膀胱癌肉瘤与肉瘤样癌诊治再讨论

目的：探讨膀胱癌肉瘤和肉瘤样癌的组织学特性、临床表现、治疗以及预后.方法：回顾性分析1例膀胱癌肉瘤及2例肉瘤样痛患者的临床、病理和随访资料,并复习相关文献进行讨论.结果：3例患者术后病理检查可见上皮源性和间质源性两种恶性成分.1例癌组织CK和EMA阳性,但Vimentin阴性,肉瘤样组织Vi-mentin阳性,诊断为膀胱癌肉瘤,术后给予M-VAC方案化疗,于10个月后死于肿瘤肺部转移.2例癌组织与肉瘤样区有移行,癌组织CK和EMA阳性,但Vimentin阴性,肉瘤样组织CK、EMA及Vimentin阳性,诊断为膀胱肉瘤样癌,术后分别给予GC和M-VAC方案化疗,于8个月和11个月后死于肿瘤肺部转移和心力衰竭.结论：膀胱癌肉瘤和肉瘤样癌具有浸润性生长的生物学特性,恶性程度高,预后不良.其确诊依赖病理学及免疫组织化学检查,手术仍是首选治疗方式.

Carcinosarcoma and Sarcomatoid Carcinoma of Bladder and a Review of the Literature

Objective： To investigate the histological features, clinical manifestations, treatment options and prognosis of bladder data of 1 case of bladder and sarcomatoid carcinoma. Methods：The clinical, pathological and follow-up and 2 cases of bladder sarcomatoid carcinoma were reviewed respectively. And -the related articles were reviewed. Results： The post-operative histopathology of 3 cases showed the tumors with epithelial and sarcomatoid mesenchymal components. The immunohistochemical test of 1 ease was positive for CK, EMA and negative for Vimentin in epithelial cancer area, but positive for Vimentin in sarcomatoid area. The final diagnosis was months later. The of bladder. The patient died of tumor distant metastasis of lung within 10 test of 2 cases was positive for CK, EMA and negative for Vimentin in epithelial cancer area, but positive for CK,EMA and Vimentin in sarcomatoid area. The final diagnosis were blad- der sareomatoid carcinoma. These two patients died of tumor distant metastasis of lung and heart failure within 8 and 11 months later , respectively. Conellions .. Bladder carcinosarcoma and sarcomatoid carcinoma have the biolog- ical behavior of invasive growth. They are often in an advanced stage at first diagnosis, leading to an unfavorable prognosis. The final diagnosis depends on histopathology and immunohistochemical test and the operation is still the first choice of treatment.