輸尿管鏡碎石手術偶發膀胱類肉瘤之案例報告
陳生文、陳嘉宏、陳修聖
台北市立聯合醫院忠孝院區外科部泌尿科
Incidental finding of bladder sarcomatoid tumor during URSL: A case report
Sheng-Wen Chen, Chia-Hung Chen, Shiou-Sheng Chen
Division of Urology, Department of Surgery, Taipei City Hospital Zhongxiao branch
Introduction:
Sarcomatoid carcinoma of the urinary bladder is a rare presentation. It has been considered as an aggressive variant of bladder carcinoma. In view of high incidence of local and distant metastasis, radical cystectomy followed by adjuvant chemotherapy and radiation should be preferred in all patients.
Case presentation:
This 56 y/o male had underlying disease of old CAD s/p stent placement and under regular medicine control. According to himself, he suffered from right flank soreness and hematuria recently. He denied frequency, urgency and there's also no fever or chills was mentioned. CT survey showed bilateral renal stones and right 1.1cm and 0.4cm ureteral stones. Hence, he was admitted to our ward for further stone management. However, bladder massive blood clot was noted during operation, and then TURBT was performed for pathology analysis and bladder sarcomatoid tumor was impressed. Bone scan revealed no bone metastasis. The immunohistochemical studies of the tumor cells show focal CK+, diffuse VIMENTIN+, GATA3+, 34BE12+ and AMACR-, which was compatible with sarcomatoid carcinoma.
Conclusion:
Sarcomatoid carcinoma is a very rare entity and its diagnosis is based on the pathological findings. Radical cystectomy followed by adjuvant chemotherapy and radiation should be preferred in all patients. Recurrence of the disease is frequent and poor prognosis was recorded in literature. Early diagnosis and surgical intervention are preferred strategies for improvement of prognosis.