原发性局限性膀胱淀粉样变一例报道并文献复习

Primary Localized Amyloidosis of Urinary Bladder: A Case Report and Review of the Literature

目的提高对原发性局限性膀胱淀粉样变性的认识。方法报告1例74岁男性患者,反复出现无痛肉眼血尿,三次行经尿道手术,最终病理确诊为原发性膀胱淀粉样变。分析该患者的临床资料并结合相关文献进行总结分析。结果原发性局限性膀胱淀粉样变男女均可发病,发病率男女大致相等,多发于中年以上,以间断无痛性全程肉眼血尿为主要临床表现,影像学检查多无特异性改变,膀胱镜检查与膀胱肿瘤及膀胱炎难以鉴别,确诊靠病理检查,治疗常用经尿道病灶切除术,术后辅以二甲基亚砜膀胱灌注。结论原发性局限性膀胱淀粉样变临床较为罕见,极易误诊为膀胱肿瘤,经尿道膀胱病灶电切术为常用治疗方法,治疗后易复发,应加强随访。

Objective To improve understanding of the primary localized amyloidosis of urinary blad- der. Methods A 74-year-old male with repeated painless gross hematuria was reported. The transurethral resection（TUR） of the lesion was performed for three times. Pathologic examination revealed amyloidosis of urinary bladder. The clinical data was analyzed and the related literature was reviewed. Results The inci- dence of the disease was roughly equal between the sexes. It more often occurred in middle-aged. The major presenting symptom was the intermittent painless gross blood. The medical imaging was unremarkable. It was difficult to distinguish from bladder cancer or cystitis by cystoscopy,while pathologic examination might help confirm the diagnosis. The main treatment was TUR with/without intravesical dimethylsulfoxide adjuvant ther- apy. Conclusion The primary localized amyloldosis of urinary bladder is a rare disease, which may easily be misdiagnosed as bladder cancer. TUR is the preferred surgical treatment,and follow-up of patients should be strengthened due to the high likelihood of recurrence.