多重原發性惡性腫瘤：同時發生的膀胱腺癌和結腸腺癌-罕見案例

徐易廷¹、李淑文¹、薛又仁^1,2、黃建榮¹、蕭毅君¹、賴昱維^1,2、邱文祥^1,2

¹臺北市立聯合醫院仁愛院區 外科部 泌尿科；²國立陽明交通大學 醫學院 泌尿學科

Multiple primary malignancies: synchronous bladder adenocarcinoma and colon adenocarcinoma – a rare case

Yi-Ting Hsu¹, Carol S. Li¹, Thomas Y. Hsueh^1,2, Andy. C. Huang^1,2, Yi-Chun Hsiao¹, Yu-Wei Lai^1,2, Allen W. Chiu^1,2

¹Division of Urology, Department of Surgery, Taipei City Hospital renai Branch, Taipei, Taiwan;

²Department of Urology, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan

Background: Most common type of bladder cancer are primary urothelial carcinoma accounting for more than 90% of all cases. The diagnosis of urinary bladder adenocarcinoma raises the question of whether the lesion is primary; urachal; or metastatic, arising from a distant or adjacent organ. Secondary tumors of the bladder are mostly caused by direct invasion of adjacent organs in the pelvic cavity. Organs that are often invaded include: prostate cancer, colorectal cancer, or uterine and ovarian cancer. It is very rare that it originates in other organs and causes distant metastasis in the bladder.

Case Presentation: A 84-year-old female patient presented to the urologic clinic with gross hematuria and recurrent pyuria for 6 months. Urinalysis showed pyuria and cytology showed atypical cells. Computed tomography showed a 5.5x4.8x3.6cm enhanced mass noted at superior bladder wall and a 3.2cm spiculated mass in sigmoid colon. The fat plane between sigmoid lesion and bladder dome lesion seems intact. Before operation, sigmoid colon cancer with bladder invasion or metastasis is suspected. The patient underwent transurethral resection of bladder tumor followed by robotic-assisted anterior resection of sigmoid colon tumor two weeks later. Pathology disclosed adenocarcinoma, T1 of urinary bladder and adenocarcinoma, pT3 of sigmoid colon. There is no direct invasion from sigmoid colon to bladder from intraoperative field of view. Immunohistochemical stain showed occasionally positive results for CK7 and partially positive for CK20. Suspicion was raised between primary bladder adenocarcinoma or secondary bladder adenocarcinoma from colon cancer metastasis. Accordingly, a primary bladder adenocarcinoma of enteric variant if considered. The final diagnosis was synchronous primary bladder adenocarcinoma and sigmoid colon adenocarcinoma.

Conclusions: For non-urachal pure bladder adenocarcinoma, additional metastatic workup should be considered. This presentation underlined the need for further evaluation of unusual sites of metastasis during initial diagnosis.