漿細胞變異型膀胱尿路上皮癌
李亞哲 林仁泰 郭威廷 蔡政諭 余家政 吳東霖
高雄榮民總醫院外科部泌尿外科
Plasmacytoid urothelial carcinoma of the urinary bladder
Ya-Che-Lee, Jen-Tai-Lin
Divsion of Urology, Depart of Surgery, Kaohsiung Veterans General Hospital
Purpose:
In medical literature plasmacytoid variant urothelial carcinoma(PUC) of the urinary bladder is extremely rare and highly malignant. We herein report the clinical and histopathological features of four cases of PUC.
Materials and Methods:
Case 1 was a case of ESRD and complained of intermittent painless gross hematuria. Abdominal CT revealed a nodule over left upper 1/3 ureter. He received nephroureterectomy and bladder cuffe excision under the impression of ureteral cancer. Case 2 did not have hematuria but complained of lower abdominal pain instead. No other urological symptoms were noted. Abdominal CT revealed asymmetric wall thickening of the U-bladder, bilateral hydronephrosis, and retroperitoneal lymphoadenopathies. Cystoscopic biopsy revealed PUC and she received systemic chemotherapy. Case 3 had urinary frequency for 2 years and infiltrative UB tumor was discovered from image studies and cystoscopy. He received radical cystoprostatectomy after cystoscopic biopsy revealed PUC. Case 4 was noted to have recurrent UC of UB and biopsy revealed the newly developed PUC. He received neoadjvuant chemotherapy followed by radical cystoprostatectomy.
Results
Case 1 was the case of PUC of left ureter. The patient died of disease five months after the standard surgery. Case 2 received (MVEC) six times, and radiation therapy 50.4 Gy/28Fx. She died of disease37 months after diagnosis. Case 3 received radical cystoprostatectomy and adjuvant chemotherapy treatment with three courses of MVEC. He is free of disease 12 month after the surgery. Case 4 received neoadjvant chemotherapy with three courses of G+C and then radical cystoprostatectomy. Microscopic LN metasstasis was noted from the pathologic examination. He was noted to be free of disease 3 months after the surgery.
Conclusions
Plasmacytoid variant of urothelial carcinoma is a rare histologic variant associated with poor prognosis which in literature was associated with advanced clinical stage upon diagnosis. The optimal treatment modality continues to be defined yet. Here we reported our cases and tumor control could be good once radical resection was done in early stage.