膀胱小細胞癌：病例報告
徐慧興*，張世琦，王旭翔， 邵翊紘，許家豪
羅東博愛醫院 外科部 泌尿科, 國立陽明大學 泌尿學科*
small cell carcinoma of urinary bladder
Hueih-Shing Hsu, Shyh-Chyi Chang, Hsu-Hsiang Wang, I-Hung Shao, Eason Hsu
Division of Urology, Department of Surgery, Lotung Pohai Hospital,
Yilan, Taiwan, Urology, National Yang Ming University*
Purposes: Small cell carcinoma of urinary bladder is a rare malignant tumor. Primary small cell carcinoma arises from lung. Extra-pulmonary small cell carcinoma may origin from multipotential stem cell. Small cell carcinoma of urinary bladder can occur as a pure malignancy or in combination with urothelial carcinoma. There are more frequent in men and many patients are with the habit of smoking. The age of disease occurred more frequently between 60 and 70 years. It is highly aggressive than urothelial carcinoma. The 5 -year survival is 16% to 18%. The overall median survival time noted from 4 to 7 months. As yet, there is no standard management of small cell carcinoma of urinary bladder. We report a case and review the bladder preserving surgery with chemoradiotherapy.
Case: We report a case of a 74-year-old man with 30-year history of smoking, who presented with gross hematuria and urine retention. The intravenous pyelogram does not show the filling defect in urinary bladder. But urine cytology suspects malignancy. Cystoscope revealed a sessile tumor with bleeding in left lateral wall of urinary bladder. Transurethral resection of bladder tumor (TURBT) was done and pathology showed a small cell neuroendocrine carcinoma with muscle invasion. Immunological stain revealed positive for CD56, synaptophysin, uroplakin, 34BE12, and focal positive for p63, GATA3, and negative for chromogranin A. He underwent a chemoradiotherapy after TURBT. We analyzed the outcomes of patients with small cell carcinoma of the bladder treated with transurethral bladder resection, chemotherapy, radiation therapy with the goal of bladder preservation
Discussions: Small cell carcinoma of urinary bladder is a rare malignant tumor. It is important for pathologists to be aware of the possible differential diagnoses. The prognosis is poor due to the aggressive clinical behavior and a high potential for metastasis. The optimal treatment remains uncertain due to its rarity. It is an effective alternative to radical cystectomy for patients who desire bladder preservation.