肾移植术后并发自体泌尿系统移行细胞癌九例的诊治体会

目的总结肾移植后并发自体泌尿系统移行细胞癌的诊治体会。方法9例患者在肾移植术后11～48个月出现间歇性血尿，通过B型超声波、静脉尿路造影（IVU）、膀胱镜、输尿管镜、逆行肾盂造影、CT及内窥镜下取材活检等，证实3例为肾盂肿瘤，2例为输尿管肿瘤，4例为膀胱肿瘤。肾盂肿瘤和输尿管肿瘤的5例均采取肾、输尿管全程及膀胱部分切除术；4例膀胱肿瘤患者中，3例行经尿道膀胱肿瘤电切术，1例施行膀胱全切及移植肾切除术。有2例患者因肿瘤复发或新发而接受了2次肿瘤切除术。术后通过膀胱灌注给予丝裂霉素、吡柔比星、表阿霉素等进行化疗。结果9例患者11次手术均顺利，治疗效果比较满意，在施行肿瘤切除术前后不需调整免疫抑制治疗方案。结论对肾移植后并发自体泌尿系统移行细胞癌的患者，关键在于早期诊断、积极治疗，应慎重对待肾移植后出现血尿的患者，以免漏诊。     

肾移植术后并发泌尿系统肿瘤的相关因素与临床干预

目的:探讨肾移植术后并发泌尿系统肿瘤的相关因素与临床干预措施.方法:报告9例(10次)此种患者的临床资料.9例肾移植术后均行免疫抑制治疗.肿瘤均发生在自体肾、输尿管和膀胱:肾透明细胞癌、肾肉瘤和膀胱腺癌各1例,肾盂输尿管膀胱移行细胞癌6例,其中1例先发生膀胱腺癌后又发生肾盂输尿管移行细胞癌.肿瘤发生于移植术后8～146个月,且8例发生在应用新型免疫抑制剂之后.患者均有服用龙胆泻肝丸或冠心苏合丸史.8例接受了根治性手术,1例未能手术切除.结果:9例随访8～44个月,未能手术切除1例于术后5个月肝转移死亡.1例肉瘤复发后放弃治疗后死亡.1例膀胱肿瘤复发,行膀胱全切腹壁造瘘术,1例腺癌已出现肺和胸膜转移.另5例最后随访时存活良好.结论:肾移植术后并发泌尿系统肿瘤以移行细胞癌为多;可能与服用含马兜铃的中药和应用新型免疫抑制剂有关;根治性手术治疗、减少免疫抑制剂用量和更换免疫抑制剂种类是主要临床干预措施.     

肾移植术后自体泌尿系统肿瘤25例临床分析

目的 总结肾移植术后并发自体泌尿系统肿瘤的诊断和治疗经验.方法 25例肾移植受者,发生肿瘤的时间平均为移植术后48.2个月(29～72个月),其中23例以间歇性血尿为首发症状,2例为体检时发现.25例中,3例为肾癌,行腹腔镜下肾癌根治术；8例为上尿路的尿路上皮肿瘤,行经腹腹腔镜下肾盂癌根治术,其中3例同时合并浅表膀胱肿瘤；14例为膀胱尿路上皮肿瘤,13例行经尿道膀胱肿瘤电切术,1例行全膀胱切除并移植肾输尿管造口.术后将吗替麦考酚酯减量至原剂量的2/3,环孢素A或他克莫司减量至2/3或1/2.4例受者将环孢素A或他克莫司转换为西罗莫司.结果 随访12～84个月.1例肾癌患者因对侧复发,合并双肺及胸壁多发转移,6个月后死亡.2例合并淋巴结转移的肾盂输尿管肿瘤患者分别于术后14和20个月,因多发转移死亡.其余22例患者存活,血清肌酐维持在98～163 μmol/L.结论 肾移植术后出现血尿的患者需注意筛查自体泌尿系统肿瘤.确诊的患者需要手术切除病变,术后调整免疫抑制方案.     

