病例報告：膀胱小細胞神經內分泌癌

羅偉恩、謝啟誠

振興醫療財團法人振興醫院泌尿部

Case Report: Small cell neuroendocrine carcinoma of bladder

Wei-En Luo, Chieh-Chen Hsieh

Department of Urology, Cheng Hsin General Hospital, Taipei, Taiwan

Case presentation: 

A 76 y/o male visited urology department due to intermittent painless gross hematuria with blood clots. At the outpatient department, urinalysis showed RBC>100/HPF, WBC 30-49/HPF. Abdomen computed tomography revealed bladder tumor with size of 2.6 x 2.3 x 2.3 cm at right anterior wall of urinary bladder, suspect urothelial carcinoma. After examination, cystoscopy revealed a tumor at dome of bladder. Transurethral resection of bladder tumor was done and the pathologist reported small cell neuroendocrine carcinoma (pT1). Radical cystectomy was suggested but the patient preferred chemotherapy and radiotherapy. Therefore, oncologist and radiotherapist was consulted for further treatment.

Discussion:

  Small cell neuroendocrine carcinoma of the bladder is a rare and aggressive form of bladder cancer, accounting for less than 1% of all bladder cancers. It arises from neuroendocrine cells in the bladder lining, resembling small cell lung cancer in its histologic features and behavior. Symptoms were similar to other bladder cancers, such as hematuria, frequent urination, pelvic pain, and urgency. Systemic symptoms like weight loss may occur due to the high metastatic potential. Markers such as chromogranin, synaptophysin, and neuron-specific enolase (NSE) help confirm neuroendocrine origin. Radical cystectomy was considered the curative treatment. However, current studies showed that primary chemoradiation provides reasonable local-regional control rates with a functioning bladder, even for patients with locally advanced disease.