原发性膀胱腺癌16例临床病理分析

Clinicopathological analysis of 16 cases with primary adenocarcinoma of the bladder

目的分析原发性膀胱腺癌的临床病理特征、治疗及预后。方法回顾性分析16例原发性膀胱腺癌患者的临床特点、病理结果、治疗及预后。结果16例患者中,3例因体检发现膀胱占位入院,10例因无痛性肉眼血尿、膀胱刺激症入院,3例因排尿困难、尿不尽入院。6例患者行膀胱癌根治术+盆腔淋巴结清扫+化疗,2例患者行经尿道膀胱肿瘤电切术(TURBT)+部分膀胱壁切除,3例患者行TURBT+部分膀胱壁切除+化疗,1例患者行膀胱癌根治术+盆腔淋巴结清扫+全子宫双附件切除术+化疗,3例患者行全膀胱切除+化疗,1例患者行化疗+盆腔肿块切除术。术后病理诊断:肠型腺癌7例,黏液型腺癌5例,印戒细胞型腺癌3例,透明细胞型腺癌1例。免疫组化结果显示,16例肿瘤细胞表达β-连环蛋白和绒毛蛋白,10例肿瘤细胞表达细胞角蛋白(CK)7,14例肿瘤细胞表达CK20,11例肿瘤细胞表达尾型同源盒转录因子2。16例患者均获得随访,随访时间5~65个月。1年、3年和5年生存率分别为71.4%、38.1%和19.1%。结论原发性膀胱腺癌发病率低,恶性程度高,预后差,临床表现无特异性,诊断依靠组织病理学及免疫组化。

Objective To analyze the clinicopathological features,treatment and prognosis of primary adenocarcinoma of the bladder.Methods The clinical characteristics,pathology results,treatment and prognosis of 16 cases with primary adenocarcinoma of the bladder were retrospectively analyzed.Results Of 16 patients,3 cases admitted due to bladder placeholder found by physical examination,10 cases were due to painless gross hematuria and bladder irritation,and 3 cases were due to dysuria and endless urination.Six cases were treated with radical resection of bladder cancer+pelvic lymph node dissection+chemotherapy,2 cases with transurethral resection of bladder tumor(TURBT)+partial resection of the bladder wall,3 cases with TURBT+partial resection of the bladder wall+chemotherapy,one case with radical resection of bladder cancer+pelvic lymph node dissection+total hysterectomy with bilateral adnexectomy+chemotherapy,3 cases with total cystectomy+chemotherapy,and one case with chemotherapy+pelvic tumor resection.Postoperative pathological diagnosis was intestinal-type adenocarcinoma in 7 cases,mucinous adenocarcinoma in 5 cases,signet ring cell type adenocarcinoma in 3 cases,and clear cell adenocarcinoma in one case.Immunohistochemical results showed thatβ-catenin and villus protein were expressed in 16 cases,cytokeratin(CK)7 was expressed in 10 cases,CK20 was expressed in 14 cases,and tail homologous cassette transcription factor 2 was expressed in 11 cases.Sixteen patients were followed up for 5 to 65 months.The 1-year,3-year and 5-year survival rates were 71.4%,38.1%and 19.1%,respectively.Conclusion Primary adenocarcinoma of the bladder has low incidence,high degree of malignancy and poor prognosis.The clinical manifestations of primary adenocarcinoma of the bladder are not specific.The diagnosis depends on histopathology and immunohistochemistry.