一氧化氮合酶在膀胱癌中的表达及临床意义

目的：探讨一氧化氮（NO）在膀胱肿瘤中的作用及临床意义。方法：采用免疫组织化学方法对58例膀胱移行细胞癌标本（实验组）及14例良性膀胱组织标本（对照组）进行一氧化氮合酶（NOS）抗体染色，观察表达结果与肿瘤生物学特性之间的相关性。结果：诱导型NOS（iNOS)在实验组中的阳性表达率明显高于对照组（P＜0．01），其表达程度与肿瘤分级、分期无关（P＞0．05）；内皮型NOS（eNOS）在实验组和对照组血管内皮细胞都有表达，但前者表达较强；而在对照组中多呈不连续的表达。结论：NO在膀胱移行细胞癌的发生、发展中起重要的作用。     

Malignant mixed mesodermal tumor of bladder occurring after radiotherapy for cervical cancer: report of a case

A rare case of radiation-induced malignant mixed mesodermal tumor of the bladder is reported. A 78-year-old woman complained of hematuria, which originated from a polypoid tumor in the bladder 15 years after radiotherapy for squamous cell carcinoma of the uterine cervix. The bladder tumor recurred 9 months after resection and partial cystectomy then was performed. Histological findings revealed malignant mixed mesodermal tumor composed of carcinomatous and sarcomatous elements. The former element consisted mainly of transitional cell carcinoma with occasional foci of squamous metaplasia and glandular differentiation, while the latter consisted of spindle cell sarcoma showing partly cartilaginous and osseous differentiation. The histogenesis of malignant mixed mesodermal tumor of the bladder also is discussed.     

Inverted papilloma with malignant change of renal pelvis

A case is presented of a rare type of renal pelvic tumor. Morphologically the structure of the lesion resembled an inverted papilloma of the urinary bladder, but the tumor cells composing the lesion underwent malignant transformation.     

A case of secondary malignant lymphoma of the urinary bladder

A 56-year-old man was admitted to our hospital for salvage chemotherapy of recurrent diffuse large B cell malignant lymphoma at clinical stage IIIb and which had been treated with 6 cycles of cyclophosphamide, doxorubicin, vincristine and prednisone (CHOP). Computed tomography showed multiple tumors in the bladder after a cycle of ifosfamide, etoposide and mitoxantrone (MINE), but cystoscopy after the second cycle revealed a single non-papillary tumor about 1cm in diameter. After 3 cycles of MINE therapy, transurethral resection of bladder tumor was performed. At the time of the operation, the protruded lesion disappeared and there remained only a scar. Biopsy of the scar revealed malignant lymphoma infiltrated into the submucosal layer. Although the rate of the bladder involvement of malignant lymphoma reaches 3-20% in autopsy cases, it is very rare for a secondary malignant lymphoma of the urinary bladder to be diagnosed clinically. The prognosis of the secondary bladder lymphoma is much poorer than that of the primary one, because of the widespread dissemination of the disease at the time of diagnosis.     

A case of primary malignant lymphoma of the bladder

A case of primary malignant lymphoma of the bladder is reported. A 61-year-old female visited our outpatient clinic with the chief complaints of asymptomatic grosshematuria and was recognized as having a bladder tumor by abdominal ultrasonography. On cystoscopic examination, the tumor was non-papillary and dome-like in shape. Computed tomography revealed that the bladder tumor was invading into the bladder wall. The histopathological study of endoscopic biopsy specimen revealed malignant lymphoma. After further examinations, it was diagnosed as primary malignant lymphoma of bladder, stage IE (Ann Arbor classification). Four courses of CHOP regimen (cyclophosphamide, vincristine, doxorubicin, predonisolone) was performed and no lymphoma cell was found by re-biopsy at the primary site. No local or distant recurrence was found during the 15 months' follow up.     

Primary malignant lymphoma of the urinary bladder: a case report

We report a case of primary malignant lymphoma of the urinary bladder. A 72-year old woman complaining of low abdominal pain was admitted to the Tone Central Hospital in February, 2001. Macrohematuria appeared, and the submucosal tumor was observed by cystoscopy, and A Transurethral bladder biopsy led to a histopathological diagnosis of non-Hodgkin's malignant lymphoma (diffuse lymphoma, large-sized cell type, B-cell type). Clinical stage was IE, but as soon, she was get bilateral hydronephrosis and bladder-ileum fistula. The administration of 6-course CHOP chemotherapy had an excellent effect of disappearing the tumor, bilateral hydronephrosis, and bladder-ileum fistula. She remained free of disease until now.     

