奇美醫學中心 1外科部 泌尿外科, 成功大學 2醫學工程研究所；
奇美醫學中心 3病理部，4內科部 血液腫瘤科
Two rare cases of primary malignanat small cell carcinoma combined with urothelial cell carcinoma in the ureter and metaanalysis
Jhih-Cheng Wang1,2, Li-Jing Ye3, Zi-Ru Chen3, Yu-Hsuan Kuo4
Divisions of Urology, Department of Surgery, Chi-Mei Medical Center, Tainan, Institution of Biomedical Engineering, National Cheng Kung University, Tainan
Department of Pathology, Chi-Mei Medical Center, Tainan,
Division of hemato-oncology, Department of Medicine, Chi Mei Medical Center, Tainan
Background: Extrapulmonary small cell carcinomas have been reported in a variety of organs, and their incidence in the genitourinary tract is second only to that in the gastrointestinal tract. To date, however, only a few cases of small cell carcinoma of the ureter have been reported. Because the extreme rarity of this combined type of carcinoma, its clinical behavior, and effective treatment modalities have not yet been studies well.
Cases Presentation: A 73-year-old man has a past history of prostate adenocarcinoma, cT3aN0M0, s/p hormone therapy and radiotherapy and regular followup at OPD. He presented with a two-month history of painless gross hematuria. He had a smoking history of one pack (Cigarettes, 20/pack) per day for over 30 years, but without having any respiratory symptoms. After intravenous pyelography survey, left UPJ tumor was suspected and diagnostic ureteronephroscopic biopsy revealed urothelial carcinoma. Laparoscopic Nephroureterectomy done and pathologic examination showed an SCC combined with a urothelial carcinoma in the ureter (Figure 1).
Another patient is a 67 year-old female with a diabetes history, present with intermittent painless gross hematuria. She also received diagnostic ureteronephroscopic biopsy then laparoscopic nephroureterectomy with bladder cuff done. The small cell carcinoma was diffusely positive for neuron-specific enolase, and exhibited focal positivity for CD 56, synaptophysin, chromogranin and cytokeratin 20 (Figure2,3,4).
They were treated with adjuvant chemotherapy, consistingof cisplatin and etopside, and has being well, without evidence of tumor recurrence or metastasis in the 6 months after surgery.
Conclusions: Small cell carcinoma of the ureter is rare. Combined urothelial carcinoma with SCC is rarer. Although its clinical behavior and diagnostic modalities have not been determined and it has yet to be diagnosed immunohistopathologically, multimodality treatment including surgery, chemotherapy and radiotherapy may improve patient survival. .