與臍尿管分化不良尿路上皮癌相關的副腫瘤症候群—罕見病例報告

曾博鴻、石宏仁

彰化基督教醫院 外科部 泌尿科

Paraneoplastic syndrome associated with urachal poorly differentiated urothelial carcinoma – a rare case report

Po-Hung Tseng, Hung-Jen Shih

Divisions of Urology, Department of Surgery, Changhua Christian Hospital, Changhua, Taiwan

Introduction

Paraneoplastic syndrome refers to a group of rare diseases that occur when the immune system mistakenly attacks normal cells and tissues in the body in response to a tumor. Paraneoplastic syndromes are relatively uncommon, and not everyone with cancer will experience these symptoms.

Here, we report a rare case of with urachal poorly differentiated urothelial carcinoma experienced recurrence and metastasis following robotic surgery, concurrently manifesting paraneoplastic syndrome.

Case report

A 64-year-old male with history of hypertension presented frequency and painless gross hematuria for 2 months. Contrast-enhanced computed tomography showed a mass (6.2 x 5.3 cm) in the dome of the bladder, with heterogenous enhancement and prominent extravesical component. Under the impression of urachal tumor, he received robot-assisted partial cystectomy with bilateral external iliac lymph node dissection. Pathology report showed poorly differentiated urothelial carcinoma and multiple regional lymph node metastasis in the true pelvis.

The patient underwent postoperative adjuvant chemotherapy with Gemcitabine and Carboplatin for 3 course in the outpatient department; however, a recurrence of the tumor was detected on computed tomography three months later. Subsequently, after receiving a course of salvage pembrolizumab, the disease continued to progress. During follow-up outpatient visits, the patient presented altered consciousness. Laboratory data revealed hypercalcemia (14.7mg/dL) and anemia, leading to hospitalization for treatment of paraneoplastic syndrome. The patient received zoledronic acid 4mg, calcitonin 200 IU every 12 hours and disodium clodronate tetrahydrate 3 times a day. The serum calcium was down to 10.3 mg/dL after treatment. Following stabilization of the condition, the patient was discharged and is currently under ongoing surveillance.

Conclusion

        Paraneoplastic syndromes associated with urachal poorly differentiated urothelial carcinoma is rare. We must always keep in mind for patients with clinical symptoms. Following monitoring through imaging studies and laboratory tests is essential for assessing the recovery of the condition and providing early treatment.