原发性输尿管肉瘤样癌的临床特点分析  

Analysis of the clinical characteristics of primary ureteral sarcomatoid carcinoma

作　　者：吕子建 李东惠 王宏伟 徐澜婷 付艳 彭亮 Lyu Zijian;Li Donghui;Wang Hongwei;Xu Lanting;Fu Yan;Peng Liang(Department of Bio-Therapeutic,the First Medical Center,Chinese PLA General Hospital,Beijing 100853,China;Department of Medical Oncology,the Fourth Medical Center,Chinese PLA General Hospital,Beijing 100048,China;Department of Pathology,the Fourth Medical Center,Chinese PLA General Hospital,Beijing 100048,China;The Second Clinical College,China Medical University,Shenyang 110122,China;Department of Oncology,the Fifth Medical Center,Chinese PLA General Hospital,Beijing 100039,China)

机构地区：[1]中国人民解放军总医院第一医学中心生物治疗科,北京100853 [2]中国人民解放军总医院第四医学中心肿瘤内科,北京100048 [3]中国人民解放军总医院第四医学中心病理科,北京100048 [4]中国医科大学附属第二临床学院,沈阳110122 [5]中国人民解放军总医院第五医学中心肿瘤医学部,北京100039

出　　处：《中华老年医学杂志》2025年第3期335-341,共7页Chinese Journal of Geriatrics

摘　　要：目的探索原发性输尿管肉瘤样癌患者的临床特点,提高对该病临床情况的认识。方法报道1例解放军总医院第四医学中心老年原发性输尿管肉瘤样癌病例,该患者通过术后病理诊断为原发性输尿管肉瘤样癌;检索同时进行文献回顾,截止至2024年7月国内外报道的原发性输尿管肉瘤样癌病例资料的相关文献,对该病临床情况的临床表现、诊断、治疗及预后信息进行总结分析。结果共获文献20篇,包含24例原发性输尿管肉瘤样癌病例,年龄大于60岁的患者17例,连同本例复习病例共18例,其中66.7%(12/18)为男性,诊断原发性输尿管肉瘤样癌的中位年龄为65岁。报道病例早期可无任何临床表现,病情发展可有尿频、尿急、尿痛或无痛性全程肉眼血尿等泌尿系统常见症状,病变多位于左输尿管(17例),常有扩张积水。病理学检查镜下见梭形细胞。20例患者行手术治疗,随访期内9例未见复发转移,7例死亡。结论原发性输尿管肉瘤样癌是一种罕见的输尿管恶性肿瘤,目前认为其临床表现不具有特异性,病理是确诊的金指标,免疫组化及影像学结果可辅助诊断。当前首选治疗方案为手术切除,一线治疗采用化疗联合免疫治疗及靶向治疗对肿瘤有较好的控制效果。ObjectiveTo explore the clinical characteristics of patients with primary ureteral sarcomatoid carcinoma,thereby enhancing the understanding of the clinical context surrounding this disease.MethodsWe report a case of primary ureteral sarcomatoid carcinoma in an elderly patient diagnosed through postoperative pathology at the Fourth Medical Center of the General Hospital of the People's Liberation Army.Additionally,a literature review was conducted to analyze articles related to primary ureteral sarcomatoid carcinoma published both domestically and internationally up to July 2024.This review summarizes and analyzes information regarding the clinical manifestations,diagnosis,treatment,and prognosis associated with this condition.ResultsA total of 20 articles were reviewed,encompassing 24 cases of primary ureteral sarcomatoid carcinoma.Among the patients,17 were older than 60 years,and when combined with the cases presented in this review,a total of 18 cases involved patients over the age of 60.Of these,66.7%(12/18)were male,with a median age at diagnosis of 65 years.The reported cases often exhibited no clinical manifestations in the early stages;however,as the disease progressed,common urinary symptoms emerged,including frequency,urgency,pain,or painless hematuria,occurring throughout the ureteral course.The lesions were predominantly located in the left ureter(17 cases),which frequently exhibited dilation with effusion.Pathologic examination revealed the presence of microscopic spindle cells.Surgical treatment was administered to 20 patients,of whom 9 did not experience recurrence or metastasis during the follow-up period,while 7 cases resulted in mortality.ConclusionsPrimary ureteral sarcomatoid carcinoma is a rare malignant tumor of the ureter.Its clinical manifestations are generally regarded as non-specific,making pathological examination the gold standard for diagnosis.Immunohistochemical and imaging studies can assist in the diagnostic process.The current preferred treatment modality is surgical resection,w

关 键 词：输尿管 肉瘤 诊断 

分 类 号：R73[医药卫生—肿瘤]