膀胱小細胞神經內分泌癌 個案報告及文獻回顧

唐靖 陳忠佐 謝德生

國泰綜合醫院 外科部 泌尿科

Primary small cell neuroendocrine carcinoma of the urinary bladder: Case report and review of the literature

Chin Tang, Chung-Tso Chen, Teh-Sheng Hsieh

Division of Urology, Department of Surgery, Cathay General Hospital, Taipei, Taiwan

Abstract

We present a case of a 69-year-old male with no past medical history presented to our urologic clinic with a chief complaint of intermittent gross hematuria for 3 months. According to his statement, he developed sudden onset of painless gross hematuria 3 months ago, and the hematuria came and went every half a month. This symptom was associated with frequency and nocturia, but he denied urinary retention, weight loss, or poor appetite. Urine analysis confirmed hematuria (RBC >100HPF) but urine cytology was negative. Urologic CT showed a 6cm lobulated soft tissue shadow at left posterior aspect of urinary bladder causing left hydroureteronephrosis and a 2.7cm left pelvic lymphadenopathy. Cystoscopy revealed a massive bladder tumor occupying the left side of the trigone, extending to the left lateral and posterior wall. Subsequent transurethral resection of bladder tumor (TURBT) was performed. The final pathology revealed small cell neuroendocrine carcinoma, with a lesser component of papillary urothelial carcinoma. The immunochemical stain was positive for chromogranin-A, synaptophysin, and INSM1. GATA-3 was positive in the lesser component of papillary urothelial carcinoma. The patient was later referred to oncology and radio-oncology department, where he received cisplatin based concurrent chemoradiotherapy.

Small cell neuroendocrine carcinoma of the bladder is a rare and aggressive form of bladder malignancy. The prognosis is usually poor due to high percentage of muscle invasion and local or distant metastases. Due to the rarity of the disease, the treatment was unable to standardized, and the optimal management for this type of tumor may be multimodality therapy, which includes surgery, chemotherapy, and radiation. We present this case to share our experience of diagnosis and management of this peculiar disease.