膀胱神經內分泌腫瘤– 病例報告

徐則中、薛又仁、黃建榮、賴昱維、蕭毅君、李淑文、陳修聖、邱文祥

臺北市立聯合醫院仁愛院區  外科部 泌尿科

Bladder double cancer with neuroendocrine carcinoma and urothelial carcinoma, high grade– a rare case report

Tze-Jung Shiu, Thomas Y. Hsueh¹, Andy C. Huang, Yu-Wei Lai, Yi-Chun Hsiao, Shu-Wen Li, Shiou-Sheng Chen, Allen W. Chiu

Division of Urology, Department of Surgery, Taipei City Hospital Renai Branch, Taipei, Taiwan

Introduction: Neuroendocrine tumours (NET) are extremely rare and aggressive, especially originated in bladder. We present a case of 86-year-old man with bladder neuroendocrine carcinoma, post TURBT many times, recurrence with small cell neuroendocrine carcinoma and high-grade UC.

Case presentation:  A 86-year-old man has underlying disease of T2DM and BPH under medication control. He complained urination with blood clots for 2 times, but he denied dysuria, gross hematuria, fever, abdominal pain, or flank pain. Physical examination presented no costovertebral angle knocking tenderness. Blood test showed no specific finding, and urine analysis showed gross hematuria. Two sets urine cytology reported atypical cells present and non-contrast abdominal CT scan revealed suspected urinary bladder urothelial tumor, T1-2N0M0. After discussion, he underwent TURBT on 2022/01/03.

      The pathological report disclosed bladder neuroendocrine carcinoma, high grade, pT2NxMB. Immunohistochemical stains reported the tumor cells are CD56 positive, synaptophysin and chromogranin focally positive. The p53 reveal moderate overexpression and the Ki-67 is around 60% positive, supporting the diagnosis of neuroendocrine carcinoma. CCRT was suggested, but the family refused chemotherapy, so only radiotherapy was done (pelvis 4500cGy/25fx, Bladder 5400cGy/27fx and tumor bed 6600cGy/33fx, VMAT, 111/2/21-4/12).

      Due to tumor recurrence, TURBT was done on 2022/11/03, 2023/01/10, 06/29 and 09/05. However, after TURBT on 06/29, the pathological report disclosed small cell carcinoma and infiltrating urothelial carcinoma, high grade. The results of immunohistochemical study:

Because of jaundice noted, abdominal echo was done, and metastatic hepatic tumor was highly suspected.