irradiation of 1, 980 R was administered.
As of March 20, 1970, 3 years-11 months after the total cystectomy, and 4 years-8 months after the radon seeds implantation, a rapidly developed large malignant mixed mesodermal tumor filled the pelvic cavity. The tumor was extirpated with the sigma and rectum. He died on July 24, with the local recurrent lesion and widespread metastases, showing no remarkable response to various antitumor agents.
On microscopic examination, repeatedly resected tumors of the bladder consistently revealed papillary transitional cell carcinoma. The tumor involving the pelvic cavity was composed of embryonal rhabdomyosarcoma, choriocarcinoma and squamoid cell carcinoma.
The relation between the concepts of rhabdomyosarcoma, botroid sarcoma and carcinosarcoma is reviewed. Though these terms are defined from various standpoints, some of them might be included in the cathegory of mixed mesodermal tumor.
The possibility of the intimate relationship between the radiotherapy and its oncogenic activity is also suggested.