病例報告- 膀胱亮細胞腺癌
Case report- Bladder clear cell adenocarcinoma in a rheumatoid arthritis patient
陳韋辰、裘坤元
臺中榮民總醫院，外科部，泌尿外科
Wei-Cheng Chen, Kun-Yuan Chiu
Divisions of Urology, Department of Surgery, Taichung Veterans General Hospital
Case report
Clear cell adenocarcinoma (CCA) of the urinary bladder is one of the rare variants of primary adenocarcinoma of urinary bladder, and predominantly affects women. CCA may show an extremely aggressive and invasive growth behavior, which indicates an early radical surgery.
We report a 82-year-old mongoloid female presented with gross hematuria and dysuria for clinical evaluation.
She is a case of rheumatoid arthritis and Sjogren syndrome, who presented to our emergency department with chief complaint of gross hematuria and dysuria for 3 days. Initial urine analysis data disclosed hematuria and hemogram found anemia (Hemoglobin: 10 g/dl). Abdominal sonography indicated a urinary bladder tumor, 2cm in size. The tumor was completely resected by bipolar transurethral resection. Bilateral retrograde pyelography was normal without filling defect.
Histopathology reported clear cell adenocarcinoma of urinary bladder, high grade. Tumor invaded to subepithelial connective tissue. Detrusor muscle invasion or angiolymphatic invasion was not identified in the specimen.
Clear cell adenocarcinoma is a very rare variant of bladder cancer. Women are predominantly affected. Most reported cases in older female and presented with hematuria and mass. Evidence showed that systemic glucocorticoid therapy more than 1 month has increased the risk of bladder cancer. In our case, she received glucocorticoids and other immune modulating treatment for rheumatoid arthritis and Sjogren syndrome over 10 years. We conclude that when hematuria occurs in patient receiving longterm glucocorticoid treatment, the differential diagnosis should always include bladder cancer.