Tan Wei Phin, Tecle Nahom, Whelan Patrick, Strong Andrea, Deane Leslie A
Department of Urology, Rush University Medical Center , Chicago, Illinois.
J Endourol Case Rep. 2016 Dec 1;2(1):235-237. doi: 10.1089/cren.2016.0124. eCollection 2016.
Upper tract urothelial carcinoma (UTUC) is an uncommon disease that is diagnosed clinically by the selective use of urine cytology, urine biomarkers, and imaging of the upper tract. We present a case of a patient with Lynch syndrome and high-grade UTUC that was diagnosed by an abnormal Cxbladder assay, prompting further endoscopic examination. A 59-year-old Caucasian female with a history of endometrial cancer and bladder cancer with Lynch syndrome presented for evaluation of recurrent urothelial carcinoma. Her previous bladder tumors have been T1 high grade and Ta high grade and have been treated with resection and multiple cycles of intravesical Bacillus Calmette-Guerin (BCG) therapy. She had also undergone a robotic left distal ureterectomy and psoas hitch for a high-grade distal ureteral tumor. Surveillance cystoscopy 7 months after revealed a biopsy-confirmed bladder tumor, which was resected, and she was started on maintenance BCG therapy. At presentation, follow-up urine cytology and UroVysion studies were negative. Cxbladder test was also initially negative. However, during close clinical monitoring, the Cxbladder test became positive. Cystoscopy was once more performed, which was unremarkable. Bilateral ureteroscopy was performed, revealing high-grade upper tract renal papillary carcinoma (UTUC) in the left renal pelvis. The patient declined a nephroureterectomy. She was treated with two sessions of holmium laser ablation of the left renal pelvis tumor and underwent 6 weekly courses of BCG + interferon instilled into her left renal pelvis using a 5F open-ended catheter. Repeat urine cytology, UroVysion, and Cxbladder tests were negative after completion of upper tract BCG therapy. Cxbladder test may be useful and an adjunct to urine cytology and the UroVysion FISH assay to evaluate patients at high risk for recurrent UTUC.
上尿路尿路上皮癌（UTUC）是一种罕见疾病，临床上通过选择性使用尿液细胞学检查、尿液生物标志物以及上尿路影像学检查来诊断。我们报告一例患有林奇综合征和高级别UTUC的患者，该患者通过异常的Cxbladder检测得以诊断，随后进行了进一步的内镜检查。一名59岁的白种女性，有子宫内膜癌和膀胱癌病史，患有林奇综合征，前来评估复发性尿路上皮癌。她之前的膀胱肿瘤为T1高级别和Ta高级别，已接受手术切除及多周期膀胱内卡介苗（BCG）治疗。她还因高级别远端输尿管肿瘤接受了机器人辅助左远端输尿管切除术及腰大肌悬吊术。7个月后的监测膀胱镜检查发现了经活检证实的膀胱肿瘤，予以切除，随后她开始接受维持性BCG治疗。就诊时，随访尿液细胞学检查和UroVysion检测均为阴性。Cxbladder检测最初也为阴性。然而，在密切临床监测过程中，Cxbladder检测转为阳性。再次进行膀胱镜检查，结果未见异常。双侧输尿管镜检查显示左肾盂存在高级别上尿路肾乳头状癌（UTUC）。患者拒绝接受肾输尿管切除术。她接受了两期钬激光消融左肾盂肿瘤治疗，并使用5F开放式导管每周向其左肾盂内灌注6次BCG + 干扰素。上尿路BCG治疗完成后，重复尿液细胞学检查、UroVysion检测和Cxbladder检测均为阴性。Cxbladder检测可能有助于评估复发性UTUC高危患者，可作为尿液细胞学检查和UroVysion荧光原位杂交检测的辅助手段。
