膀胱副神经节瘤的临床特点

目的 探讨膀胱副神经节瘤的临床诊治特点. 方法 回顾性分析1994年6月至2012年4月5例膀胱副神经节瘤患者的临床资料.男2例,女3例.年龄23 ～ 68岁,平均43岁.体检发现膀胱肿物2例,以间断无痛肉眼血尿为主要临床症状1例,1例表现为进行性排尿困难10年,另1例排尿时伴心悸、胸前区不适2年.1例有高血压病史6年,术前血压最高160/90 mm Hg(1 mm Hg=0.133 kPa).膀胱镜检查可见膀胱内突起肿物或膀胱内呈外压性改变,肿瘤位于三角区1例,后壁1例,顶部1例,膀胱前壁2例,3例行病理活检,均为阴性.3例行术前内分泌检查提示血去甲肾上腺素明显升高,分别为1957、3581、60 500 pmol/L.2例术前诊断为膀胱副神经节瘤,1例考虑为脐尿管癌,另2例诊断为膀胱肿瘤. 结果 行开放膀胱部分切除1例,经尿道膀胱肿瘤电切1例,腹腔镜下膀胱部分切除3例.4例患者术中出现高血压危象,其中行经尿道膀胱肿瘤电切患者术中出现应激性心肌病,1例手术顺利.出血量20 ～800 ml,平均126 ml,1例输血600 ml.术后恢复顺利.随访3 ～ 48个月,患者血压正常,未见肿瘤复发. 结论 膀胱副神经节瘤临床少见,极易误诊,对于排尿时伴有血压变化、心悸、头晕等表现的膀胱肿瘤患者应高度警惕膀胱副神经节瘤的可能.膀胱部分切除术是治疗膀胱副神经节瘤的主要方法.     

膀胱副神经节瘤二例报告并文献复习

目的 总结膀胱副神经节瘤的临床特点及诊疗方法。方法 报告2例膀胱副神经节瘤诊治情况,并复习国内外有关文献。结果 2例均为女性,1例为功能性副神经节瘤,予苯苄胺控制血压至正常后行膀胱部分切除术。术后血压正常,排尿无头痛等;1例为非功能性副神经节瘤,经常规术前准备,行经尿道膀胱肿瘤电切术。病理报告为副神经节瘤。术后效果均满意,分别随访2年和1年余,无复发。结论 功能性和非功能性膀胱副神经节瘤各有其特点,病理及免疫组化是确诊的唯一手段,手术治疗是主要治疗方法。     

肠膀胱重建术后尿路结石的微创治疗(附4例报告)

目的：探讨肠膀胱重建术后尿路结石的微创治疗效果。方法：报告4例膀胱癌膀胱全切肠代膀胱术术后并发尿路结石患者的临床资料。结果：1例行经皮肾穿刺肾盂输尿管造影定位下体外冲击波碎石术，结石粉碎并排至结肠膀胱；1例行经皮肾镜碎石术；另2例行经尿道输尿管镜下钬激光碎石术，结石粉碎并取出。结论：肠膀胱重建术后尿结石的发生与尿路感染和手术操作等因素有关，对可控膀胱术后上尿路结石可实施经皮肾镜取石术或尿路造影定位下ESWL治疗，原位回肠代膀胱术后尿路结石可实施腔内碎石治疗。     

Hemangiopericytoma arising from the wall of the urinary bladder

Hemangiopericytoma (HPC) arising from within the urinary bladder is exceptionally rare. A 45-year-old man having the symptoms of left groin pain, vague suprapubic discomfort and frequency was admitted to our clinic. Pelvic tomography revealed a tumor in the bladder wall measuring 4 × 3 cm and was not clearly distinct from the lower abdominal wall. Partial cystectomy was performed and the histopathological examination confirmed the hemangiopericytoma. Three thousand rad exterior beam irradiation was performed after operation. Partial cystectomy and adjuvant radiotherapy may be a simple and effective alternative operation for the patient with HPC.     

膀胱副神经节瘤二例报告并文献复习

目的 总结膀胱副神经节瘤的临床病理学特征及诊疗方法.方法膀胱副神经节瘤2例.例1,女,35岁.临床表现排尿后心慌、头痛,B超及CT检查示膀胱左侧壁肿块2.6 cm×1.5cm,尿3-甲氧-4-羟苦杏仁酸(VMA)35.3～43.3 μmol/24 h(正常值10～35 μmol/24 h).例2,男,22岁.临床表现无痛性全程血尿,B超及CT检查示膀胱右前壁肿块2.5 cm× 2.0 cm,尿VMA 17.9～31.3 μmol/24 h.结果行经尿道膀胱肿瘤电切术1例,行膀胱部分切除术1例.病理诊断为膀胱副神经节瘤.免疫组化CgA、Syn、S-100蛋白和NSE(+).患者术后症状消失,行膀胱镜及B超分别随访3个月、3年肿瘤无复发.结论膀胱副神经节瘤为潜在恶性肿瘤,诊断需结合临床、病理及免疫组化结果判断,膀胱部分切除为主要治疗手段.

