膀胱腺癌的诊断与处理(附41例报告)

目的　提高膀胱腺癌的诊断与治疗水平。　方法　分析经手术病理证实的 4 1例膀胱腺癌患者资料。原发性膀胱腺癌 18例 ,作全膀胱切除 尿流改道 8例 ,膀胱部分切除 10例 ;脐尿管腺癌 12例中扩大膀胱部分切除 11例 ;转移性腺癌 11例均切除膀胱病灶。　结果　膀胱腺癌占同期膀胱癌的 3.2 %。 37例随访 5个月～ 10年 ,1年生存 19例 (5 1.3% ) ,2年生存 16例 (43.2 % ) ,5年生存 8例 (2 1.6 % )。　结论　原发性膀胱腺癌宜行根治性全膀胱切除术 ,脐尿管腺癌应作扩大性膀胱部分切除 ,对复发、转移性患者应采用综合治疗 ,以提高生存率     

膀胱腺癌(附26例报告)

目的 提高膀胱腺癌的诊治水平。方法 回顾分析１９８０年１月至１９９８年１月收治的２６例膀胱腺癌资料。其中脐尿管腺癌１２例,原发性膀胱腺癌１４例。结果 ２６例中膀胱部分切除术８例,全膀胱切除＋尿流改道术１３例,根治性全膀胱切除＋尿流改道术２例,姑息性尿流改道术３例。随访１年生存率５２％,５年生存率２０％。结论 较局限的脐尿管腺癌可行广泛性部分膀胱切除术,原 性膀胱腺癌应行根治性全膀胱切除。     

膀胱腺癌的诊治(附23例报告)

目的 提高膀胱腺癌的诊断与治疗水平.方法 对1998年1月～2008年10月收治的23例膀胱腺癌患者临床资料进行回顾性分析.结果 2例患者失访,21例患者随访时间为5个月～10年.1年生存10例(47%),2年生存7例(33%),5年生存4例(19%).生存时间超过5年者均为早期患者.结论 早期诊断、选择合适的手术方式及术后辅助放化疗有益于改善患者预后.     

膀胱腺癌的诊断与治疗(附21例报告)

目的：提高膀胱腺癌的诊治水平。方法：对1990年1月一2001年12月收治的21例膀胱腺癌患者临床资料进行回顾性分析，其中原发性膀胱腺癌18例，脐尿管癌3例。经尿道电切术3例，膀胱部分切除术9例，根治性全膀胱切除术8例，姑息性尿流改道术1例。结果：13例获得随访，1年生存率46．2％，5年生存率16．7％。结论：提高膀胱腺癌的早期诊断水平、严格术式选择、术后辅助放化疗有益于改善患者预后。     

膀胱腺癌的诊断和治疗（附21例报告）

目的提高膀胱腺癌的诊治水平。方法回顾性分析21例膀胱腺癌临床资料，其中原发性膀胱腺癌14例，全膀胱切除 尿流改道术4例，膀胱部分切除6例，经尿道膀胱肿瘤电切术3例，姑息性尿流改道术1例；脐尿管腺癌7例，扩大膀胱部分切除术4例，根治性全膀胱切除 尿流改道术2例，放弃治疗1例。结果5年生存率18％(3／16)。结论原发性膀胱腺癌宜采用根治性全膀胱切除术，脐尿管腺癌宜采用扩大膀胱部分切除术，综合性治疗有助于提高复发、转移患者的生存率。     

膀胱腺癌的诊治(附22例报告)

目的：探讨膀胱腺癌的诊治效果。方法：回顾性分析22例膀胱腺癌的临床资料，其中原发性膀胱腺癌19例，脐尿管癌3例。结果：22例有8例次行根治性膀胱全切术，4例行次膀胱全切术，2例次行扩大膀胱部分切除术，3例次行膀胱部分切除术，5例次行经尿道膀胱肿瘤切除术。术后随访1－5年，其2年生存率为55.5%，5年生存率为33.3%。结论：扩大性膀胱部分切除术是脐尿管癌的主要手术方式，原发性膀胱腺癌多行根治性膀胱全切术，总体疗效需进一步提高。     

膀胱腺癌(附5例报告)

报告膀胱腺癌5例,占同期膀胱恶性肿瘤的4.7%。主要症状为无痛性血尿及下腹部肿块。粘液尿为粘液型腺癌的特殊症状。本文结合文献讨论了膀胱腺癌的组织学起源及分类,提出了原发性膀胱腺癌与脐尿管癌之鉴别要点。     

膀胱腺癌（附31例报告）

１９６０年１月～１９９３年１月收治膀胱腺癌３１例，经病理证实原发性膀胱腺癌２５例，脐尿管腺癌６例。就临床表现、膀胱镜检查及膀胱造影等特点，结合文献分析讨论组织起源、早期诊断、及时正确治疗的重要性。手术治疗主张广泛膀胱部分切除术及根治性膀胱全切术，联合放疗，化疗。本组５年生存率２２．６％。     

