膀胱癌併直腸侵犯：個案報告

顏維晨、楊明昕、蒙恩、卓育慶

國防醫學院三軍總醫院外科部泌尿外科

Bladder carcinoma presenting with rectal obstruction

Wei-Chen Yen, Ming-Hsin Yang, Meng En, Yu-Ching, Jhuo

Division of Urology, Department of Surgery, Tri-Service General Hospital, Taipei, Taiwan

The most common cause of rectal obstruction is primary rectal carcinoma. Although bladder carcinoma invading the colon has been previously described, cases in which this invasion produces annular constriction of the rectum are rare.

A 62-year-old female denied the history of systemic disease before. She complained about anal pain and difficult defecation for one week. Upon recall, she noted poor appetite, intermittent nausea and tenesmus in recent one year. On digital rectal examination, a hard, fixed, ringlike constricting mass was palpated 2 cm from the anal verge. Results of screening laboratory studies were normal, except for a hemoglobin level of 7.1 g/dL. The colonoscopy was undertaken and the rectal mass with near total lumen obstruction was found and the biopsy was performed. However, the biopsy result showed only mild dysplasia of the rectal tissue. A computed tomographic (CT) scan of the pelvis showed circumferential wall thickening of rectum and a mass posterior to the bladder and thickening of the perirectal walls and a papillary enhancing lesion in the dome of the urinary bladder with bilateral mild hydronephrosis. Re-biopsy of the rectal tumor was done. Biopsy specimens of the rectal mucosa was few atypical epithelial cells. Cystoscopy revealed nodular tumor over the dome of the bladder and the tumor was resected via transurethral resection of bladder tumor (TURBT). The pathology report showed poorly differentiated carcinoma of the urinary bladder tissue, characterized by nested tumor cells with nuclear pleomorphism and clear cytoplasm, invading to the muscularis propria. Transanal wide excision was undertaken. The specimens confirmed metastatic, poorly differentiated, metastatic carcinoma. A magnetic resonance imaging (MRI) of the pelvis 1101135 showed an enlarged lymph node over the mesorectum which favor a regional metastatic lymph node. The patient was given concurrent chemoradiotherapy with weekly Cisplatin+5- FU and radiation therapy with 45 Gy in 25 fractions to the whole pelvis, followed by gross tumor boost up to 60-66 Gy in total 30-35 fractions.