膀胱神经内分泌癌6例临床与病理学观察

Clinicopathologic Analysis of 6 Cases of Bladder Neuroendocrine Carcinoma

目的:探讨膀胱神经内分泌癌(BNEC)的病理学特征及临床预后,提高对该病的诊断水平。方法:对6例BNEC患者临床及病理特征进行回顾性分析,探讨肿瘤组织来源、病理及免疫组化特征,并对其进行3个月至9年随访。结果:6例膀胱肿瘤切除标本,病理诊断4例为小细胞神经内分泌癌,2例不典型类癌。免疫组化染色显示肿瘤均表达神经内分泌标记物CD56、Syn和CgA。行膀胱肿物部分切除及术后化疗后,4例术后随访复发。结论:膀胱神经内分泌癌是一类比较少见的高度恶性的肿瘤,有其独特的病理特征,临床以血尿为主要症状,早期即可发生转移,确诊依靠病理诊断及免疫组化,手术切除及联合化疗是较有效的治疗手段。

Objective： To study the clinical and pathological characteristics of bladder neuroendocrine carcinoma （BNEC） in order to improve the diagnosis and treatment of this disease. Methods： Six cases of bladder neuroendocrine carcinoma were analyzed retrospectively to determine the characteristics of histogenesis and pathological features. Six patients were followed up for 3 months to 9 years. Results： Transurethral resection of bladder tumors was performed in all 6 patients. Four cases were pathologically diagnosed as small cell carcinoma and two as atypical carcinoid tumor. Immunohistochemical staining showed that all tumors expressed neuroendocrine markers such as neuron specific enolase （CD56）, synaptophysin （Syn） and chromogranan A （CgA）. All of the 6 patients received partial cystectomy and chemotherapy. Four cases had recurrence during the follow-up period. Conclusion： BNEC is a highly malignant cancer with low incidence that has specific pathological features. Hematuria is the major symptom of BNEC. Metastasis occurs early and exacerbates the prognosis. Final diagnosis depends on histopathological and immunohistochemical assays. Surgical resection combined with radiotherapy and chemotherapy is considered the most effective therapy.