原发性非脐尿管型膀胱黏液腺癌临床病理学特点分析

Characters of clinical pathology in primary non-urachal mucinous adenocarcinoma of bladder

目的探讨原发性非脐尿管型膀胱黏液腺癌的临床及病理学特点。方法原发性非脐尿管型膀胱黏液腺癌患者9例。男6例，女3例。平均年龄62（55～78）岁。间歇性、无痛性全程肉眼血尿8例，其中黏液血尿4例；体检发现1例。B超及CT检查均提示膀胱占位性病变；膀胱镜检发现膀胱肿物9例，取活检5例，病理报告均为膀胱黏液腺癌。肿瘤直径平均3．1（1.9～4．7）cm。手术治疗8例，其中膀胱部分切除术4例，膀胱全切加尿流改道3例，TURBt1例。TURBt1例术后6个月肿瘤复发，再行膀胱全切加尿流改道。1例体弱患者未手术。结果9例病理报告均为原发性非脐尿管型膀胱黏液腺癌，病理分期T2a5例、T2b2例、T3a2例。病理分级高分化5例、中分化4例。9例平均随访16．5（3～60）个月。术后1年内死亡4例，1例未手术者随访4个月死于心功能衰竭；1例行TURBt患者，再行根治术术后3个月死于肺转移；2例行膀胱部分切除术者分别于术后9、11个月死于肿瘤转移。其余5例未见肿瘤复发及转移。结论原发性非脐尿管型膀胱黏液腺癌少见，预后差。手术为主要的治疗手段，对复发或转移患者，配合放疗或化疗等综合治疗可延长患者生存期。

Objective To discuss the pathologic and clinical features of primary non-urachal mucinous adenocarcinoma of the bladder. Methods Nine cases （6 men and 3 women; mean age, 62 years） of primary non-urachal mucinous adenocarcinoma of the bladder were reviewed and analyzed. Intermittent macrohematuria without pain was found in 8 cases, with muco-hematuria in 4 cases; 1 case was found by routine health examination. Both Ultrasound and CT showed occupying lesion in bladder. Cystoscopy found tumor in 9 cases, biopsy in 5 cases and showed mucinous adenocarcinoma of the bladder. The tumors diameter was 3. 1 cm in average. Eight cases received operation, among which 3 had undergone radical cystectomy and 4 with partial cystectomy, 1 case with TURBT primary and then with radical cystectomy after tumor recurrence. One case didn＇t receive operation. Results Nine cases were pathologically diagnosed as primary non-urachal mucinous adenocarcinoma of the bladder. Histological staging was T2a 5 cases,T2b 2 cases,T3a 2 cases. Histological grading was well dif ferentiated in 5 cases, moderately differentiated in 4 cases. Four cases died in 1 year after treatments, 1 case who didn＇t receive operation died of cardiac function failure after 4 months; 1 case treated with TURBT died of lung metastasis; 2 cases treated with partial cystectomy died of metastasis after sur gery in 9 month and 11 month respectively. The other 5 cases were alive without recurrence and metastasis. Conclusions Primary non-urachal mucinous adenocarcinoma of the bladder is rare, but with a poor prognosis. Surgery is the main treatment for primary non-urachal mucinous adenocarcinoma of the bladder, comprehensive therapy such as radiotherapy or chemotherapy should be applied to those patients with metastatic or tumor recurrence.