案例報告:具有快速進展及轉移的膀胱基底樣鱗狀細胞癌

王嘉源、張東平、薛又仁、黃建榮、賴昱維、蕭毅君、李淑文、陳修聖、邱文祥、高國維

台北市立聯合醫院仁愛院區 外科部 泌尿科

A Case Study: Bladder basaloid squamous cell carcinoma with rapid progression and metastasis

Chia-Yuan Wang, Tung-Ping Chang, Thomas Y. Hsueh, Andy C. Huang, Yu-Wei Lai, Yi-Chun Hsiao, Shu-Wen Li, Shiou-Sheng Chen, Allen W. Chiu, Kuo-Wei Kao

Divisions of Urology, Department of Surgery, Taipei City Hospital Renai branch

Introduction: Basaloid squamous cell carcinoma (BSCC) is an variant of squamous cell carcinoma that is extremely rare in the bladder. Bladder BSCC is generally associated with a high-grade, poorly differentiated histology and a tendency toward local invasion and distant metastasis. We present a 55-year-old female with bladder BSCC and explore the diagnostic challenges, treatment strategies, and clinical course of this rare and aggressive tumor.

Results: A 55-year-old female with a history of left breast cancer status post breast-conserving surgery and adjuvant chemotherapy two years ago. She presented with occasional hematuria for two months 10 months ago. Abdominal computed tomography revealed a bladder mass at the right anterior wall. She underwent transurethral resection of the bladder tumor (TURBT), and pathology reported poorly differentiated carcinoma basaloid-squamous cell carcinomas, staged as cT3N0M0. Follow-up cystoscopy three months after TURBT showed tumor recurrence. Thus, laparoscopic partial cystectomy was performed and concurrent chemoradiotherapy with MMC+5-FU was given. Follow-up abdominal CT three months postoperatively revealed a 2.3 cm spiculated mass on the peritoneal wall and focal 4 mm peritoneal wall thickening. Laparoscopic tumor resection was performed, and pathology confirmed metastatic basaloid squamous cell carcinoma of urinary bladder origin. Palliative chemotherapy with two cycles of gemcitabine and cisplatin followed by two cycles of nivolumab, gemcitabine, and cisplatin was administered. However, tumor progression with peritoneal, liver, and lung metastasis was observed on CT. The patient was expired three days after palliative chemotherapy.

Conclusions: Bladder basaloid squamous cell carcinoma (BSCC) is a rare and highly aggressive bladder cancer. This case highlights the rarity and aggressive nature of bladder basaloid squamous cell carcinoma despite multiple treatments of surgery, chemotherapy, and radiotherapy, underscoring challenges in diagnosis and management. This case adds to the limited literature on bladder BSCC and highlights the urgent need for further research to better understand its pathogenesis, molecular targets, and develop more effective treatments