Abstract：

Objective To study the clinical,histopathological,immunohistochemical features and the diagnosis and treatment of paraganglioma of urinary bladder. Methods Two cases of paraganglioma of urinary bladder were treated. The first case was a male with painless haematuria. The abdominal ultrasonography and CT scan showed a 2.5 cm× 2.0 cm mass in the right anterior wall of the bladder, and urine vanillylmandelic acid elevated to 17. 9- 31. 3 μmol/24 h (normal range 10- 35 μmol/24 h). The second case was a female who presented with 8 years history of headache and palpitation after voiding. Abdominal ultrasonography and CT scan showed a 2. 6 cm× 1.5 cm mass in the left wall of the bladder, and her urine vanillylmandelic acid was 35.3-43.3 μmol/24 h. Results One patient underwent transurethral resection (TURBT) and the other underwent partial cystectomy.The two cases were diagnosed as bladder paraganglioma by pathological examination. Immunohistochemically, the tumor cells were positive for CgA, Syn, NSE and S-100. No evidence of recurrence was detected during follow-up at 3 months and 3 years. Conclusions Paraganglioma of urinary bladder should be considered as a low grade malignancy. Partial cystectomy should be recommended. The diagnosis depends on clinical symptoms, pathological and immunohistochemical results.     

A review of 218 pediatric cases of hepatocellular carcinoma

Purpose

This study evaluates the incidence trends and clinical outcomes of children with hepatocellular carcinoma (HCC) and assesses factors predictive of patient survival.

Methods

The Surveillance, Epidemiology, and End Results registry was queried from 1973 to 2009 for all patients between ages 0 and 19 with primary HCC. Demographics, tumor histology, surgical intervention, and patient survival were collected.

Results

Overall, 218 patients were identified. The annual age-adjusted incidence was 0.05 cases per 100,000 in 2009. Fibrolamellar subtype tumors were exclusive to children > 5 years old and exhibited greater survival compared to non-fibrolamellar subtype (57% vs. 28%, respectively, p = 0.002). Tumor extirpation for patients with resectable disease significantly improved overall survival at 5 years compared to no surgery (60% vs. 0%, respectively, p < 0.0001). Overall 5-, 10- and 20-year survival for the entire cohort was 24%, 23%, and 8%, respectively. Independent prognostic factors of lower mortality according to multivariate analysis were surgical resection (hazard ratio (HR) = 0.18), non-Hispanic ethnicity (HR = 0.52), and local disease at presentation (HR = 0.46).

Conclusion

Over the past four decades, the incidence of HCC has remained relatively stable. Children of Hispanic ethnicity have high mortality rates. However, HCC resection for curative intent significantly improves outcomes.     

Malignant paraganglioma of the urinary bladder. A case report

Paraganglioma (pheochromocytoma) is probably the most fascinating of alltumors as it can present with a wide range of clinical manifestations.Paraganglioma of the urinary bladder is one of the rare tumors andconstitute less than 10% of all bladder tumors. The common presentationof paraganglioma of the urinary bladder is painless haematura, headache,palpitation and anxiety. Malignancy is uncommon and no histological featureis characteristic of malignancy. Invasion of adjacent organs or metastasisto the lymph nodes is the only criteria to suggest malignancy. In thepresence of proven metastasis radical cystectomy with pelviclymphadenectomy is recommended. In the present case the tumor wasarising from anterior wall of the bladder away from the bladder neck andthat in a large capacity bladder it was possible to get a wide margin forpartial cystectomy along with bilateral pelvic lymphadenectomy withoutviolating the oncological principles. At a follow up of two years there is noevidence of recurrence of tumor.     

Alpha-fetoprotein-producing transitional cell carcinoma of the urinary bladder: a case report

We report a 76-year-old man with alpha-fetoprotein (AFP)-producing transitional cell carcinoma of the bladder. Although the serum level of AFP was 1,428 ng/ml, and he was anti-hepatitis C virus (anti-HCV) antibody-positive, liver tumors were not detected by either a computed tomography (CT) scan or a hepatic angiography. However, removal of a bladder tumor by transurethral resection and subsequent pathological examination revealed a grade III transitional cell carcinoma (TCC). Furthermore, immunohistochemical detection of AFP was diffuse-positive. After the tumor partially responded to concomitant chemoradiotherapy, the serum AFP levels decreased to 966 ng/ml. However, the tumor eventually progressed with multiple lung metastases, and serum AFP levels increased to 3,906 ng/ml. In conclusion, AFP-producing TCC of urinary bladder is rare, and the nature and pathophysiology remains unclear and warrants further investigation.     

