嘉義基督教醫院 外科部 泌尿科
Bladder cancer of urothelial cell carcinoma with trophoblastic differentiation: A case report and literature review
Chang-Yu Tsai, Wei-Hong Lai, Yeong-Chin Jou, Cheng-Huang Shen, Chang-Te Lin, Ming-Chin Cheng
Divisions of Urology, Department of Surgery, Chia-Yi Christian Hospital
Bladder cancer of urothelial cell carcinoma with trophoblastic differentiation is rare. In this article, we report a case with initial presentation of gross hematuria and urinary retention. And the literatures of urothelial cell carcinoma with trophoblastic differentiation will be reviewed.
This is a 62-year-old male with past history of hepatitis C and coronary artery disease who had suffered from dysuria with gross hematuria for 3 days. He came to our emergency department for help where acute urinary retention was diagnosed. At outpatient office, further urotract ultrasound, Transrectal ultrasound (TRUS) and computed tomography (CT) scan revealed urinary bladder tumor. The patient underwent transurethral resection of bladder tumor (TURBT) and pathologic report revealed high-grade muscle invasive urothelial cell carcinoma. Four cycles of neoadjuvant chemotherapy with gemcitabine and cisplatin was conducted for 3 months which is followed by laparoscopic radical cystoprostatectomy and ileal conduit.
After the operation, the pathologic report showed urothelial cell carcinoma with trophoblastic differentiation (pT4aN2). The postoperative clinical course was smooth except the condition of postoperative ileus. After prolonged ileus improved, the patient was discharged on postoperative day 18.
According to the NCCN guideline, the treatment of muscle invasive urothelial cell carcinoma (T3) should be neoadjuvant chemotherapy followed by surgical intervention. However, in this case, after neoadjuvant chemotherapy, CT scan revealed stable disease (SD) according to RECIST criteria. This response is not as good as we expected. According to the literatures we had reviewed, urothelial cell carcinoma with trophoblastic differentiation had poor response to chemotherapy compared to common urothelial carcinoma. Early surgical intervention should be considered when chemotherapy did not achieve the goal of down staging. Besides, in cases with poor response to Gemcitabine and Cisplatin, immunotherapy (ex. pembrolizumab) might stand a chance to make a better response and prognosis.
This case reminds us that urothelial cell carcinoma with trophoblastic differentiation indicates a poor response to chemotherapy. Early restaging in the middle of neoadjuvant chemotherapy should be done and early surgical intervention should be considered when restaging shows no response or progressive disease. Immunotherapy might be an alternative treatment for neoadjuvant therapy in the future.