肾移植患者并发泌尿系统恶性肿瘤

目的　分析肾移植受者并发泌尿系统恶性肿瘤的特点。方法　回顾分析肾移植后发生泌尿系统恶性肿瘤的 9例患者的临床资料。结果　泌尿系统恶性肿瘤的发生率为 0 .39% (9/ 2 30 0 ) ,占所有肿瘤的 1/ 3(9/ 2 7) ,其中肾细胞癌 1例 ,双侧肾盂癌 2例 ,单侧肾盂癌 3例 ,输尿管癌 1例 ,膀胱癌 2例 ,发病年龄 (5 7.5± 5 .6 )岁 ,发病时间为移植术后 (5 8± 18)个月 ,6例免疫抑制治疗使用环孢素A、硫唑嘌呤和泼尼松 ,3例使用环孢素A、霉酚酸酯和泼尼松。 8例接受了根治性手术 ,1例在根治手术后不久并发脑溢血死亡。结论　泌尿系统恶性肿瘤是肾移植术后的一个重要并发症 ;免疫抑制剂的使用与肿瘤发生密切相关 ;对无痛性肉眼血尿应予重视     

肾移植术后并发泌尿系统恶性肿瘤22例

目的 分析肾移植受者泌尿系统恶性肿瘤的发病情况,并探讨其发病机理及治疗方法.方法 回顾性分析1978年至2010年12月间肾移植受者发生泌尿系统恶性肿瘤22例的资料.结果 22例的病理检查结果分别为膀胱移行上皮细胞癌9例(其中1例第3次手术后发现转化为腺癌),膀胱鳞状细胞癌1例,膀胱腺癌1例,肾透明细胞癌3例(其中2例为双侧肾癌),肾低分化癌1例,肾盂移行细胞癌1例,肾盂+膀胱移行细胞癌1例,输尿管移行细胞癌2例,输尿管+膀胱移行细胞癌2例,输尿管移行细胞癌+膀胱腺癌1例.肾癌及输尿管癌均发生在患者原肾及输尿管.11例膀胱癌患者中9例存活,均保有全部或部分肾功能;4例肾癌患者均在发病后半年内死亡;肾盂癌、输尿管癌除2例术后早期死亡外,其余5例存活.22例发现肿瘤后1年存活率为73.7%.结论 肾移植后泌尿系统恶性肿瘤可见少见的病理类型.治疗中应注意免疫抑制剂的使用和移植肾功能保护的问题.肾实质性恶性肿瘤预后很差.

Abstract：

Objective To investigate the incidence of urological malignancy in renal allograft recipients and explore the mechanism of increased incidence in China and the management. Methods A retrospective study was performed on 22 patients with urological malignancy in renal allograft recipients between 1978 and 2010. Results Twenty-two cases of urological malignancy were diagnosed by pathologic evidence, including 9 cases of transitional cell carcinoma (TCC) of bladder, 1 case of squamous cell carcinoma of bladder, 1 case of adenocarcinoma of bladder, 1 case of TCC of pelvis, 1 case of TCC of bladder and pelvis, 1 case of TCC of ureter complicated with adenocarcinoma of bladder, 2 cases of TCC of ureter, 2 cases of TCC of ureter and bladder, 3 cases of clear cell carcinoma of kidney, and 1 case of undifferentiated carcinoma of kidney. All the malignancies belonged to native organs. All the patients suffering bladder cancer had normal function of allograft. Five patients with TCC of pelvis or ureter survived and 2 cases died early after operation. All the patients suffering renal carcinoma deceased within 6 months after diagnosis. One-year survival rate was 73. 7 % after the diagnosis of urological malignancy. Conclusion Urological malignancy ranked highest in malignancy in renal allograft recipients, and rare pathological types of urological malignancy in non-renal allograft recipients are often demonstrated. The strategy of treatment should take consideration of the relationship between the usage of immunosupressive agents and the preservation of allograft function. It is critical for the therapy of malignancies to possess satisfactory allograft function. The prognosis of renal cell carcinoma is poor.     

肾移植后发生双侧肾盂和输尿管移行细胞癌的探讨(附5例报告)

目的:探讨肾移植术后发生双侧肾盂、输尿管移行细胞癌的临床特征。方法:报告5例肾移植后发生双侧肾盂、输尿管移行细胞癌患者的临床资料。于肾移植术后21～58个月检出,其中同时发现双侧肾盂、输尿管移行细胞癌3例,一侧移行细胞癌术后发现对侧移行细胞癌2例。2例分两次分别切除双侧肾脏、输尿管和部分膀胱壁,3例一次性切除双侧肾脏、输尿管和部分膀胱壁。术后给予丝裂霉素、吡柔比星、表阿霉素等进行膀胱灌注化疗。结果:5例均手术成功,术后继续膀胱灌注化疗,随访5～19个月无复发。结论:国人肾移植术后发生双侧肾盂、输尿管移行细胞癌并不鲜见,必须警惕;采用腹腔镜手术和下腹部开放手术切除病变,调整免疫抑制治疗方案有效。     

