腎盂尿路上皮癌合併局部弦索、腺體與鱗狀上皮分化：罕見案例報告

林奇柏、王百孚、石宏仁、林介山、張進寶、嚴孟意、黃勝賢、陳俊吉、江恆杰、張建祥、
陳柏華、陳一中、潘岳

彰化基督教醫院泌尿外科

Infiltrating urothelial carcinoma with focal chordoid, glandular and squamous differentiation of the renal pelvis: a rare case report

Chi-Bo Lin, Pai-Fu Wang, Hung-Jen Shih, Jesun Lin, Chang-Pao Chang, Meng-Yi Yan, Sheng-Hsien Huang, Chun-Chi Chen, Herng-Jye Jiang, Jian-Xiang Zhang, Pao-Hwa Chen, Yi-Zhong Chen, Pan Yueh

Division of Urology, Department of Surgery, Changhua Christian Hospital

  Upper urinary tract tumors are almost always urothelial carcinoma(UC) and pure non-urothelial histology is rare. However, histological subtypes are present in approximately 25% of UTUCs. Urothelial carcinoma with divergent squamous differentiation is present in approximately 15% of cases. Upper urinary tract UCs with different subtypes are high grade and have a worse prognosis compared with pure UC. Invasive urothelial carcinoma with chordoid features is a rare entity with only 18 reported cases to date in English literature. Herein, we present a case with infiltrating urothelial carcinoma with focal chordoid, glandular and squamous differentiation of the renal pelvis from clinical presentation, image, management, pathology and follow-up condition after nearly a year.

  This is a 78-year-old female patient with past history of hypertension and hyperlipidemia. She presented with intermittent left flank pain and gross hematuria for 2-3 months. The abdominal computed tomography revealed a left renal pelvic tumor about 4cm. Hand-assisted retroperitoneoscopic nephroureterectomy with bladder cuff excision was performed on 2022-05-13. The patient was discharged uneventful five days after the operation. The pathology reported infiltrating urothelial carcinoma with focal chordoid, glandular and squamous differentiation. Immunohistochemically, the tumor cells are focal positive GATA-3 and positive CK20. Heterogenous p53 expression was also present. No recurrence of urothelial carcinoma was noted in one year follow-up. Currently, the patient is still following-up in our outpatient department.