膀胱癌肉瘤3例临床病理分析

Carcinosarcoma of urinary bladder:a clinicopathological observation

目的探讨膀胱癌肉瘤的临床病理特征和组织发生。方法回顾性分析3例膀胱癌肉瘤患者的临床资料,进行病理组织学及免疫组化观察并进行文献复习。结果3例患者中男2例,女1例。发病年龄50～75岁,均以肉眼血尿入院,其中1例有尿痛。膀胱镜检查见膀胱顶部或侧壁可见菜花样或息肉状肿物,浸润性生长。2例行膀胱部分切除术,1例行经尿道膀胱肿瘤电切术。病理检查瘤组织均由明确的癌和肉瘤成分构成。分别构成于腺癌和梭形细胞肉瘤、移行上皮癌和横纹肌肉瘤、移行上皮癌和软骨肉瘤。结论膀胱癌肉瘤是一种少见的高度恶性的膀胱肿瘤,预后较差。诊断主要靠病理组织学检查及免疫组化染色。

Purpose To study the clinicopathologic features and histogenesis of carcinosarcoma in the urinary bladder.Methods Retrospective analysis of the clinical data,light microscopic examination and immunohistochemical study was performed in 3 cases of carcinosarcoma in the urinary bladder,and the related literatures were reviewed.Results The patients included 2 men and 1 woman aged between 50 and 75 years.All 3 patients presented with gross hematuria,and one with pain in urination,similar to that presented in transitional cell carcinoma.Cystoscopy examination revealed that the tumours were of polypoid or cauliflower-like shape,growing invasively,mainly located in the vertex or lateral wall of urinary bladder.3 patients all accepted surgery,of which 2 cases underwent partial cystectomy and the other case underwent TURBT.Histopathologic examination confirmed that the tumors consisted of an admixture of malignant epithelial and mesenchymal elements,including the admixture of adenocarcinoma and spindle cell sarcoma,transitional cell carcinoma,chondrosarcoma,transitional cell carcinoma and rhabdomyosarcoma,respectively.Conclusion Carcinosarcoma of the urinary bladder is a rare malignant tumor,which has poor prognosis.The diagnosis is mainly dependent on the pathological features and immunohistochemical patterns.