膀胱癌肉瘤的临床特征

目的:探讨膀胱癌肉瘤的临床特征、病理特点及诊治方案。方法:复习我院自1999年～2009年收治的3例膀胱癌肉瘤患者的临床资料并结合文献进行讨论。结果:3例患者均为男性,临床表现均以无痛性肉眼血尿为主要症状,IVP提示膀胱充盈缺损,CT提示膀胱占位性病变。1例患者行膀胱部分切除术,1例行膀胱部分切除加左输尿管再植术,1例行膀胱血块清除术+膀胱肿物等离子电切术,其中1例术后辅以膀胱灌注治疗8周。术后病理检查均呈双重形态,由上皮成分和间质成分两种不同恶性成分组成,免疫组化结果:2例Vi mentin(++),CK(++),1例CK(++)、Vi mentin(++)、MyoD1(+)、Moglobin(+)、Desin(-)、SMA(-)、S100(-)。3例均诊断为膀胱癌肉瘤。1例术后存活12个月,死于全身多器官转移。1例术后随访6个月无特殊异常,后失访。1例术后随访已满6月,无异常,仍在随访中。结论:膀胱癌肉瘤临床罕见,其组织分化低,恶性程度高,发展迅速,预后极差,根治性膀胱切除术是治疗的最佳选择。

Clinical feature of bladder carcinosarcoma

Objective.- To explore clinical and pathological features of bladder carcinosarcoma and to probe the diagnosis and treatment. Methods： Clinical data of 3 male patients with bladder carcinosarcoma from 1999 to 2009 in our hospital were retrospectively analyzed. Results- IVP showed filling defect of bladder and CT showed occupying lesion in bladder. One cases had partial cystectomy, one had partial cystectomy ＋ left ureter reimplant, and one had blood clots cleaning ＋ bladder tumor plasma eleetroeision. Furthermore, one had bladder irrigation for 8 weeks. The pathologic test showed double morphous, com- posed of epithelium and mesenchyme tissue, and 3 cases were diagnosed as bladder carcinosarcoma. Im- munohistochemistry showed positive expression of Vimentin and CK in the first two cases and positive expression of CK, Vimentin, MyoD1, Moglobin and negative expression of Desin, SMA and S--100 in the third patient＇s tumor tissue. One patient died of multi--organ metastasis 12 months after surgery, one was failed to be followed up after 6 months survival, and the other was well now 6 months after surgery with the following--up continuing. Conclusion： Bladder carcinosarcoma is a rare malignant tumor in clinic, with poor histodifferentiation, high malignancy, rapid progression and poor prognosis. Early radical cystectomy is the best choice.