Hirano Daisaku, Yoshida Toshiyuki, Funakoshi Daigo, Sakurai Fuminori, Ohno Shou, Kusumi Yoshiaki
Department of Urology, Higashimatsuyama Municipal Hospital, Higashimatsuyama 355-0041, Japan.
Department of Urology, Nihon University School of Medicine, Tokyo 173-8610, Japan.
Case Rep Urol. 2018 Jan 15;2018:1405108. doi: 10.1155/2018/1405108. eCollection 2018.
Carcinosarcomas of the urinary bladder are rare biphasic neoplasms, consisting of both malignant epithelial and malignant mesenchymal components, and the prognosis of this tumor is unfavorable in most patients with even possibility of resection of disease. A 77-year-old male with a history of transurethral resection (TUR) of urothelial carcinoma (UC) of the bladder and adjuvant intravesical chemotherapy with pirarubicin 10 years ago revisited our department with a gross hematuria. Cystoscopy demonstrated an approximately 2.5 cm nonpapillary tumor on the right wall of the bladder. Pelvic MRI showed the tumor without extending the base of the bladder wall. The tumor could be completely removed with TUR. The malignant epithelial elements consisted of high-grade UC and the majority of mesenchymal components were fibrosarcomatous differentiation based on immunohistochemical studies. The tumor could be pathologically also suspected to be an early stage on TUR specimens. Although he has received no additional intervention due to the occurrence of myocardial infarction at three weeks after the TUR, he has been alive with no evidence of recurrence of the disease 27 months after the TUR. Some early stages of bladder carcinosarcoma might have a favorable prognosis without aggressive treatments.
膀胱癌肉瘤是一种罕见的双相性肿瘤，由恶性上皮成分和恶性间叶成分组成，大多数患者的这种肿瘤预后不佳，即便有可能切除病灶。一名77岁男性，10年前有膀胱尿路上皮癌经尿道切除术（TUR）病史，并接受吡柔比星膀胱内灌注化疗，因肉眼血尿前来我院复诊。膀胱镜检查发现膀胱右壁有一个约2.5厘米的非乳头状肿瘤。盆腔磁共振成像显示肿瘤未侵犯膀胱壁基底。经尿道切除术可将肿瘤完全切除。免疫组化研究显示，恶性上皮成分由高级别尿路上皮癌组成，大多数间叶成分呈纤维肉瘤样分化。在经尿道切除标本上，该肿瘤在病理上也可能被怀疑处于早期阶段。尽管经尿道切除术后三周因心肌梗死未接受额外干预，但经尿道切除术后27个月他仍存活，无疾病复发迹象。一些早期膀胱癌肉瘤患者即便不进行积极治疗，预后可能也较好。