Chronic perforation of the urinary bladder by self-inserted foreign body

We report on a 14-year-old girl with pyelonephritis, secondary to a foreign body, in her urinary bladder. A self-inserted pencil led to stone formation and bladder perforation at two sites. Eighteen months after insertion, the pencil was removed by suprapubic cystotomy.     

Cancer of the urinary bladder —Epidemiology and aetiology

Summary A brief review of the geographical variations in bladder carcinoma incidence is given and the known aetiological factors, e.g. industrial exposition and pharmaceutic drugs, are surveyed.     

Ureterocystoplasty: a novel approach to augment small capacity urinary bladder in adults

Ureterocystoplasty is a novel operation well suited for patients having small capacity urinary bladder with unilateral poorly functioning kidney and megaureter. The megaureter is detubularized and used for urinary bladder augmentation. The ureter lining has advantage of being non-secretory and free from the metabolic complications of enterocystoplasty. This operation is mainly done in children. This is one of the very few from the Asian subcontinent which describes the short term results of ureterocystoplasty in an adult patient. We report a case wherein ureterocystoplasty was performed in an 18-year male presented with a small capacity neurogenic bladder with a grossly dilated and tortuous left ureter and a non-functioning left kidney. Left ureter was detubularized and used for augmentation after left nephrectomy. Blood supply to the left ureter was preserved during the dissection. After the operation, the bladder capacity increased adequately and he is doing well at a followup of 1 year. Ureterocystoplasty works well in the adult patients also and the bladder capacity increases adequately following this procedure.     

An analysis of 73 cases of pediatric malignant tumors of the thymus

Background

Tumors of the thymus are very rare in the pediatric population. This study examines the current trends and outcomes of children with thymus tumors.

Methods

The Surveillance, Epidemiology and End Results (SEER) registry was queried for all patients <20 y of age with primary thymic malignancies from 1973 to 2008.

Results

A total of 73 pediatric patients were identified with malignant thymic tumors. The median age at diagnosis was 13 y old. Among the 20 patients that presented with distant disease, 70% died. Conversely, among the 23 patients that presented with locoregional disease, 70% survived. Although the overall mean survival time was 89 ± 116 mo, 45% of patients died over the study period. Patients with Hodgkin lymphomas and germ cell tumors exhibited the highest survival (76% and 60% at 10 y, respectively). Multivariate analysis was used to identify local or regional tumor stage (odds ratio = 4.5, 95% confidence interval = 1.4–14.5) and surgical resection (OR = 3.8, 95% confidence interval = 1.4–10.8) as independent predictors of survival.

Conclusions

Malignant thymomas and lymphomas are the most common histological variants of pediatric thymus tumors, and patients with Hodgkin lymphomas exhibit the highest survival. Surgery is more commonly performed on malignant thymomas and is an independent prognostic indicator of survival.     

膀胱压力监测在移植肾间隔室综合征防治中的意义

目的 探讨膀胱压力(UBP)监测在术后腹胀所致移植肾间隔室综合征(RACS)中的意义.方法 监测59例亲属肾移植受者术后0、12、24、48、72 h膀胱压力,结合同一时间点腹胀程度及尿量变化,分析三者间关系.结果 57例患者术后72 h内出现腹胀,且随着腹胀程度不同尿量亦有所减少,平均减少(13.44±11.11)%;而UBP在4～36 cm H2O[(15.40±6.99)cm H2O].腹胀程度与UBP升高呈正相关(P＜0.05),而UBP与尿量变化呈负相关(P＜0.05).随着腹胀缓解,UBP可降至10 cm H2O以下,多数患者尿量改善,仅4例发生RACS.结论 UBP监测是早期发现RACS的有效手段,及时进行处理可有效减少此并发症.     

Denudation of the urinary bladder mucosa in the cat by formaldehyde

Summary Chemical Stripping of the urinary bladder mucosa was studied in 38 cats using 5 to 25% formaldehyde solutions. The contact time varied from 1 to 20 min. With a 20% solution and contact time of 1 min, total denudation was possible without necrosis of subepithelial layers. In such cases, complete reepithelialisation and normal bladder dynamics were seen within 3–4 weeks after formaldehyde instillation. Signs of formaldehyde intoxication due to vesical resorption were not observed.     

Laparoscopic repair of inguinoscrotal hernia with complete herniation of the urinary bladder

Summary We describe a rare case of complete herniation of the urinary bladder into a groin hernia. The hernia was operated successfully using the laparoscopic approach.     

