頭骨轉移膀胱癌免疫治療（Pembrolizumab）後再骨化之病例報告

吳敏瑞、周孟翰、高建璋、蒙恩

國防醫學院三軍總醫院外科部泌尿外科

Metastatic Urothelial Carcinoma to Skull with Significant Reossification after Pembrolizumab: A Case Report

Min-Jui Wu, Meng-Han Chou, Chien-Chang Kao. En Meng, D. Phil

Division of Urology, Department of Surgery

Tri-Service General Hospital, National Defense Medical Center

Abstract

    Urothelial carcinoma ranks as the fourth most common cancer in men in the U.S; upon diagnosis, 10–15% have metastasized, mostly to lymph nodes, liver, lung, bone, and adrenal glands. Very few cases of skull invasion have been reported, and there is no established definite treatment. A 64-year-old Taiwanese male presented with metastatic urothelial carcinoma (mUC) of bladder with skull invasion. A sunken forehead without painful sensation could be palpated. After failure of chemotherapy, the patient received immunotherapy pembrolizumab, and complete remission of distant metastasis with reossification of osteolytic skull were noted. While skull metastasis usually suggests late progression of the disease, immunotherapy has fewer systemic adverse effects than chemotherapy, and should be taken into consideration as a first-line therapy.