膀胱小細胞癌：一個預後不佳的罕見腫瘤──病例系列報告與文獻回顧
吳芃諺、裘坤元、陳卷書、楊晨洸、陳正哲、熊小澐、吳致瑩、歐宴泉、楊啟瑞
台中榮民總醫院外科部泌尿科，放射線部，病理檢驗部；童綜合醫院外科部泌尿科；中國醫藥大學附設醫院泌尿部
Small Cell Carcinoma of the Urinary Bladder: a Rare Neoplasm with Poor Prognosis. Case Series Report and Literature Review
Peng-Yen Wu, Kun-Yuan Chiu, Chuan-Shu Chen, Cheng-Kuang Yang, Cheng-Che Chen, Siu-Wan Hung, Chih-Ying Wu, Yen-ChuanOu, Chi-Rei Yang
Division of Urology, Department of Surgery, Department of Radiology andDepartment of Pathology and Laboratory Medicine, Taichung Veterans General Hospital, Taichung Taiwan; Division of Urology, Department of Surgery, Tungs’ Taichung MetroHarbor Hospital, Taichung, Taiwan; Department of Urology, China Medical University Hospital, Taichung, Taiwan
Purpose: Small cell carcinoma of the urinary bladder (SCCUB) is a rare but clinically aggressive disease.No standard treatment has been proposed due to lack of prospective randomized studies resulting from the low incidence and poor survival of SCCUB. The aim of this study is to present our experience with 7 SCCUB patients and discuss the epidemiology, pathogenesis, diagnosis, clinicopathologic characteristics and treatment strategy of SCCUB.
Materials and Methods: Patients who were diagnosed with small cell carcinoma of the urinary bladder and received treatment at Taichung Veterans General Hospital from January, 2007 to February, 2018 were included. The clinicopathologic characteristics, treatments and outcomes were analyzed.
Results:A total of 7 patients were included in our analysis. Most patients were male (85.7%) with a mean age of 60 years (ranging from 54 to 72 years) at diagnosis.Six cases presented with gross hematuria as their first symptom, and one showed lower urinary tract symptoms as the initial presentation, while the bladder tumor was accidentally found during the procedure oftransuretheral resection of prostate (TURP).Four patients were diagnosed with pure small cell carcinoma while the other 3 cases presented with small cell carcinoma mixed with urothelial carcinoma. Most cases (n=6, 85.7%) had muscle invasion, and 4 cases had regional disease at diagnosis.Radical cystectomy was carried out in 4 patients, in combination with neoadjuvant or adjuvant chemotherapy, while the other 3 received bladder-sparing treatment with partial cystectomy or transuretheral resection of bladder tumor (TURBt) only combined with chemotherapy and/or radiotherapy. The patients were followed up, ranging from 1 to 75 months with the median survival of13 months.
Conclusion: SCCUB develops predominantly in aged males. A multimodal therapy was recommended for management of local and regional disease. Chemotherapy may have a significant effect in all stages and should be a major component of treatment. Neoadjuvant chemotherapy may generate favorable outcomes for surgically resectable SCCUB. Further prospective studies are needed to improve the treatment strategy.