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膀胱小细胞癌五例报告并文献复习

Bladder small cell carcinoma: 5 cases report and literature review

摘要:

目的 分析膀胱小细胞癌患者的诊断、治疗和预后情况,提高对膀胱小细胞癌的认识.方法 回顾性分析5例膀胱小细胞癌患者的临床及病理资料.患者均为男性,年龄50~78岁,平均64岁.临床表现为肉眼血尿4例,健康查体发现膀胱占位1例.B超检查示肿物直径2.1~4.0 cm,平均3.0 cm,中等回声肿物3例,低回声肿物2例;行CT检查3例,双肾积水伴盆腔多发淋巴结增大1例.5例均先行诊断性TURBT术,其中3例未进一步手术,单纯化疗1个疗程,另2例行根治性膀胱切除术,并术后化疗3个疗程.结果 病理检查:肿瘤细胞体积小,呈圆形,片状排列,核浓染,缺乏巢状结构.免疫组化染色:2例神经元特异性烯醇化酶(+),3例嗜铬素A(+),3例突触素(+),诊断为膀胱小细胞癌.3例接受TURBT加术后化疗者中2例在术后7、8个月死亡,1例随访32个月未见复发、转移;2例行根治性膀胱切除术并术后化疗患者随访16、26个月,未见复发、转移.结论 膀胱小细胞癌是一种罕见的膀胱恶性肿瘤,预后差.根治性膀胱切除术配合术后化疗是主要的治疗方法,若采取保留膀胱的手术应配合全身化疗.

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Objective To analyze the diagnosis,treatment and prognosis of small cell carcinoma of bladder (SCCB) in order to improve the understanding of it.Methods The pathological and clinical data of 5 cases of SCCB were retrospectively analyzed.All patients were male,aged 50 to 78 years (mean age,64 years).Clinical manifestations of 4 cases were gross hematuria,the other case was found by health examination.Ultrasonography results of 3 cases were medium echo tumors,the other 2 cases were hypoecho tumors.The diameter of the tumor was 2.1 to 4.0 cm (mean,3.0 cm).There were 3 patients accepted CT scan.One of them was found of hydronephrosis and multiple pelvic lymph nodes.All patients accepted diagnostic TURBT.Three of them accepted postoperative chemotherapy (1 cycle) without other surgery.Two patients accepted radical cystectomy with postoperative chemotherapy (3 cycles) after bladder tumor biopsy.Results Pathological findings showed that tumor cells were small,round and sheet in arrangement.These hyperchromatic nuclei showed limited cytoplasm with lack of nesting character.Neuron specific enolase,chromogranin A and synaptophysin were positive in immunohistochemistry.The final diagnosis was SCCB'.Two of the three patients who accepted TURBT with postoperative chemotherapy died 7 and 8 months postoperatively,the other one was alive for 32 months.Another two patients who accepted radical cystectomy with postoperative chemotherapy were alive for 16 and 26 months.Conclusions SCCB is a rare tumor which has high malignancy and poor prognosis.Radical cystectomy in combination with postoperative chemotherapy is the main treatment.Retained bladder surgery with chemotherapy is an alternative choice.

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