膀胱肉瘤样癌的病理诊断和临床分析膀胱肉瘤样癌的病理诊断和临床分析

目的:分析6例膀胱肉瘤样癌病理诊断、临床治疗情况及其随访结果。方法:HE染色后观察癌组织病理形态特征，SP免疫组化法检测其免疫表型。总结本病的临床及病理资料、诊治及预后。结果:病理结果显示6例膀胱肉瘤样癌均有不同级别的尿路上皮癌成分，同时伴有50％以上的肉瘤样成分。免疫组化结果显示，肉瘤样癌区域vimentin（VIM）及CK均阳性。治疗及预后情况显示，6例中3例行经尿道膀胱肿瘤切除术（TUR-BT），其中1例死亡，另外2例随访中；1例行膀胱部分切除术，术后间断行膀胱灌注化疗，之后失去随访；2例会诊病例资料不详。结论:膀胱肉瘤样癌是一种罕见的具有上皮性和间叶性双重分化特征的膀胱恶性肿瘤，其恶性程度高，预后不良。因其临床症状不特异,诊断主要依靠病理及免疫组化检查。早期诊断及积极的手术治疗能够有效的改善预后，提高患者生存率。

Pathological diagnosis and clinical analysis of sarcomatoid carcinomas of the urinary bladder

Objective:We described the status of diagnosis and treatment as well as follow-up of 6 cases of bladder sarcomatoid carcinomas(SC).Methods:The pathological and immunohistochemistry characters，the diagnosis and prognosis of sarcomatoid carcinomas were analyzed.Results:The pathological changes indicated that different grade urothelial carcinomas was present in all 6 cases,while sarcomatoid components were more than 50% of the carcinomatous components.Immunohistochemical staining showed the sarcomatoid cells were positive for cytokeratin（CK)and vimentin.Among 6 cases，transurethral resection of the bladder tumor（TUR-BT)was performed in 3 patients.One patient died，the other two are being followed up.Besides，for one patient，partial cystectomy had been done.Postoperatively，chemotherapy by instillation was performed interruptly，but the follow-up information was not available.Conclusion:Sarcomatoid carcinomas of urinary bladder is a rare form of malignant tumor of the urinary bladder which have the character of epithelium and mesenchyma.It is a highly malignant disease with high grade at the time of presentation.The prognosis is very poor.As the clinic symptom of bladder SC is not extraordinary，the diagnosis of this tumor depends on pathological and immunohistochemical examination.Early diagnosis and actively surgical intervention may be effectively improve prognosis and enhence survival rate.