膀胱小細胞癌：病例報告
林弋筑、謝啟誠、黃家倫
振興醫療財團法人振興醫院 泌尿部
Bladder small cell carcinoma: Case report
Yi-Chu Lin, Chi-Cheng Hsieh, Chia-Lun Huang
Department of Urology, Cheng Hsin General Hospital, Taipei, Taiwan
Introduction:
Small cell carcinoma of the bladder is a rare bladder tumor, accounting for less than 1% of
all primary bladder tumours. It associated with aggressive behavior and poorer prognosis compared to bladder urothelial carcinoma (UC). It is always diagnosed at advanced stage. Current knowledge of this disease is limited and was based mainly on retrospective investigations. Treatment is extrapolated from the treatment of small cell lung carcinoma. Here we shared 2 cases of small cell carcinoma of urinary bladder.
Case 1:
The 46 year-old female had painless gross hematuria since one half months ago. For persistent hematuria, she visited our urology outpatient department (OPD) for help, where urine analysis showed hematuria, intravenous urography (IVU) showed normal bilateral collecting system and urinary bladder. For hematuria still persisted, cystoscopy showed anterior wall tumor. Under the impression of bladder tumor with hematuria, she was admitted for further management. After admission, computed tomography (CT) for tumor staging showed a 3.5 cm x 2.5 cm soft tissue mass with contrast enhancement in anterior bladder wall which showed peri-vesical tissue invasion. Transurethral resection of bladder tumor (TURBT) was then arranged, and the tumor pathology was small cell carcinoma of urinary bladder. For bladder small cell carcinoma, partial cystectomy was arranged, the final pathology was T3b small cell carcinoma of bladder with free resected margin. After partial cystectomy, the patient was discharged under stable condition, and she was referred to medical oncology department for adjuvant chemotherapy.
Case 2:
The 94 year-old male had history of benign prostate hyperplasia and received transurethral resection of prostate before. He complained of painless gross hematuria for 2 weeks, and he visited urology OPD for help, where urine analysis showed hematuria and cystoscopy showed left lateral bladder wall tumor. For bladder tumor, he was admitted for further management. After admission, CT for tumor staging showed left lateral wall bladder tumor with contrast enhancement and peri-vesical tissue invasion was suspected. TURBT was then arranged, and the tumor pathology was small cell carcinoma of urinary bladder, at least T2b. However, for the patient’s old age, his family refused further surgical intervention. After discharge, he was referred to radiation oncology department for radiation therapy.
Discussion:
Small cell cancer of the bladder is a rare bladder malignancy with a mean range between 0.35% and 1.8%. The majority of patients are male, with a mean sex ratio about 5:1. Most patients are in the sixth to seventh decade, mean age of diagnosis is 67 years. The clinical features of bladder small cell carcinoma are similar to those of bladder UC. Gross hematuria is the most common symptoms, dysuria is the second most common symptom. Diagnosis of bladder small cell carcinoma is mainly based on cystoscopy finding and via pathological examination of specimens obtained by TURBT. More than 95% of cases are diagnosed at muscle invasive stage T2 or more. As for bladder UC, the TNM-staging system was commonly used for bladder small cell carcinoma. Radical resection of tumor, either radical cystectomy or partial cystectomy, was the primary treatment of bladder small cell carcinoma. Adjuvant radiation therapy or chemotherapy was recommended for advanced disease. The most used chemotherapy regimen was cisplatin plus etoposide. In our 2 cases, case 1 was a female, none of them was aged between 60~70 years old. Both of the cases had gross hematuria as their chief complaint, and they were diagnosed by pathology of TURBT specimen. Case 1 received partial cystectomy, but case 2 received TURBT only and would receive radiation therapy in the future. Long term follow-up might be needed for disease outcome.