膀胱原发性恶性黑色素瘤1例并文献复习

目的 观察原发性恶性黑色素瘤的病理形态、免疫组化和电镜特征,进一步探讨其组织起源和鉴别诊断,指导临床诊治.方法 用组织病理学、免疫组化、透射电镜方法进行观察,并结合国外文献资料进行探讨.结果 肿瘤位于膀胱黏膜下,瘤细胞呈巢状或弥漫排列,具有一定异型性,部分为透亮型,部分为小细胞型,靠近边缘的肿瘤细胞呈梭形伴黑色素沉着....     

膀胱非上皮性肿瘤的诊治

目的 总结膀胱非上皮性肿瘤的诊治经验。方法 对1953～2002年收治的28例膀胱非上皮性肿瘤患者的诊治情况进行总结、分析。结果 膀胱非上皮性肿瘤的主要临床表现为血尿、盆腔肿块、尿频、排尿困难等症状。主要辅助检查为B超、CT、膀胱镜检查及镜下活检。本组28例中,经术后病理检查,恶性肿瘤17例(占61．7％),有7种病理类型,分别为膀胱横纹肌肉瘤、膀胱小细胞癌、膀胱平滑肌肉瘤、膀胱恶性淋巴瘤、膀胱恶性纤维组织细胞瘤、膀胱脂肪肉瘤、膀胱黑色素瘤;良性11例(占39．3％),有4种病理类型,分别为膀胱海绵状血管瘤、膀胱壁纤维瘤、膀胱平滑肌瘤、膀胱嗜铬细胞瘤。11例良性肿瘤均完整切除或电灼、电切。17例恶性肿瘤中,膀胱部分切除术7例、膀胱全切除术9例、无法切除1例,有7例恶性肿瘤因复发多次行手术切除。17例恶性肿瘤患者均获随访,3年存活率47．0％(8／17)。结论 膀胱非上皮性肿瘤临床少见,病理类型复杂,恶性居多且预后较差,良性肿瘤预后较好。术前诊断率低,膀胱镜下深部活检可提高诊断率。手术是该病的主要治疗方法。良性肿瘤应完整切除,恶性肿瘤应争取广泛切除,结合其病理特点辅助放化疗可能提高疗效。     

Multiple synchronous primary malignant tumors of fibrosarcoma and squamous cell carcinoma in the urinary bladder: a case report

A 65-year-old housewife presented with a diagnosis of malignant spindle cell tumor of the bladder which had been diagnosed by work up for chance hematuria. Urine cytology revealed a small number of squamous epithelial cells showing dyskeratosis but no spindle cells. Computed tomography and magnetic resonance images showed a markedly enhanced mass, 4 cm in diameter, on the anterior wall of the urinary bladder, which appeared to be adhesive to the pubic bone. However, no metastasis was found. Under the suspicion of sarcoma of the urinary bladder, we performed anterior pelvic exenteration with construction of an ileal conduit. Although the anterior wall of the urinary bladder was mildly adhesive to the pubic bone, the surgical margin was negative for malignant cells. The tumor corresponded to a fibrosarcoma that infiltrated the adipose tissue surrounding the urinary bladder. The entire mucosa of the bladder showed diffuse squamous metaplasia, and well differentiated squamous cell carcinoma with pearl formation was found in part. These two malignant tumors were clearly apart from each other, resulting in the histologic diagnosis of synchronous multiple malignant tumors of the bladder. The patient developed a local relapse and pulmonary metastasis of fibrosarcoma one month postoperatively and died two month later without any response to chemotherapy (CYVADIC) and radiotherapy. The current case seems to be the first one in Japan (third in the world) of a patient with multiple synchronous primary malignant tumors, carcinoma and sarcoma, airsing in the urinary bladder.     

