輸尿管之小細胞神經內分泌癌-案例報告
劉家翔1、鍾孝仁1,2,3、林登龍1,2,3、陳光國1,2,3
1臺北榮民總醫院 泌尿部
2國立陽明大學 醫學院 泌尿學科 3書田泌尿科學研究中心
Ureteral small cell neuroendocrine carcinoma-case report
Chia-Hsiang Liu1, Hsiao-Jen Chung 1,2 , Alex T. L. Lin1,2, Kuang-Kuo Chen1,2
1Department of Urology, Taipei Veterans General Hospital, Taipei , Taiwan; 2Department of Urology, School of Medicine, National Yang-Ming University, Taipei, Taiwan; 3Shu-Tien Urological Science Research Center , Taipei, Taiwan
Introduction:
Neuroendocrine carcinomas consist of a heterogeneous group of neoplasms, which arise from peptide- or amine-producing endocrine cells throughout the body. The most frequent primary locations of the tumors are pulmonary. We report case of a ureteral small cell neuroendocrine carcinoma in a 68-year-old woman.
Case presentation:
This 68-year-old woman with diabetes mellitus was admitted due to painless gross hematuria for 1 month. She went to local hospital and non-contrast CT scan showed left ureteral tumor. Ureteroscopy showed a polypoid extruding patch and biopsy was done which pathology revealed small cell neuroendocrine carcinoma. ERPF revealed L't 234,R't 288.Whole body bone scan showed no definite evidence of bone metastasis. Left robotic-assisted laparoscopic nephroureterectomy with bladder cuff excision was performed.
Pathologically, the tumor, which measured 1.5 x 1.5 x 1.1 cm, was seen in the upper portion of the left ureter close to renal pelvis. Microscopically, the tumor was composed of uroepithelium infiltrated with solid aggregates of small tumor cells which have scanty cytoplasm and a highly hyperchromatic, oval to elongated nucleus. Crush artifact and necrosis could be seen. Immunohistochemically, the tumor cells are diffusely immunoreactive for CD56, focally immunoreactive for synaptophysin and chromogranin A, show dot-like staining of CK (AE1/AE3), and are nonreactive for CK20, p53, and AMACR.
Conclusion:
Neuroendocrine carcinomas arising from the urinary tract are extremely rare and represent <0.5% of urinary tract tumors. The bladder is the most common location of small cell neuroendocrine carcinomas, whereas they are extremely rare in the ureter , with only 25 previous cases found in the literature since the first case in 1986, which was reported by Ordonez et al . To the best of our knowledge, the present case is the twenty-sixth to be reported and the second case to be reported in the Chinese population.