分化不良膀胱腫瘤已少見直接腹腔內轉移並大量腹水呈現-病例報告
邵郁鏵1,2吳勝堂1唐守宏1查岱龍1曹智惟1蒙恩 1于大雄1孫光煥1高建璋1
國防醫學院 三軍總醫院 外科部 泌尿外科1
桃園國軍總醫院 外科部 泌尿外科
Unusual presentation of direct intra-peritoneal metastases complicated with massive ascites from poor differentiation bladder tumor : a case report
Yu-Hua Shau1,2, Sheng-Tang Wu1, Shou-Hung Tang1, Tai-Lung Cha1 , Chih-Wei Tsao1, En Meng1, Dah-Shyong Yu1, Guang-Huan Sun1 and Chien-Chang Kao1
1.Division of Urology, Department of Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan, R.O.C.
2. Division of Urology, Department of surgery, Taoyuan armed forces general hospital , Taiwan
Introduction:
Plasmacytoid urothelial carcinoma variant is a rare histological finding, which was first described in 1991. Since then, only 70 cases have been described in the literature and the biological behavior of this variant of urothelial carcinoma is still not well known. The plasmacytoid variant is usually very aggressive; distant metastases are detected in up to 60 % of cases at the time of diagnosis with special predilection for dissemination through the fascia causing peritoneal carcinomatosis. Despite being a tumor of poor
prognosis, it has been shown to be chemosensitive. This report describes a patient who have adenocarcinoma of colon and plasmacytoid urothelial carcinoma variant of bladder. Clinically mimicking a massive ascites and pitting edema of bilateral low legs without hematuria.
Case report:
The 74-year-old male suffered from abdominal fullness and bilateral low legs edema in mid-Aug, 2015. He had visited our GU outpatient department and abdominal sonography was performed which revealed massive ascites. He was referred to our ER on 2015/08 and abdomen CT revealed three important finding (1)massive ascites and omental cake, (2) Enlarged nodes in the para-aortic space, (3) Diffuse irregular wall thickening in the urinary bladder, which suspected bladder. In ER, abdominal paracentesis was done and cytology was collected. After admission, tumor markers were checked and CEA elevated, so he was scheduled to receiving colonoscopy and one 3cm colon tumor was found at sigmoid colon and several small nodules over whole colon. He also received cystoscopy and non-papillary type bladder tumor was found. After colon tumor biopsy and transurethral resection of bladder tumor, we confirmed that the patient have double cancer. Ascites cytology suggested malignancy and peritoneal carcinomatosis cannot be rule out. We had used ascites immunohistochemistry method for search primary tumor. Usually, we think the origin is form the colon tumor. However, this is not what we think as a patient. The histological diagnosis of the tumor was plasmacytoid urothelial carcinoma variant of bladder with peritoneal metastasis. He was referred to oncology for further chemotherapy.
Conclusions:
The plasmacytoid variant of urothelial carcinoma, defined as the presence of plasma cells similar to
myeloma, has had an increase in prevalence in recent years, which has aided in increasing our understanding of its biological behavior and clinical implications. It is considered to be a type of carcinoma with an aggressive histological behavior with special predilection for local invasion of fascia and adjacent tissue. It also has a poor prognosis with a significant percentage of patients having
metastases at diagnosis, especially intraperitoneal dissemination.