膀胱肾源性腺瘤八例报告并文献复习

目的:分析8例膀胱肾源性腺瘤的临床特点,以提高对该病的认知和诊疗水平。方法:回顾性分析2016年7月至2019年6月中山大学孙逸仙纪念医院收治的8例膀胱肾源性腺瘤患者的临床和病理资料。男5例,女3例。年龄55(33~71)岁。临床表现为血尿7例,尿路刺激征6例,无明显症状1例。合并疾病:7例膀胱炎,3例尿石症,2例膀胱癌,1例侵袭性结肠肠系膜纤维瘤,1例无其他合并疾病。5例有泌尿系手术史。5例发生于侧壁;5例单发;肿物平均直径为0.9(0.1~1.8)cm。膀胱镜下可见乳头状肿物,表面呈鲜红色,蒂不明显,乳头粗短,触之易出血;部分呈散在片状苔藓样改变。8例均接受经尿道膀胱病变黏膜电切术。结果:8例术后病理检查:镜下见膀胱黏膜组织呈慢性炎,间质水肿,肉芽组织增生,嗜酸性粒细胞浸润,上皮呈中肾样化生。8例均获得电话随访,平均随访时间17.1(2~38)个月,均未出现复发。结论:膀胱肾源性腺瘤确诊依靠病理检查,术中应切除完全,术后应密切观察,及时处理复发和恶变。     

Inhibition of two-step urinary bladder carcinogenesis by the somatostatin analogue RC-160

Summary Fisher 344 female rats were exposed for 4 weeks to the initiator carcinogen N-butyl-N-(4-hydroxybutyl)-nitrosamine (BBN) 0.05% in the drinking water and thereafter to the promoter carcinogen mitomycin C (0.08 mg per animal per week) intravesically for 12 weeks. High incidence of urinary bladder transitional cell cancers was observed (17 in situ and 17 invasive carcinomas among 40 rats). When the somatostatin analogue RC-160 (d-Phe-Cys-Tyr-d-Trp-Lys-Val-Cys-Trp-NH₂) was administered s.c. at the dose of 50 g per animal per day during 6-week period of promotion with mitomycin C, the incidence of urinary bladder cancer was dramatically reduced. Only 1 in situ carcinoma was observed among 20 rats and only preblastomatous lesions (dysplasias and papillomas) occurred. This effect could indicate that RC-160 interferes with the process of promotion by induction of enhanced apoptosis (programmed cell death) of the dysplastic urothelial cells. RC-160 could be tried therapeutically for the hormonal prevention of malignant transformation of preneoplastic lesions in the urinary bladder.     

Immunoperoxidase staining of carcinoembryonic antigen in urinary bladder cancer

Summary An immunoperoxidase study of the presence of carcinoembryonic antigen (CEA) in primary cancers of the urinary bladder, metastases to the bladder, non-malignant diseased bladder, and normal bladder tissues revealed that approximately 10 percent of the urothelial carcinomas (transitional cell and squamous cell types) contained detectable quantities of this antigen. The other tissues were devoid of stainable CEA. It thus appears that the incidence of positive CEA by immunoperoxidase staining of formalin-fixed, paraffin-embedded tumour tissue sections is much less than the frequency of blood or urinary CEA elevations in patients with urothelial cancer.     

Contractile and cytoskeletal proteins in urinary bladder smooth muscle from rats treated with epidermal growth factor

Systemic treatment with epidermal growth factor (EGF) induces growth of all wall layers in the urinary tract of pigs and rats. The present study was initiated to describe morphological and biochemical changes in the bladder smooth muscle from rats treated with EGF for 4 weeks. Eight-week-old female Wistar rats were treated with subcutaneous injections of vehicle (n=16) or EGF (n=8, 150 g/kg per day) for 4 weeks. After EGF treatment the bladders were increased in weight [74.4±0.4 vs 122.1±0.5 mg, P<0.001 (mean ± SEM)]. Sodium dedecyl sulphate polyacrylamide gel electrophoresis (SDS-PAGE) analyses of six bladders from each group revealed that the total amounts of actin, myosin and desmin were statistically significantly increased by 62%, 61% and 154%, respectively. The relative amounts of actin and myosin were unchanged whereas the desmin to actin ratio was significantly increased — as previously described in rat bladder smooth muscle hypertrophy. Light and electron microscopy of two bladders from each group revealed increased wall thickness involving all wall layers. The smooth muscle fibres at a midventral bladder location seemed only slightly hypertrophic — some degree of hyperplasia was therefore suspected. In conclusion, EGF treatment for 4 weeks induced a net synthesis of contractile and cytoskeletal proteins in the urinary bladder smooth muscle.