膀胱癌肉瘤诊治2例报告并文献复习.docVIP

膀胱癌肉瘤诊治2例报告并文献复习【摘 要】 目的 结合文献复习,提高膀胱癌肉瘤的诊治水平。方法 回顾分析2 例膀胱癌肉瘤患者的临床和病理资料。男女各1 例,均以无痛性肉眼血尿为主要症状，B 超或CT提示膀胱占位,膀胱镜下见膀胱内肿物,活检病理2例均提示移行细胞癌。结果 2 例均行膀胱部分切除，术后病理均为膀胱癌肉瘤，显微镜下主要由高分化移行细胞癌和肉瘤成分组成。免疫组化显示：CK及Vimentin 反应均为阳性。结论 诊断依赖病理及免疫组化检查，治疗以根治性手术为主，预后不良。 ?【关键词】 膀胱肿瘤;膀胱癌肉瘤 Carcinosarcoma of the urinary bladder：a report of 2 cases with literature reviewWANG Le-hao，LI Xing-hong，LI Guang-zhao．The 2rd People′s Hospital，Shantou 515011，China?【Abstract】 Objective To review the literature of carcinosarcoma of the urinary bladder,in order to increase level of the diagnosis and treatment．Methods 2 cases of carcinosarcoma (one man and one woman) were included．They were admitted to hospital with painless，macroscopic hematuria．Clinic opathalogic features of all findings of the 2 cases were reviewed．All the B- ultrasonic and CT examination of the bladder were confirmed the presence of parenchymatous tumors．Cystoscopy of both cases showed the tumor in the bladder．Pathology of 2 cases showed transitional cell carcinoma．Results Partial cystectomy was performed in 2 patients．Postoperative pathology of 2 cases showed carcinosarcoma．Microscopically，the tumors composed mostly of high grade transitional cell carcinoma mixed with sarcomatous components．Immunohistochemically，all tumors were positive for CK andVimentin．Conclusion Diagnosis of carcinosarcoma depends on the pathology and immunohistochemically．The patients should be treatment with radical operation．Carcinosarcoma of the urinary bladder has an unfavorable prognosis． 【Key words】 Bladder neoplasms；Carcinosarcoma of the urinary bladder 膀胱癌肉瘤临床罕见。我们收治2 例,结合文献对该病的临床及病理学特征进行复习，现报告如下。 1 病历摘要 例1：女,25岁。因无痛性全程肉眼血尿伴尿频、尿急、头晕2 d入院。B 超示膀胱左前壁有2 cm×2 cm 低回声团块。膀胱镜检查发现膀胱左前壁有2 cm×2 cm宽基肿物，活检病理提示移行细胞癌。予硬膜外麻醉下行膀胱部分切除术，术中见膀胱左前壁2 cm×1．8 cm×2．2 cm 实质性肿块,基底宽,表面不平,中心溃烂坏死，有血凝块附着，伴有肌层浸润，膀胱外膜层未见明显浸润。病理报告为膀胱癌肉瘤。镜下见癌组织为膀胱移行细胞癌Ⅲ级，肉瘤成分为梭形细胞,侵及肌层。免疫组化显示CK(+)，Vim(+)，AAT(+)，SMA(+)，S100(-) 。术后未行放化疗，目前为术后2个月，未见肿瘤复发、转移，仍在随访中。 例2：男,70 岁。因间歇肉眼血尿2月入院。B 超示膀胱左侧壁有2