膀胱肉瘤样癌二例报告

目的探讨膀胱肉瘤样癌组织学特性，提高对膀胱肉瘤样癌和膀胱癌肉瘤病理学上区别的认识。方法报告2例膀胱肉瘤样癌病例资料。2例均为男性，年龄分别为76、59岁。均以肉眼血尿就诊，膀胱镜、CT和B超检查均诊断为膀胱肿瘤，肿瘤呈浸润性生长。术前活检均提示为移行上皮细胞癌。结果2例均行膀胱部分切除术。1例术前行新辅助化疗。术后病理可见上皮和肉瘤样问质2种恶性成分，但癌与肉瘤样区有移行，诊断为膀胱肉瘤样癌。术后均行全身化疗和膀胱灌注化疗，3个月后复查局部肿瘤复发。1例5个月后死于心脏疾病，另1例仍在随访中。结论膀胱肉瘤样癌为尿路上皮癌的一种亚型，具有呈浸润性生长的生物学特性，恶性程度高，预后不良，在制定治疗方案尤其是化、放疗方案时应充分考虑。

Sarcomatoid carcinoma of the urinary bladder( report of 2 cases)

Objective To investigate the histological essence of the sarcomatoid carcinoma of the urinary bladder,and to improve the recognition of the pathological differences between sarcomatoid carcinoma and carcinosarcoma of the urinary bladder.Methods The data of 2 cases(both males;76 and 59 years,respectively) of bladder sarcomatoid carcinoma were reviewed.They both presented with gross hematuria.Cystoscopy,CT and B-ultrasound showed bladder tumor growing invasively in both of them.Preoperative biopsies indicated transitional cell carcinoma.Results Both cases underwent partial cystectomy.Preoperatively,1 of them received neoadjunctive chemotherapy.Histopathology showed the tumors with epithelial and sarcomatoid mesenchymal components,but the transition area existed in both.The ultimate diagnosis was sarcomatoid carcinoma of the bladder.Postoperatively,chemotherapy through the veins and by bladder instillation was performed in them.Both of them had relapse 3 months later.One died of cardiopathy within 5 months,and the other has been followed and is alive till now.Conclusions Sarcomatoid carcinoma of the urinary bladder is a subspecies of urothelial carcinoma with the biological behavior of invasive growth.It is most often in an advanced stage at presentation,leading to an unfavorable prognosis.Its cancerous essence mostly decides the treatment of choice,especially the chemotherapy and radiotherapy.