成人女性的 膀胱橫紋肌肉瘤之病例報告

蕭伯任¹、王紹全^1,2,3

¹中山醫學大學附設醫院泌尿科；²中山醫學大學醫學院；³中山醫學大學醫學研究所

Rhabdomyosarcoma of the urinary bladder in an adult woman: A case report

Po-Ren, Hsiao¹、Shao-Chuan, Wang^1,2,3

¹Department of Urology, Chung Shan Medical University Hospital, Taichung, Taiwan; ²School of Medicine and ³Institute of Medicine, Chung Shan Medical University, Taichung, Taiwan

Case Presentation:

A 39-year-old Southeast Asian woman presented with lower urinary tract symptoms lasting one week, including dysuria, frequency, and nocturia for 2-3 times per night. Urinalysis revealed pyuria and microscopic hematuria. However, cystoscopy identified a large bladder tumor with debris coating, occupying almost the entire bladder (Fig. 1). Contrast-enhanced abdominal computed tomography confirmed the tumor, measuring approximately 7.8 cm with focal perivesical fat stranding (Fig. 2). The patient subsequently underwent transurethral resection of the bladder tumor, yielding a 130 g specimen. Pathology reported sarcomatous tissue composed of spindle, epithelioid, pleomorphic, and small blue round tumor cells, with immunohistochemical staining results as follows: Desmin(+), SMA focal(+), MDM-2(-), CDK4(-), P63(-), GATA-3(-), BRG-1 retained, CK(-), MyoD1(+), and Myogenin(+), consistent with rhabdomyosarcoma.

Discussion:

Rhabdomyosarcoma is predominantly a soft tissue malignancy seen in childhood, accounting for 6% of all pediatric cancers. Rhabdomyosarcomas involving urinary bladder in adults are extremely rare, with approximately 35 cases reported. It typically presents with symptoms such as urinary retention, urgency, frequency, or incontinence. Hematuria and urinary tract infection may also be observed. These tumors are infiltrative and challenging to resect with clear margins. Neoadjuvant and adjuvant systemic therapies are recommended, and surgical approaches may include partial or radical cystectomy. Due to its rarity in adults, the exact treatment modalities remain unclear and are often based on protocols from the Children’s Oncology Group. According to the literature, there are no significant differences in stage, lymph node status, gender, or site between adults and children with rhabdomyosarcoma, and current analyses do not show any associations between age, sex, histology, or stage and disease prognosis. Nonetheless, the 5-year survival rate for pediatric rhabdomyosarcoma is 66%, compared to 22% in adults, with a high tendency for recurrence. More high-quality evidence is required to establish standardized treatment protocols.