伴隨大量出血的膀胱腫瘤- 發炎性肌纖維母細胞瘤
葉星佐、陳彥達
高雄長庚紀念醫院泌尿科
A Bladder Tumor With Massive Bleeding- Inflammatory Myofibroblastic Tumor
Hsing-Tsuo, Yeh, Yen-Ta Chen
Kaohsiung Chang Gung Memorial Hospital, Department of Urology
Introduction: Hematuria is the characteristic sign that typically leads to detection of bladder cancer. Up to 85% of patients with newly diagnosed bladder cancer have gross hematuria, and almost all have microscopic hematuria. However, bladder cancer presented with massive bleeding and severe anemia is seldom seen. Here we demonstrate a rare case of bladder cancer with massive hamaturia- inflammatory myofibroblastic tumor of urinary bladder.
Case Report: This 47-year-old man has no known underlying disease. He was brought to our emergent department because of progressive gross hematuria for one week, accompanying symptoms included fever, right flank pain, and dysuria. Upon arrival, the patient appeared weak and pale, the temperature was 37.80C, respiration 20 breaths/min, pulse 122 beats/min, and blood pressure 96/62 mmHg. Other physical exams were unremarkable. Urine analysis showed hematuria (RBC>500/uL), pyeuria (WBC>uL), and bacteriuria (positive). Blood tests reported creatinine 1.47mg/dL, sodium 128 mEq/L, WBC 21,200/uL, hemoglobin 5.9 g/dL. Totally 6 units of leucocyte-poor red blood cells were transfused, and hemoglobin rose up to 8.6 g/dL. KUB showed no radioapaque stones. Abdomen enhanced computed tomography revealed a 6.4x5.6 cm lobulated mass containing strongly enhanced nodule (3.3x2.6 cm) in urinary bladder.
Urologist was consulted and transurethral resection of bladder tumor was arranged. There was a flat 4 cm sized bladder tumor with stalk located at posterior wall, with fat-like appearance and covered with blood clots. The tumor was resected by unipolar resectoscope completely. The patient tolerated the surgery well, and had his Foley catheter removed on postoperative day 3, and discharged on day 5. Results of immunohistochemical stain revealed ALK (+), CD34 (-), CK7 (focal +), Desmin (focal +), GATA3 (-), SMA (focal +). The final diagnosis from pathology reported muscle invasive inflammatory myofibroblastic tumor.
Discussion: Inflammatory myofibroblastic tumor can occur anywhere in the body, most commonly seen in the lungs and mesentery. It has been reported in <1% of bladder tumors and thought to be a proliferative lesion of the submucosal stroma, though the exact pathogenesis remains unclear. The most common presentation was hematuria (around 70%), and about 3% patients had hemodynamic instability on presentation. Overall, it has a low recurrence rate (only 4%) and good prognosis, bladder-sparing treatment modalities, such as TURBT or partial cystectomy, are recommended. However, close follow-up is still warranted due to its uncertain malignant potential.