Primary sarcomatoid urothelial carcinoma of the ureter: A case report and literature review.

Primary sarcomatoid urothelial carcinoma of the ureter is rare and aggressive, with limited evidence to guide treatment. We report a 57-year-old man with gross hematuria and a left ureteral mass who underwent robot-assisted radical nephroureterectomy with bladder cuff excision. Histopathology confirmed sarcomatoid urothelial carcinoma with full-thickness ureteral-wall involvement. One month later, retroperitoneal lymph nodes were radiologically suspicious for metastatic disease. The patient received one cycle of pirarubicin followed by five cycles of pirarubicin plus ifosfamide and subsequent anlotinib maintenance. At 11 months, the nodes had markedly decreased; the disease remained radiographically stable at the latest follow-up.