膀胱癌肉瘤4例临床病理分析

目的:探讨膀胱癌肉瘤的临床表现、病理特征、治疗方法等。方法:报告1995～2010年天津医科大学第二医院的4例膀胱癌肉瘤疾病的情况,并结合文献对之诊断、病理、治疗等行进一步分析。结果:4例患者中,男2例,女2例,年龄63～80岁。均因间歇性无痛全程肉眼血尿入院,膀胱镜检查均提示菜花样肿物,呈浸润性生长。2例行膀胱部分切除术,2例行膀胱全切加双侧输尿管皮肤造瘘术。术中所见与膀胱癌基本相同。术后病理检查均有癌和肉瘤两种成分,免疫组化有膀胱癌肉瘤较特异性表现。术后予以不同的化疗等。结论:膀胱癌肉瘤在膀胱恶性肿瘤中罕见,没有特征性的临床表现,确诊主要依靠病理和免疫组化检查;治疗方法采用根治性膀胱切除术较佳,但其恶性程度高,预后不良,诊断和治疗需要进一步探索。     

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.     

原发性膀胱癌28例报告

目的：提高原发性膀胱腺癌的诊治水平。方法：回顾分析1983至2001年收治的28例原发性膀腺癌资料。结果：28例分别接受了6种手术治疗。26例获得随访，1a生存率88.5％，5a生存率38.5％。结论：认清膀胱腺癌的临床特点，做到早期诊断，早期广泛手术切除，联合放疗和化疗，可提高五年生存率。     

Clear cell adenocarcinoma of the urinary bladder inducing acute renal failure

We report a case of clear cell adenocarcinoma of the urinary bladder. A 59-year-old male was referred to our hospital complaining of oliguria, left lower abdominal pain and loss of appetite. Ultrasonography revealed bilateral hydroureteronephrosis and obstructions at the ureterovesical junction. Magnetic resonance imaging demonstrated an invasive irregular tumor located in the posterior wall of the urinary bladder and urinary infiltration to the left retroperitoneal space.The clinical diagnosis was acute post renal failure due to bilateral ureteral obstructions from an invasive bladder tumor. After we performed bilateral percutaneous nephrostomy, the patient underwent trans urethral biopsy of the bladder tumor, which showed clear cell adenocarcinoma extending from the submucosa to the muscular layer, histopathologically. The patient died of metastatic disease 8 months after diagnosis. To our knowledge, the present case is the 23rd to be reported and demonstrates the shortest survival period in the related literature.     

Intra-arterial infusion of 5-fluorouracil, leucovorin and cisplatin for primary adenocarcinoma of the urinary bladder.

BACKGROUND: Primary invasive adenocarcinoma of the urinary bladder was diagnosed in a 59-year-old man with a 6-month history of macrohematuria. METHODS: He was treated with intra-arterial infusion of 5-fluorouracil, leucovorin and cisplatin and underwent radical cystectomy and construction of ileal conduit. RESULTS: The pathologic examination of the specimen revealed no viable malignant cells. CONCLUSION: 5-Fluorouracil combined with leucovorin and/or cisplatin has been used in the treatment of gastrointestinal adenocarcinoma and may be useful in primary adenocarcinoma of the bladder.     

Granular cell tumor of the urinary bladder with pseudoepitheliomatous hyperplasia and colocalization with adenocarcinoma

Granular cell tumor of the bladder is exceptionally rare, with only 11 cases reported in the published reports. Pseudoepitheliomatous hyperplasia of the overlying squamous epithelium has been observed in non-bladder granular cell tumors. We herein report the first case of bladder granular cell tumor to exhibit pseudoepitheliomatous hyperplasia. This phenomenon is significant as it may potentially lead to difficulty in the distinction between infiltrative squamous cell carcinoma and pseudoepitheliomatous hyperplasia in cases of granular cell tumor of the bladder. This case also represents the first granular cell tumor to demonstrate colocalization with adenocarcinoma of the bladder. Based on our findings and a review of the published reports, management for granular cell tumor of the bladder should involve a course of local resection combined with active surveillance given its typical benign course, albeit with the potential for local recurrence.     

Advanced adenocarcinoma of the urinary bladder successfully treated by the combination of cisplatinum, mitomycin-C, etoposide and tegafur-uracil chemotherapy

Primary adenocarcinoma of the urinary bladder has shown an extremely poor response to radiation or chemotherapy. Therefore, radical surgery is the only therapeutic treatment for it. A case report is presented of a primary advanced adenocarcinoma of the urinary bladder invaded into the uterus with distant metastases which responded completely to systemic combination chemotherapy including tegafur-uracil. The patient was a 53-year-old woman with a history of asymptomatic macrohematuria. She was treated with the combination of cisplatinum, mitomycin-C, etoposide and tegafur-uracil chemotherapy. After four courses of the chemotherapy, computed tomography showed marked regression of the primary tumor of the urinary bladder and the complete disappearance of the distant metastases in the liver, lung and para-aortic lymph node. Subsequently, she underwent radical cystectomy and cutaneous ureterostomy. Pathologically, no viable cancer cells were detected. Three years after the operation, she has no evidence of disease recurrence. Treatment of advanced adenocarcinoma of the urinary bladder by this combination chemotherapy is of benefit.