经尿道输尿管口及周围膀胱壁袖套状切除治疗肾盂移行细胞癌方法探讨

目的探讨治疗肾盂移行细胞癌的新方法及疗效。方法总结2009年1月至2010年12月收治的38例患者资料,所有患者经病理证实为肾盂移行细胞癌Ⅰ～Ⅲ级,均采用经尿道输尿管口及周围膀胱壁袖套状切除加腰部斜切口肾输尿管全切术。合并膀胱肿瘤及腺性膀胱炎者同期行汽化电切处理。术后1周拔除导尿管开始膀胱灌注化疗,每半年行膀胱镜检。结果本组术后均一期愈合,无出血、感染、漏尿等并发症发生。3例术后10个月膀胱肿瘤复发,行汽化电切。现患者均存活。结论腔镜下经尿道输尿管口及周围膀胱壁袖套状切除加腰部斜切口肾输尿管全切术操作简单,疗效好,创伤小,并发症少,恢复快,也可同时查看并处理膀胱其他疾患,是治疗肾盂移行细胞癌的最佳术式。     

肾移植术后并发泌尿系统恶性肿瘤44例临床分析

目的：对肾移植受者并发泌尿系统恶性肿瘤的情况进行分析，探讨其防治措施。方法：回顾分析肾移植术后发生泌尿系统恶性肿瘤的44例患者的临床资料。44例受者的免疫抑制方案，11例为环孢素A（CsA）、霉酚酸酯及泼尼松（Pred）联用，1例采用CsA、咪唑立宾及Pred联用，1例采用他克莫司、咪唑立宾及Pred联用，其余采用CsA、硫唑嘌呤及Pred联用。结果：44例的肿瘤诊断时间为移植后2～273个月，中位数为39．5个月，其中肾细胞癌5例，双侧肾盂输尿管癌10例，单侧肾盂输尿管癌16例，输尿管癌1例，膀胱癌12例；共有8例出现淋巴结或远处转移。诊断肿瘤后，对免疫抑制方案进行调整，43例患者接受了手术治疗，1例由于诊断不及时，丧失手术机会。经过治疗，39例存活，5例死亡。结论：肾移植术后恶性肿瘤尤其是泌尿系统恶性肿瘤的发生率明显升高，治疗的关键在于早期诊断、及时手术，并辅以免疫抑制方案的调整。     

肾移植术后并发自体尿路上皮多器官癌6例诊治研究

目的：探讨肾移植后并发自体尿路上皮多器官癌的诊治方法。方法：回顾性分析6例肾移植术后自体尿路上皮多器官癌的临床资料。结果：发现6例中1例为亲属肾移植。5例临床表现为肾移植术后2～48个月出现间歇性血尿,1例B超发现膀胱占位病变。6例均为非同时发生的移行细胞癌,非同时发生肿瘤的时间为1．5～16个月。6例患者因肿瘤复发或新发而接受2～5次肿瘤切除术,1例行全膀胱切除术及移植肾输尿管皮肤造瘘术,1例行全膀胱切除术、移植肾输尿管皮肤造瘘术及全尿道切除术。术后通过膀胱灌注给予丝裂霉素、吡柔比星、表阿霉素等进行化疔。治疗效果比较满意。结论：肾移植术后的尿路上皮多器官癌往往进展快,易扩散和转移,预后较差。对肾移植后并发自体尿路上皮多器官癌应高度重视,严把受体关,密切随访,早期诊断,积极治疗,慎重对待移植肾切除。     

肾细胞癌并发尿路移行细胞癌的诊断与治疗

目的 探讨肾细胞癌并发尿路移行细胞癌的临床特点和诊治方法。方法 回顾性分析5例肾细胞癌并发尿路移行细胞癌患者的临床资料。男4例，女1例。年龄42～75岁，平均62岁。间歇无痛全程肉眼血尿4例，间歇全程肉眼血尿伴右侧腰痛1例。B超、IVU及CT提示肾肿瘤并发尿路肿瘤4例，肾癌不除外合并同侧肾盂占位1例。结果 5例均行根治性手术，4例同时行不同部位肿瘤根治术，1例行分次手术。病理为肾癌并发膀胱癌3例，肾癌并发同侧输尿管癌1例，肾癌并发同侧肾盂癌1例。随访6～18个月，平均11个月。1例术后10个月膀胱肿瘤局部复发，再行经尿道膀胱肿瘤切除术；4例无瘤生存。结论 肾细胞癌并发尿路移行细胞癌临床少见，对肾癌患者行泌尿系超声、IVU和术中肾脏剖开检查有助于正确诊断。根治性手术宜同时切除肾癌侧输尿管，以避免残余输尿管发生肿瘤。     

