儿童及青少年膀胱癌临床特点与发病机制研究(附1例罕见17岁女性膀胱癌报告)

Clinicopathological features and pathogenesis of urothelial carcinoma of bladder in children and adolescent(Report of a 17-year-old female)

目的:分析总结小儿膀胱癌临床特点,发病机制及相应的诊疗方案。方法:回顾分析1995~2016年北京大学第一医院泌尿外科收治膀胱癌患者,报告1例17岁女性膀胱癌患者的临床病理特点及诊疗过程,并探讨儿童膀胱癌的发病机制。结果:17岁膀胱癌女性患者主要临床表现为间断无痛肉眼血尿、无吸烟等常见膀胱癌相关危险因素,予以行经尿道膀胱肿瘤电切术(TURBT),术后未予行膀胱灌注化疗或免疫治疗。术后病理提示:低度恶性潜能尿路上皮乳头状肿瘤。免疫组化:Ki-67<1%,FGFR3-。术后24个月复查泌尿系统超声及膀胱镜未见肿瘤复发。结论:儿童及青少年膀胱癌十分少见,女性患者更为少见。其发病机制与传统成年人的发病机制截然不同。病理类型多为分化较好的低度恶性潜能尿路上皮乳头状肿瘤或低级别尿路上皮癌,肌层浸润少见。临床预后较好。治疗方案主要为TURBT,除术后病理提示高级别尿路上皮癌外,术后可不予与膀胱灌注化疗或免疫治疗。

Objective： To analyze the clinicopathological features and pathogenesis of urothelial carcinoma of the bladder in patients under 18 years old, and to help in further establishment of appropriate therapeutic regimen. Method： A 17-year-old female was admitted to our center with urothelial carcinoma of the bladder. The clinico- pathological features, means of treatment and prognostic outcomes were reviewed from the medical records. Result： Intermittent painless macroscopic haematuria was presented as main clinical manifestations in the patient. No evidence of classical risk factors, such as smoking history was observed in this patient. Transurethral resection of bladder tumor （TURBT） was performed and papillary urothelial neoplasm of low malignant potential （PUNLMP） was confirmed by postoperative pathological examination. No evidence of recurrence or progression was detected during the follow-up. Conclusion： In childhood, urothelial carcinoma of the bladder which carries an excellent prog- nosis is low-grade and non-invasive. Moreover, the pathogenesis of urothelial carcinoma in this age group is dis tinct from those of older group. The general principle of therapy is TURBT without postoperative intravesical in stillation therapy, except for those with high-grade urothelial carcinoma.