The urinary bladder: An extremely rare location of pediatric neuroblastoma

Pediatric malignant tumors in the urinary bladder are rare with a high prevalence of rhabdomyosarcomas. A 15-month-old patient was referred to the authors’ center because of a urinary bladder tumor. Imaging studies disclosed a solid pelvic mass in the dome of the bladder confirmed by a cystoscopy. Surprisingly, the biopsy done during this procedure confirmed a neuroblastoma with a favorable SHIMADA classification. This tumor had no bad prognostic factors. But, vessel compression and local infiltration led to delayed surgery, and neoadjuvant chemotherapy was initiated. After chemotherapy, a complete surgical resection was accomplished. Currently, this patient is in complete continuous remission. Only 5 other cases have been reported. Thus, urinary neuroblastoma seems to be a very rare pediatric tumor, but it should be considered in the differential diagnoses of urinary bladder tumor.     

A collision cancer between urothelial carcinoma and malignant lymphoma of the urinary bladder: a case report

A man in his 70's visited the Department of Internal Medicine due to lumbago that had first appeared two months previously. Abdominal computed tomography showed a low-density area in the liver and swelling of lymph nodes surrounding the abdominal aorta. Four months later, he was hospitalized on an emergency basis in a urology ward in order to control bladder tamponade. Cystoscopy revealed massive blood clots and a papillary tumor at the left wall of the urinary bladder. He underwent transurethral resection of a bladder tumor, and the pathological diagnosis was a collision tumor between urothelial carcinoma (G2, pTa) and malignant lymphoma (B cell type). He underwent a liver biopsy soon thereafter, and the pathological diagnosis was malignant lymphoma (as for the one found in the urinary bladder). Bladder tamponade was repeated, which was relieved after one course of chemotherapy for malignant lymphoma. He underwent six courses of chemotherapy (THP-CO), and he was well without recurrence of either malignant lymphoma or urothelial carcinoma with 3 years' follow-up. To our knowledge, this is the 14th reported case of a collision tumor in the urinary tract.     

Single polypoid cystitis cystica and glandularis presenting as benign bladder tumor

A case report of a ten-year-old boy with a benign polypoid bladder tumor is presented. The rarity of benign or malignant bladder tumors in children is reviewed, as well as the possible etiology of this unique lesion.     

膀胱非上皮性肿瘤

目的：提高膀胱非上皮性肿瘤的诊治效果。方法：回顾性分析1990／2002年收治的11例膀胱非上皮性肿瘤的临床资料。结果：膀胱平滑肌瘤、血管瘤及副神经节瘤各1例,行膀胱部分切除,术后无复发;膀胱小细胞癌3例,其中1例仅作探查活检术,术后行髂内动脉插管化疗,于术后18月死亡;另外2例作膀胱部分切除术,分别于术后3月和7月死亡;膀胱横纹肉瘤2例,1例仅作根治性膀胱全切 原位回肠膀胱术,于术后6月死亡,另1例行膀胱部分切除术后失访;恶性副神经节瘤1例,行膀胱部分切除术后9年出现广泛转移;肉瘤样癌2例,1例仅作探查活检术,另1例仅作膀胱部分切除术,均于术后6月内死亡。结论：膀胱非上皮性肿瘤少见,良性肿瘤预后好;恶性肿瘤预后差,须行综合治疗,并作密切随访。     

Malignant peripheral nerve sheath tumor of the urinary bladder in von Recklinghausen disease

A case of malignant peripheral nerve sheath tumor of the bladder in a 57-year-old man with multiple neurofibromatosis type 1 is presented. The patient had a recent history of a transurethrally resected bladder ganglioneuroma. A probable histogenetic association between these two extremely rare neoplasms is proposed.     

膀胱非上皮性肿瘤25例诊治报告

目的 总结膀胱非上皮性肿瘤的影像及临床诊断特点,探讨治疗方法与预后的关系.方法 回顾性分析25例膀胱非上皮肿瘤临床资料.男16例,女9例.年龄2～71岁.其中血尿6例,下腹部肿块2例,尿频14例,排尿困难2例,排尿晕厥1例.超声及CT检查发现22例膀胱占位病变,3例盆腔肿物及膀胱壁受累.均行膀胱镜检查,穿刺活检17例.结果 15例良性肿瘤行单纯肿瘤剜除术或膀胱部分切除术;10例恶性肿瘤行膀胱部分切除术或膀胱全切术.恶性肿瘤术后辅助化疗、放疗.随访3个月～11年.良性肿瘤均无复发,恶性肿瘤9例死于术后3年内,平均存活16个月;1例膀胱恶性淋巴瘤带瘤存活6年.结论 膀胱非上皮性肿瘤临床上少见,病理类型复杂,恶性居多,预后较差.膀胱部分切除术或膀胱全切术是本病的主要治疗方法,恶性肿瘤结合其病理特点辅助放化疗,疗效不理想,预后差别较大.     

