陳世亮、張廷瑞、許智凱

台南市立醫院 泌尿科

Shih-Liang Chen, Ting-Jui Chang, Chih-Kai Hsu

Divisions of Urology, Tainan Municipal Hospital, Tainan, Taiwan

 

Background: Solitary fibrous tumor (SFT) is a rare neoplasia of mesenchymal origin, initially described in visceral pleura and lately found to have ubiquitous distribution. The urogenital tract involvement is very rare. Most tumors are benign and, contrary to previous beliefs, they do not derive from the mesothelium; but rather from dendritic interstitial cells, which express CD34 and have generalized distribution in tissues. Here we presented a case of solitary fibrous tumor of urinary bladder and literature review.

Case Report: A 58 year old male patient suffered from nocturia (3-4 times/night), urinary frequency and terminal dribbling since several years. He come to our OPD for help. During sonography examination bladder tumor was noted. Cystoscopy examination was arranged and showed prostate enlargement with solitary bladder tumor on right lateral wall. TUR-P with TUR-BT was done. The pathology reported solitary fibrous tumor of bladder. Immunohistochemically, the cells are positive for CD34 but negative for S-100. Three months later, bladder sonography was performed again and showed not tumor recurrence.

Discussion: SFT is a rare mesenchymal neoplasm that accounts for less than 2% of all soft-tissue tumors usually involving the pleura, pericardium, and peritoneum. It was first described by Klemperer and Rabin in 1931; but the first case in the urinary tract was reported in 1997. SFT occurs equally in both sexes and the age of presentation varies from the second to sixth decade. Clinically it is a slow-growing, painless, well-delineated exophytic mass. Fewer presents with paraneoplastic syndromes. Most tumors have a benign clinical course, although 10% to 20% may show aggressive behavior. The criteria for malignancy include increased cellularity, pleomorphism, increased mitotic activity (more than 4 mitoses on 10 high power fields), necrosis, and hemorrhage. The diagnosis depends on histological and immunohistochemical examinations. A complete surgical excision with negative margins whenever feasible is the treatment of choice with a five year overall survival approaching 100%. Chemotherapy is reserved for metastatic or symptomatic non-resectable malignant tumours. There are no standard chemotherapeutic indications, but the most effective drugs seem to be anthracyclines and ifosfamide.