肾移植术后并发双侧自体肾盂和输尿管移行细胞癌16例

目的 总结肾移植术后发生双侧自体肾盂、输尿管移行细胞癌的诊治经验.方法 回顾性分析16例肾移植术后发生双侧自体肾盂、输尿管移行细胞癌患者的资料.首次发现上尿路肿瘤的时间为移植后(56.2±33.0)个月.2例同时发现双侧上尿路肿瘤,其余14例双侧上尿路肿瘤先后发现的时间间隔为(8.6±6.7)个月.临床症状和检查阳性结果以血尿和自体肾积水为主.均行自体上尿路根治性切除术,术后行膀胱灌注化疗.结果 16例手术均成功.32次自体肾、输尿管的病理检查结果均为移行细胞癌,包括单纯肾盂肿瘤4次,单纯输尿管肿瘤9次,合并肾盂、输尿管肿瘤19次.23次肾盂肿瘤的分级为1级8例,2级11例,3级4例;28次输尿管肿瘤的分级为1级6例,2级10例,3级12例.术后随访(26.8±25.1)个月,1例出现肺部转移后死亡;1例发生腰背部软组织转移性移行细胞癌,局部切除;其他患者未发现肿瘤复发及转移.结论 肾移植后自体上尿路移行细胞癌的常见表现为血尿合并自体肾积水,该肿瘤侵袭性较强,对于膀胱及一侧自体上尿路同时存在移行细胞癌者,应行对侧自体肾上尿路预防性切除术.

Abstract：

Objective To investigate the clinical features of bilateral native pelvic and ureteral transitional cell carcinoma (TCC) in renal transplant patients. Methods A retrospective analysis was carried out on 16 patients with bilateral native pelvic and ureteral TCC after kidney transplantation.The mean time between transplantation and diagnosis of upper urinary TCC was 56. 2 ± 33. 0 months.Two patients were suffered from bilateral upper urinary TCC at the same time. The mean interval between 2 upper urinary tract operations of the remaining 14 cases was 8. 6 ± 6. 7 months. Hematuria and hydronephrosis of native kidneys were the main symptoms and targets in checkup. Intravesical chemotherapy was postoperatively given. Results All operations were performed successfully. All specimens obtained from the operations were pathologically diagnosed as TCC. The TCC location involved pure native pelvis (n = 4), pure native ureter (n = 9), and pelvis combined with ureter (n = 19). Pelvic TCC pathological grades included grade 1 in 8 cases, grade 2 in 11 cases, and grade 3 in 4 cases; Ureteral TCC grades included grade 1 in 6 cases, grade 2 in 10 cases, and grade 3 in 12 cases.Patients were followed up for 26. 8 ± 25. 1 months. One patient died of lung metastasis. (One case of lumbar soft tissue transfer was given local excision. The remaining patients had no recurrence and metastasis. Conclusion Renal transplant patients with hematuria and native renal hydronephrosis should be highly vigilant of the occurrence of upper urinary tract TCC. TCC after renal transplantation is invasive. Prophylactic contralateral nephroureterectomy should be performed on the recipients having TCC at the bladder and one side of native upper urinary tract.     

A case of renal cell carcinoma metastasizing to the contralateral kidney and renal pelvis

Extremely rarely renal cell carcinoma metastasizes to the contralateral renal pelvis or ureter. A 42-year-old man had undergone left radical nephrectomy for renal cell carcinoma (pT1b, grade 2) in March, 2000. Fifteen months later, he complained of macroscopic hematuria. Computed tomographic scanning and retrograde pyelography showed a right renal pelvic tumor. Enucleation of pelvic tumor was performed and a parenchyma mass incidentally identified in the right kidney was also resected. Histopathological examination of each tumor revealed renal cell carcinoma identical to the primary tumors in the left kidney suggesting metastasis to renal pelvis and de novo tumor or metastasis in the right kidney.     

