乳腺癌环磷酰胺化疗后继发膀胱平滑肌肉瘤1例报告并文献复习

Bladder Leiomyosarcoma Following Cyclophosphamide Chemotherapy for Breast Cancer(Report of 1 Case and Review of the Literature)

目的:探讨环磷酰胺相关性膀胱平滑肌肉瘤(bladder leiomyosarcoma,BLMS)的发病机制和及诊治方法。方法:报道1例乳腺癌环磷酰胺化疗后继发BLMS的病例。50岁女性患者接受环磷酰胺化疗8个月出现为尿频、尿急。B超、CT示膀胱颈部左侧壁一24 mm×20 mm×30 mm的实性肿块,膀胱镜检示膀胱颈部1～3点处隆起,表面呈滤泡样增生。检索MEDLINE和CBM数据库中相关文献,进行复习。结果:患者行膀胱部分切除,术后病理诊断为低度恶性BLMS。镜下肿瘤细胞呈梭形,胞浆嗜酸性,核长顿圆,多型性明显。免疫组化显示SMA、vimentin和desmin阳性,EMA和CK为阴性。文献报道了环磷酰胺相关性BLMS 12例,而乳腺癌环磷酰胺化疗后继发BLMS尚未见报道。结论:环磷酰胺治疗是发生BLMS的重要原因,因此接受环磷酰胺治疗的患者应进行泌尿系统的密切随访。

Objective： To study the pathogenesy, pathological diagnosis and treatment of cyclophosphamide （CPM） related bladder leiomyosarcoma （BLMS）. Methods： We report an unusual case of BLMS occurring after CPM chemotherapy for breast cancer. A 50-year-old female presented with urinary frequency and urgency in 8 months after CPM chemotherapy, and was found to have a mass of 24 mm×20 mm ×30 mm in urinary bladder through ultrasound and computed tomography. Cystoscopy displayed 1-3 local eminentias with follicular hyperplasia in their surface on left bladder wall. The MEDLINE and CBM databases were searched for related articles, and the clinical data were reviewed. Results：The patient underwent partial cystectomy and the final pathologic examination confirmed lowpotential malignancy BLMS. Microscopically, The tumor cells had elongated blunt-ended nuclei and acidophilic fibrillary cytoplasm. There was marked nuclear pleomorphism with atypia. Immunohistochemical studies showed that the smooth muscle actin （SMA）, vimentin, and desmin were positive. No reaction with epithelial membrane antigen （EMA） and cytokeratin （CK） was seen. A total of 12 cases of CPM related BLMS were identified through the literature retrieval and the present case is the first BLMS following CPM therapy for breast cancer. Conclusions：The CMP treatment may have played a key role in initiating the secondary BLMS and the regular urinary system follow-up is necessary after CMP therapy.