Chan Robert C, Hundemer Greg L, Tatsas Amy, Cookson Michael S
Department of Urology, Vanderbilt University Medical Center, Nashville, TN, USA.
ScientificWorldJournal. 2007 Jun 12;7:1000-3. doi: 10.1100/tsw.2007.168.
The skeletal system is a frequent site for metastases of urothelial carcinoma (UC) of the bladder (22-37%). Of those cases involving bone, the marrow is infiltrated in 27% of patients. Imaging modalities, such as X-ray and CT, will detect gross skeletal lesions in the vast majority of these patients with bone marrow involvement, however, most patients with bone involvement are symptomatic at presentation. Additionally, there have been few reports in the literature of bone marrow metastases from UC presenting with isolated thrombocytopenia. This case report describes the case of a 53-year-old male with muscle-invasive transitional cell carcinoma of the bladder treated with cystoprostatectomy. Preoperative evaluation was significant only for mild thrombocytopenia. Standard workup for metastatic bony involvement, which included history, physical, chest X-ray, and whole body CT, was negative. Postoperatively, the patient's thrombocytopenia worsened and he bled diffusely from his pelvic bed. Bone marrow biopsy was obtained and showed the entire marrow cavity to be filled with metastatic transitional cells. In the event of a similar future presentation of isolated thrombocytopenia in the setting of invasive UC, the clinician should consider a bone marrow biopsy, in addition to the standard workup for metastatic bony involvement, prior to proceeding with any surgical intervention.
骨骼系统是膀胱尿路上皮癌（UC）转移的常见部位（22%-37%）。在那些累及骨骼的病例中，27%的患者骨髓受到浸润。X线和CT等影像学检查方法能在绝大多数骨髓受累的此类患者中检测到明显的骨骼病变，然而，大多数骨骼受累患者在就诊时都有症状。此外，文献中鲜有关于UC骨髓转移以孤立性血小板减少为表现的报道。本病例报告描述了一名53岁男性膀胱肌肉浸润性移行细胞癌患者，接受了膀胱前列腺切除术。术前评估仅发现轻度血小板减少。包括病史、体格检查、胸部X线和全身CT在内的转移性骨受累的标准检查均为阴性。术后，患者血小板减少加重，盆腔创面弥漫性出血。进行了骨髓活检，结果显示整个骨髓腔充满转移性移行细胞。对于未来侵袭性UC患者出现类似的孤立性血小板减少情况，临床医生在进行任何手术干预之前，除了进行转移性骨受累的标准检查外，还应考虑进行骨髓活检。