肾移植术后并发尿路上皮肿瘤的临床分析

目的 分析肾移植患者并发尿路上皮肿瘤的特点，探讨其诊治方法。方法 自1998～2003年肾移植患者1293例，术后发生尿路上皮恶性肿瘤21例（1．6％）。男4例，女17例。17例原发病为慢性问质性肾炎。发生尿路上皮肿瘤距肾移植6～62个月，平均26个月。其中膀胱癌6例，单侧肾盂或输尿管癌6例，单侧肾盂或输尿管、膀胱癌8例，双侧肾盂输尿管癌1例。10例上尿路肿瘤发生部位与移植肾同侧，4例发生于移植肾对侧。临床症状以无痛性肉服血尿和反复泌尿系感染为主。19例行手术治疗，术后所有患者免疫抑制剂用量减少1／3并辅以局部灌注化疗。结果 2例行姑息性治疗的晚期肿瘤患者分别于发现肿瘤5、8个月死亡。余19例现已随访2～5年。13例肿瘤复发，复发部位为膀胱或对侧原。肾、输尿管。所有患者在免疫抑制剂减量期间均未出现急性排斥。2例因切除移植肾恢复透析，17例肾功能正常。结论 慢性间质性。肾炎导致。肾功能衰竭的。肾移植患者和女性肾移植患者易发生移植后尿路上皮肿瘤；移植肾同侧上尿路较对侧好发肿瘤；对移植肾对侧为首发的上尿路发生肿瘤者可预防性行双侧上尿路根治性切除。     

Bladder cancer with skin metastasis: a case report

Bladder carcinoma with skin metastasis is extremely rare. We herein report a case of a bladder tumor with skin metastasis. A 68-year-old man was referred to our hospital with macroscopic hematuria. Cystoscopy revealed a trigone papillary tumor. Transurethral resection of bladder tumor (TURBT) was performed and the pathological diagnosis was transitional cell carcinoma (TCC), pT1, G3. Thereafter, he received several courses of TURBT, intravesical chemotherapy (pirarubicin, bacillus Calmette-Guerin and mitomycin C) and intra-arterial chemotherapy because of recurrence. Thirteen years later, he underwent total cystoprostatectomy with neobladder formation. Histological examination revealed muscle-invasive bladder cancer with a staging of T3bNOM0. Two years and three months later, multiple firm nodules with eruptions appeared on the skin in several regions; they were resected and the histological findings revealed TCC. This indicated metastatic spread from the primary bladder TCC. He received only supportive treatment during this period due to renal dysfunction. He died four months after the manifestation of the skin metastasis due to multiple metastases.     

影响肾盂输尿管癌预后的多因素分析

目的 探讨影响肾盂输尿管癌患者的预后因素. 方法回顾性分析220例经病理证实的肾盂输尿管癌患者资料.男146例,女74例.年龄38～84岁.肾盂癌103例,输尿管癌84例,肾盂癌合并输尿管癌13例,肾盂癌合并膀胱癌5例,输尿管癌合并膀胱癌11例,肾盂癌、输尿管癌、膀胱癌同时发生4例.TNM分期:Ta2例、T1116例、T248例、T337例、T417例;WHO分级:G15例、G287例、G3128例.选择11个对预后可能产生影响的因素,应用Cox比例风险回归分析各因素与术后生存率的关系,生存率分析采用Kaplan-Meier方法.生存分析比较采用Gehan比分检验和Log-rank时序检验.应用logistic回归分析各因素与术后再发膀胱癌的关系. 结果 Ta～T1患者5年生存率为80.5%(95/118),T2为70.8%(34/48),T3为45.9%(17/37),T4为17.6%(3/17),Ta～T1、T2与T3～T4之间比较差异有统计学意义(u=9.429,P=0.002).输尿管肾镜术治疗组生存率与其他手术组生存率分析比较,差异无统计学意义(x2=0.217,P=0.641).影响肾盂输尿管癌患者长期生存率的因素为年龄(RR=1.639,P-0.027)、症状初发到手术时间(RR=1.279,P=0.019)、肿瘤分期(RR=1.373,P=0.011).与术后再发膀胱癌显著相关的因素足肿瘤多部位生长(RR=11.292,P=0.003)及伴发膀胱癌(RR=8.780,P=0.001). 结论 年龄、症状初发到手术时间、肿瘤分期是影响肾盂输尿管癌患者长期存活的危险因素,肿瘤多部位生长及伴发膀胱癌是术后再发膀胱癌的高风险因素.     

