膀胱肉瘤样癌的临床病理分析  

Clinical and pathological analysis of bladder sarcomatoid carcinomas

作　　者：胡自力[1] 冷志[2] 张唯力[1] 杨光永[1] 林艳君[1] 乔天愚[1] 

机构地区：[1]重庆医科大学第二临床学院泌尿外科 [2]重庆医科大学第二临床学院病理科,重庆400010

出　　处：《重庆医科大学学报》2005年第1期151-153,共3页Journal of Chongqing Medical University

摘　　要：目的提高对膀胱肉瘤样癌的认识和诊治水平。方法总结本病的临床、病理资料,结合文献分析该肿瘤的组织来源、病理和免疫组织化学特征、与癌肉瘤的区别、诊治及预后。结果本组2例术前诊断膀胱移行细胞癌,均行膀胱部分切除。术后病检发现该肿瘤由大量梭形细胞组成,其中见移行细胞癌、鳞状细胞癌、腺癌及小圆细胞巢等成分,梭形细胞与癌成分间有移行区。免疫组化染色见肉瘤成分仍表达上皮标记。术后患者恢复良好,未行放疗化疗。2例均于术后10个月内因肿瘤复发、转移相继死亡。结论本病临床表现类似膀胱癌以血尿为主要症状,术前诊断困难;B超、CT、MRI对分期有帮助,确诊依靠病检及免疫组化。应与癌肉瘤相鉴别。该肿瘤早期就可发生血行转移,预后极差。早期发现是改善预后的关键。Objective:To improve the realization, diagnosis and treatment level of bladder sarcomatoid carcinomas.Methods:The tissue resource,the pathological and immunohistochemistry characters,the diagnosis and prognosis of sarcomatoid carcinomas were analyzed and differential diagnosis from bladder carcionomas was established by summarizing the clinical,pathological data and existing related articles.Results:2 cases in this group were diagnosed as transitional cell carcinoma of bladder.The patients underwent partial cystectomy.The pathological study indicated the tumor composed of many fusiform cells,and the transitional cell carcinoma,squamous carcinoma,adenocarcinoma and small cell nest were all included.There was transitional area between fusiform cells and tumor cells.Immunohistochemical examination showed that sarcomatous compoments were stained for epithelial markers.The patiems recovered well without radiotherapy and chemotherapy.However,these 2 patients died of tumor recurrence and metastasis 10 months later.Conclusion:Like general bladder tumor,hematuria is the chief symptom of sarcomatoid carcinomas.B-ultrasonography,CT and MRI can help turnor staging.Final diagnosis depends on pathology and immunohistochemistry.Differential diagnosis between sarcomatoid carcinoma and carcinosaroma should be made.The tumor will undergo blood metastasis in early stage.Prognosis of this kind is poor.The key to improve the prognosis is its early detection.

关 键 词：膀胱肿瘤 肉瘤样癌 免疫组织化学 

分 类 号：R737.14[医药卫生—肿瘤]