膀胱癌类白血病反应一例报告并文献复习

Leukemoid Reaction Associated with Bladder Carcinoma:A Case Report and Literature Review

目的探讨膀胱癌类白血病反应(leukemoid reaction,LKR)的诊断、治疗及发生机制。方法对我院2006年收治的1例膀胱癌LKR的临床资料进行回顾性分析。结果本例因膀胱癌复发行电切术后20d、无尿1d入院。行腹部彩超、CT扫描示膀胱癌表现,未见盆腔、淋巴结转移。查血肌酐1460μmol/L,粒细胞集落刺激因子(G-CSF)4032 ng/L,血白细胞持续升高至58.4×109/L,中性粒细胞计数高达54.9×109/L,不伴有发热。疑诊白血病,予骨髓穿刺、DNA检测排除感染及白血病可能,诊断为LKR。予对症治疗后行根治性膀胱切除术和双侧输尿管皮肤造口术,术后病理诊断为浸润性膀胱移行上皮癌Ⅲ级,免疫组织化学检查示肿瘤细胞G-CSF染色阳性。术后血白细胞明显下降接近正常水平。第1次出院后3个月因左下肢水肿再次入院,诊断为左侧盆腔淋巴结转移,第2次出院后3个月死于全身转移。结论膀胱癌LKR极为少见,提示高度恶性和预后不良,分析肿瘤细胞中G-CSF的自分泌可能与LKR的发生有关。

Objective To discuss the diagnosis,treatment and machanisms of the leukemoid reaction（LKR） associated with bladder carcinoma.Methods The clinical data of a patient with LKR associated with bladder carcinoma hospitalized in 2006 was analyzed retrospectively.Results The patient was admitted to our hospital for 20 d after transurethral resection of bladder tumor（TURBt） and 1 d of anuria.Color ultrasound image and computerized tomography demonstrated bladder tumor,without pelvic cavity and lymph node metastasis.Serum creatinine was 1460 μmol/L and granulocyte colony-stimulating factor（G-CSF） was 4032 ng/L.Leucocyte was 58.4×109/L,and neutrophilic granulocyte was 54.9×109/L,but without fever.The patient was diagnosed as having LKR after bone marrow aspiration and DNA test,radical cystectomy and construction of bilateral cutaneous ureterostomy were performed.The histological diagnosis showed transitional cell carcinoma,grade Ⅲ.Immunohistochemical stain showed that the tumor cells were immunoreactive for G-CSF.After surgery leucocyte value became nearly normal.The patient was admitted to our hospital 3 months after he discharged from hospital for the first time with complaints of left leg edema,diagnosis as pelvic lymph node metastasis,and died of systemic metastasis in the 3rd month after he discharged from hospital for the second time.Conclusion Bladder cancer associated with leukemoid reaction,though it rarely occurs,is considered highly malignant,poor prognosis,and difficult to diagnosis,the autonomous production of G-CSF in this bladder carcinoma maybe induced LKR.