Ureteral and bladder metastases of renal cell carcinoma following synchronous renal cell carcinoma and bladder cancer; a case report

A 73-year-old man presented with gross hematuria. Ultrasonography and computerized tomography showed small bladder tumors and a left renal mass protruding to renal pelvis. Transurethral resection of bladder tumor and ureteroscopic tumor biopsy were performed, and pathological examinations revealed transitional cell carcinoma in the bladder and renal cell carcinoma in the kidney. He underwent left radical nephrectomy. A 4-month postoperative cystoscopy revealed a solitaly non-papillary tumor in the bladder. Transurethral resection was performed and pathological diagnosis was metastasis from renal cell carcinoma. At that time, multiple metastases to ureteral stump and lung were found. He had undergone palliative treatment because of his poor general condition until he died 26 months postoperatively. Care should be taken for management of ureteral stump when diagnostic ureteroscopy was done for renal cell carcinoma invading the renal pelvis.     

Small cell carcinoma of the urinary bladder: a case report

We report a case of primary small cell carcinoma of the urinary bladder. A 74-year-old woman was referred to our hospital because of pollakiuria. Cystoscopy showed a papillary tumor. We operated transurethral resection of the bladder tumor (TUR-Bt). Histopathological finding was transitional cell carcinoma (TCC), grade3, pT1 containing pTis. About six months later, tumor recurred to the bladder. Pathologic diagnosis was TCC in part and most was small cell carcinoma. Pelvic magnetic resonance imaging revealed a huge mass lesion with extravesical extension in the urinary bladder, and computed tomography scan showed external iliac lympho node metastasis. The rapid rise of a tumor maker NSE and pro-GRP were remarkable. It was diagnosed as a rapid advance of small cell carcinoma. We performed pelvic radiotherapy, and chemotherapy using carboplatin (CBDCA) and etoposide (VP-16). However 14 months after it had left hospital, computed tomography showed paraaortic lympho node metastasis. The patient died due to rapidly progressive disease.     

进展期腹、盆腔脏器肿瘤侵犯膀胱21例诊治分析

目的探讨进展期腹、盆腔脏器肿瘤侵犯膀胱的临床特点及其诊断和处理。方法回顾性分析经临床和病理证实的21例进展期腹、盆腔脏器肿瘤侵犯膀胱的临床资料。结果本组原发癌占13例和复发癌8例。其中降、乙状结肠癌10例,直肠癌7例,卵巢癌2例,恶性子宫内膜异位症2例。临床表现主要为便血,血尿,腹痛,腹部肿块,肾积水。手术配合化疗15例(根治性手术9例,姑息性手术6例),放弃治疗6例。术后随访15例,随访3个月～5年,平均2.6年,无瘤生存6例,局部复发带瘤生存4例,死于癌症或晚期并发症11例。结论进展期腹、盆腔脏器肿瘤侵犯膀胱,主要依据临床表现、影像和窥镜等检查而诊断。处理取决于原发肿瘤的进展情况,对局部进展侵犯膀胱者,可以施行肿瘤扩大根治手术或姑息切除术,配合化疗等综合措施,近期效果良好,生活质量改善。     

Metastatic small intestinal tumor associated with transitional cell carcinoma: a report of 2 cases and review of cases in Japan

Transitional cell carcinoma (TCC) frequently metastasizes to lymph nodes, liver, lungs and bone. However, metastasis to the gastrointestinal tract is rare. We report two cases of bladder tumor which metastasized to the ileum. According to the literature, these are the 7th and 8th cases in Japan. Case 1: A 87-year-old man had a history of bladder tumor (TCC, grade 3, pT2bN0M0) and has transurethral resection of bladder tumor (TUR-BT) three times. Two months after the last TUR-BT, he was admitted with ileus. As computed tomography (CT) showed abdominal free air, our diagnosis was perforation of gastrointestinal tract. The patient received an operation which resected partial ileum. We found the elastic hard tumor in the ileum on the perforated lesion, which showed metastatic TCC in the ileum pathologicaly. Case 2 : A 53-year-old man visited our hospital with gross hematuria. Cystoscopy showed a non-papillary broad based tumor in the right wall of the bladder. CT showed a bladder tumor invaded into the prostate (pT4aN1M0), we performed total cyctectomy and ileal conduit after neo-adjuvant chemotherapy. During the operation, we found the tumor (2 cm in diameter) in the small intestine which was metastasized of bladder tumor.