Malignant pheochromocytoma of the urinary bladder

A case of malignant pheochromocytoma of the urinary bladder is presented. A 54-year-old woman visited our hospital for screening and was found to have an abnormal mass in the bladder on ultrasonography. The patient was not hypertensive. Cystoscopy revealed a broad-based, small fingertip-sized, nonpapillary tumor on the posterior wall of the urinary bladder. Transurethral resection (TUR) was performed without suspicion of pheochromocytoma because of her well-controlled blood pressure and lack of characteristic symptoms. Transient elevation of systolic blood pressure to 240 mmHg occurred during resection of the tumor. Radical resection was therefore not possible. The serum norepinephrine level was elevated postoperatively. Pathologic examination revealed a malignant pheochromocytoma. On January 30, 2003, partial cystectomy of the residual tumor and pelvic lymphadenectomy were performed. She has had no clinical sign of recurrence for 1 year after the second operation.     

Nephrogenic Adenoma in a Patient with Transitional Cell Carcinoma of the Bladder Receiving Intravesical Bacillus Calmette-Guérin

A 76-year-old-man was admitted to our hospital for a recurrent bladder tumor. He had received intravesical bacillus Calmette-Guérin (BCG) treatment for a transitional cell carcinoma of the bladder. A follow-up cystoscopy revealed a solitary papillary tumor in the left bladder wall. A transurethral cold cup biopsy revealed a nephrogenic adenoma without any evidence of malignant cells. We discuss the pathogenesis of nephrogenic adenoma and suggest that prolonged cystitis caused by intravesical BCG may play an etiological role.     

A case of combination with proliferative cystitis and pelvic lipomatosis causing bilateral hydronephrosis

A 70-year-old man consulted our hospital complaining of gross hematuria and bilateral hydronephrosis. Cystoscopic findings suggested non-papillary sessile tumor at the bladder neck. CT findings revealed bilateral hydronephrosis caused by the stricture of lower ureters. Tumorous structure existed between bladder and prostate. Abundant fatty tissue was observed around bladder and rectum, the shape of the bladder was distorted to inverted tear-drop and the bladder was transferred anteriorly, showing findings of pelvic lipomatosis. Urethrocystography revealed elongation of prostatic urethra and anterior displacement of the bladder. Transurethral tumor resection was performed under spinal anesthesia. Pathological diagnosis was proliferative cystitis and no malignant cells were observed. Transperineal tumor biopsy also revealed no malignant cells. The patient was followed under administration of "Saireitou" (chinese medicine) and cetirizine hydrochloride, followed by antibiotics and anti-inflammatory enzyme preparations.     

Nitric oxide synthase expression in human bladder cancer and its relation to angiogenesis

Nitric oxide (NO) is synthesized by the enzyme family of nitric oxide synthases (NOS) and plays an important role in tumor growth and angiogenesis. The expression of two of the NOS isoforms, the endothelial and inducible isoforms (eNOS and iNOS, respectively), were evaluated in bladder tissue from patients with transitional cell carcinoma (TCC). The specimens were procured from 58 patients with TCC and 14 cases of normal bladder mucosa were used as a control group. NOS immunohistochemistry was performed and microvessal density (MVD) was determined. iNOS specific proteins were found in 47 of 58 bladder cancer specimens but not in control bladder tissue. The endothelial cells in both normal urothelium and tumor tissue showed a highly positive eNOS immunostaining. The MVD was 39.3+/-19.5 and 29.3+/-10.5 in TCC positive and negative for iNOS, respectively ( P<0.01). A correlation between iNOS immunoreactivity and tumor grade in bladder carcinoma could not be verified. These results indicate that NO generation from iNOS in the malignant epithelium and from eNOS in tumor stroma play a important role in tumor angiogenesis.     

Long ureteral polyp: a case report

A case of long ureteral polyp is presented. The patient was a 62-year-old woman complaining of asymptomatic macrohematuria. Radiological examinations revealed ureteral tumor. A tumor was found with cystoendoscopy, and by transurethral biopsy in bladder the tumor was not malignant. Polypectomy was performed. The tumor removed was fibrous polyp measuring about 8 cm in length.