膀胱癌肉瘤: 罕見膀胱腫瘤型態之病例報告
江佩璋2、顏敬恒1、羅華成1、蘇忠仁1、李俊德1
1三軍總醫院松山分院 2三軍總醫院 外科部 泌尿外科
Carcinosarcoma of the bladder: A case report of rare type bladder cancer
Pei-Jhang Chiang2, Ching-Heng Yen1, Hua-Cheng Lo1, Chung-Jen Su1, Chun-Te Lee1
Division of Urology, Department of Surgery, 2Tri-Service General Hospital,
1Tri-Service General Hospital Songshan Branch, Taipei, Taiwan, R.O.C
Introduction: Carcinosarcoma (CS) or sarcomatoid carcinoma of the urinary bladder (SCUB) is a rare malignancy, presenting both epithelial and mesenchymal components. Considering this aggressive type of bladder cancer, radical cystectomy was suggested in previous studies. However, limited to case reports and small case series, no standardized management is available for this disease.
Case report: An 85-year-old male presented with gross hematuria. Computed tomography disclosed wall thickness with contrast enhancement of left lateral wall and hydronephrosis of left kidney. The tumor was resected via initial transurethral resection of bladder tumors (TURBT) then immediate intravesical chemotherapy, and a second TURBT was subsequently performed to resect suspicion of recurrence four month later. Surgical pathology from these two resections revealed carcinosarcoma with invasion into the muscularis propria and ulcer with regenerative atypia, respectively. Postoperatively, the patient did not receive systemic chemotherapy or radiation and currently remains disease-free 6 months post initial TURBT.
Conclusion: Although optimal treatment of CS or SCUB is still uncertain. For those who are not suitable candidates for cystectomy. Maximal TURBT could be equally effective in selective case. Long-term follow-up is required to confirm the benefit of our practice.