吳冠諭，楊文宏

國立成功大學醫學院附設醫院泌尿部

Kuan-Yu Wu, Wen-Horng Yang,

Department of Urology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan

Introduction:

We report this case of a patient with recurrent transitional cell carcinoma in an ileal conduit. There was a 4-year interval between the initial cystectomy and the recurrence of the malignancy.

 

Case report:

This 84 year old woman with a history of transitional cell carcinoma of the bladder treated by radical cystectomy and reconstruction of an ileal conduit on March, 2010. Histological examination of the resected tumors showed high grade, T2aN0Mx. One year after radical procedure, left hydronephrosis was found on March, 2011. The result of CT revealed left distal ureteral tumor, and then left nephroureterectomy was done and histological examination showed T1NxMx, stage I. She was seen in the urology clinic every 3 months without significant problems. Unfortunately, she had hematuria for 3 days in April 2014. Physical exam revealed no abnormalities. Urinalysis showed grossly hematuria. CT urogram revealed filling defect within ileal conduit. Conduitoscopy confirmed the presence of papillary tumor recurrence at proximal end of ileal conduit. Endoscopic biopsy was arranged and TCC was confirmed by histological examination. After discussed with patient and her family, she choose active surveillance because of old age and she is still alive now.

 

Discussion:

The occurrence of transitional cell carcinoma in an ileal conduit is relatively rare. Since Soloway et al. reported two patient with recurrent carcinoma in the ileal conduit. There was only 14 patients reported in recent literature have had this complication. The average time to recurrence is 46.9 months. The site of recurrent tumor in ureteroileal anastomosis were 7 patients and in ileal loop were 7 patients. The most common clinical initial presentation is gross hematuria(60%). Retrograde urogram via the ileal conduit gave valuable information in previous studies and this case. Filling defect or “napkin ring” appearance was presented if tumor recurrence in the ileal conduit.

There are no formal recommendations for routine follow up of patients with ileal conduits. According to previous research, hematuria may be a harbinger of tumor recurrence, and workup including radiographic, endoscopic, and cytologic studies of the loop is considered.

In summary, recurrent TCC after radical cystectomy and reconstruction of an ileal conduit can be located in ureteroileal anastomosis or ileal loop. Retrograde loop studies can contribute valuable information if tumor recurrence in ileal conduit cannot be excluded.