皮革样膀胱癌的临床特点分析

Clinical Features and Diagnosis of Encrusted Bladder Cancer

膀胱癌是发病率及死亡率均较高的泌尿系统恶性肿瘤,向膀胱腔内突起的肿物是临床诊断膀胱癌的重要特征。然而,皮革样膀胱癌患者(EBC)并不表现为向膀胱腔内突起,临床上容易漏诊、误诊。北京大学人民医院泌尿外科于2015年7月至2016年2月收治了4例EBC患者,均为男性,年龄40~77岁。临床表现均以下尿路症状为主,表现为尿频、尿急、夜尿增多,单次排尿量减少,伴或不伴排尿困难。影像学检查示膀胱壁弥漫增厚,均未见外突性膀胱占位。3例患者行尿动力学检查,膀胱最大容量41~128ml。1例患者出现肉眼血尿,2例患者镜下血尿,1例患者无血尿膀胱壁增厚。膀胱镜检查未见肿物,最终通过反复活检或术中冰冻确诊为膀胱癌。

Bladder cancer is a urological malignant tumor with high morbidity and mortality. Masses protruding into the bladder cavity is an important feature for clinical diagnosis of bladder cancer. However,patients with encrusted bladder cancer(EBC)do not present with masses protruding into the bladder cavity and thus this malignancy is often misdiagnosed. Four patients were admitted in Peking University People ’s Hospital from July 2015 to February 2017. All of them were males aged 40 to 77 years(mean:58 years). Patients were mainly manifested as frequent urination,urgency,nocturia,and decreased bladder capacity,with or without difficulty of voiding.Although the bladder walls were markedly thickened,there was no obvious mass on imaging scans. Three patients received urodynamic test,which showed the maximum capacity of the bladder was 41 to 128 ml(mean:91 ml). One patient presented with gross hematuria,two patients presented with microscopic hematuria,and the remaining one patient had no hematuria. No mass was observed by cystoscopy. All of the patients were diagnosed with bladder cancer by repeated biopsy or intraoperative frozen section analysis.