膀胱浆细胞样尿路上皮癌:附2例报告及文献复习

Plasmacytoid Urothelial Carcinoma of the Bladder:Report of Two Cases and Review of Literatures

目的:探讨膀胱浆细胞样尿路上皮癌(plasmacytoid urothelial carcinoma of the bladder,PUCB)的临床特征及其诊治方法。方法:对2例PUCB患者的临床资料进行分析,并进行文献复习和总结。结果:2例PUCB患者均为男性,年龄分别为62岁、70岁。病例1行剖腹探查加右输尿管皮肤造瘘术,术中探查发现大量腹水、肝转移、肿瘤侵犯腹膜,患者术后3个月死于肿瘤广泛转移。病例2行全膀胱切除术+双侧闭孔淋巴结切除+双侧输尿管皮肤造瘘术,术后病理学结果显示其为浸润性尿路上皮癌,高级别,部分浆细胞样变,侵犯膀胱外脂肪组织,两侧闭孔淋巴结均见癌转移,患者术后2个月死于肺多发转移。结论:PUCB是一种罕见的移行细胞癌,恶性程度高,进展迅速,难以早期诊断,治疗效果不佳,预后极差。

Objective：To investigate the clinical features,diagnosis and treatment of plasmacytoid urothelial carcinoma of the bladder（PUCB）.Methods：The clinical data of two patients with PUCB were analyzed,and the related literatures were reviewed.Results：Both cases were male,aged 62 and 70,respectively.Case one underwent laparotomy and right cutaneous ureterostomy,because intraoperative probe revealed a great quantity of ascites,liver metastasis and peritoneal involvement.Three months after operation,the patient died of widespread metastasis.Case two received radical cystectomy,obturator lymph nodes dissection and bilateral cutaneous ureterostomy.Postoperative pathologic results showed invasive urothelial carcinoma,high grade,partial plasmacytoid variation;the involvement of paravesical adipose tissue,and both side obturator lymph nodes metastasis.The patient died of multiple lung metastasis two months after operation.Conclusions：PUCB is a rare variant of transitional cell carcinoma with high malignant degree,and it progresses rapidly.It is also difficult for early diagnosis of PUCB,which is associated with dismal prognosis and poor treatment effect.