膀胱肉瘤样癌的诊断与治疗(附四例报告)

Diagnosis and treatment of sarcomatoid carcinoma of the urinary bladder (report of 4 cases)

目的提高膀胱肉瘤样癌的诊治水平。方法分析4例膀胱肉瘤样癌患者的临床资料,4例患者中男3例,女1例,年龄62～81岁,均有肉眼血尿或伴膀胱刺激症。肿瘤主要由移行上皮癌细胞和恶性间叶细胞(梭形或多形性细胞)组成,之间可见移行过渡。CK(+)、EMA(+)、Vim(+)。结果3例行膀胱部分切除加化疗,1例行膀胱全切加化疗及放疗。2例于1年内死于肿瘤复发和转移,另2例至今分别无瘤存活13个月和20个月。结论膀胱肉瘤样癌是一种高度恶性、预后差的肿瘤。确诊需依赖病理和免疫组织化学等检查,早期诊断和采用膀胱部分切除或根治性切除,配合放疗和(或)化疗可提高疗效。

Objective To improve the diagnosis and treatment of sarcomatoid carcinoma of the urinary bladder.Methods Four patients with sarcomatoid carcinoma of the bladder were presented include 3 males and 1 female, the age of the 4 patients was 62～81, the clinical symptoms were macrohematuria and/or vesical irritability. Sarcomatoid carcinoma was mainly composed of transitional epithelial cancer cells and malignant mesenchymal cells (spindle cells and polymorphic cells), with a transitional region of interlacement of these cells. Immunohistochemical testing showed the cells were positive for cytokeratin(CK)、epithelial membrane antigen (EMA) and vimentin.Results Partial cystectomy and chemotherapy were performed in 3 patients, radical cystectomy and chemotherapy/radiotherapy were carried out in 1. Two patients have been surviving with tumor-free for 13 months and 20 months respectinely, while the other two died less than 1 year postoperatively. Conclusion Sarcomatoid carcinoma of the urinary bladder is a highly malignant disease, and the prognosis is very poor. The diagnosis depends on histopathologic and immunohistochemical studies. Early diagnosis and patients are treated with partial cystectomy or radical cystectomy together with chemotherapy/radiotherapy, which may improve the curative effect.