個案報告：狀似膀胱癌之術後膀胱梭狀細胞結節
張琮昕1、陳建志1、林文榮1、邱文祥1,2
1台北馬偕紀念醫院 泌尿科；2國立陽明大學 醫學院
Case Report and Review of Literature: Post-Operative Spindle Cell Nodule of Urinary Bladder Resembling Bladder Tumor.
Tsung-Hsin Chang, MD1, Chien-Chih Chen, MD, PhD1,
Wun-Rong Lin, MD1, Wen-Hsiang Chiu, MD, PHD1,2,
1Department of Urology, Mackay Memorial Hospital, Taipei, Taiwan
2 School of Medicine, National Yang-Ming University, Taipei, Taiwan, ROC.
Case report:
A 48-year-old male patient with past history of hypertension and type II diabetes mellitus presented to our clinic due to painless gross hematuria for months. Examine of the bladder showed multiple flat tumors over right lateral wall. Transurethral resection of the bladder tumors (TURBT) was done. Pathology reported bladder urothelial carcinoma with subepithelial connective tissue invasion. The patient received repeated TURBT during follow up due to tumor recurrence 6 months later. However, the followed-up cystoscope showed one huge solid tumor growth over previous resection site. TURBT was done again and the final pathology reported postoperative spindle cell nodule (PSCN). The patient was well without tumor recurrence after 6-month postoperative follow up.
Discussion:
Proppe et al first studied a series of patients with common pathological spindle cell morphology in 1984 and coined the term “Postoperative spindle cell nodule (PSCN)”. It was described as a benign lesion resembling the appearance of a bladder malignancy. It was frequently misdiagnosed as soft tissue malignancy such as sarcomatoid carcinoma of the bladder due to similar pathological appearance. However, due to limitations of examination techniques, it was not fully studied until recent days.
PSCN is a reactive phenomenon that occurs following procedures such as cystoscope, biopsy, or resection of tumor or prostate. It has been reported in only a few case series. The microscopic characteristics of PSCN includes: fascicles of spindle cells, various chronic inflammatory cells scattered in myxoid stroma. No atypical mitosis of nuclei was present. To distinguish it from sarcomatoid carcinoma, which is a rare malignancy of the bladder, they share numerous similarities. Including reactive inflammatory cells and spindle cells scattered in myxoid stroma. However, sarcomatoid carcinoma resembles as other malignancy with atypical cell proliferation and irregular mitoses.
Zhao et al. reported a case report and reviewed a series of 21 cases in 2013. The clinical presentation, size, prior bladder procedures, treatment and follow-up time was described. The mean age of diagnosis was 65 years old. Average size of PSCN nodule was 2.0cm. 17 out of 20 patients were disease free without tumor recurrence after transurethral resection of PSCN. They concluded that PSCN tends to be a benign lesion and transurethral resection of the lesion should be a sufficient treatment.
Conclusions:
Postoperative spindle cell nodule is a benign disease and may mimic malignant bladder lesions. Careful examination by pathologists is necessary to avoid misdiagnosis, especially in a patient with previous urological procedures.