摘要
目的:探讨膀胱恶性纤维组织细胞瘤(MFH)的临床诊治和预后特点。方法:膀胱MFH 1例,女,71岁。因无痛肉眼血尿伴反复发热2个月入院。CT示膀胱右前壁局部增厚,可见不规则形软组织密度影,大小约4.9cm×3.4cm,CT值约47HU,其内见钙化灶;增强CT提示病灶呈明显均匀强化,病灶突破浆膜层,与前腹壁粘连境界不清。膀胱镜检查见膀胱顶部右侧一3.5cm×3.5cm大小新生物,基底宽,表面部分有坏死。膀胱镜取活检,病理报告膀胱恶性肿瘤。行根治性膀胱切除术。检索相关文献复习讨论。结果:病理示膀胱、腹膜粘连性肿物大小7.5cm×6.5cm,灰白的鱼肉样组织质嫩,切面有出血坏死。镜检示膀胱肌壁多量梭形细胞增生,排列呈束状或席纹状,伴多量核怪异及泡沫样多核巨细胞形成,病理性核分裂易见。免疫组化:CD68+,S-100+,Lys+,Calponin-,ALK-,SMA-,CK-,EMA-,HMB45-,Ki-67 60%+。病理诊断为膀胱MFH,腹膜组织见肿瘤侵犯。病理分期pT4bN0Mx。术后采用吉西他滨联合紫杉醇(GT)方案化疗4个周期。随访6个月,未见肿瘤复发及转移。结论:膀胱MFH罕见,诊断主要依靠病理和免疫组化检查确诊,手术切除辅助放化疗的综合治疗是主要的治疗手段。膀胱MFH恶性度高,易复发、转移,生存率低。
Objective： To investigate the diagnosis, treatment and prognosis of malignant fibrous histiocytoma （MFH） of the bladder. Method： A 71-year-old female presented with painless gross hematuria accompanied by recurrent fever for two months and was admitted into our hospital. CT demonstrated the local thickening of right anterior wall of bladder, and there existed a 4.9 cmX 3.4 cm irregular shaped soft tissue density with irregular calcification. CT value was about 47 HU. Contrast-enhanced CT showed obvious homogeneous enhancement, focal breakthrough Serosa, and anterior abdominal wall adhesions ambiguous realm. Cystoscopy revealed a 3.5 crux 3. 5 cm bottom width tumor associated with surface part necrosis on the right anterior wall of the bladder. Biopsy pathology revealed malignant tumor of the bladder. Radical cystectomy was performed. Related literature was retrieved and analyzed. Result： A 7. 5 cm X 6. 5 cm peritoneal adhesive bladder tumor, fish-like gray tissue was found and its section revealed hemorrhage and necrosis. Microscopic examination showed a large number of spindle cell proliferations arranged in fascicular and storiform and there were a large number of weird nuclear and bubble formation of multinucleated giant cells in the bladder muscular wall. Pathological karyokinesis was easily found. Immunohistochemistry showed the tumor cell was CD68n-, S-100＋, Lys＋, Calponin-, ALK-, SMA-, CK -, EMA-, HMB45-, Ki-67 60＋. Pathological diagnosis was MFH of bladder and peritoneal tissue tumor invasion. The pathological stage was pT4u NoMx. Four-cycle postoperative adjuvant systemic chemotherapy was given with gemcitabine and paelitaxel （GT）. No tumor progression was noted over six-month follow-up period. Conclusion.. MFH primarily arising from the bladder is extremely rare. The diagnosis should be confirmed by pathological and immunohistochemical examination. MFH of the bladder is the tumor with high-grade malignancy, high local recurrence, metastasis and low survival rate. Surgical resection i
出处
《临床泌尿外科杂志》
2015年第4期302-305,共4页
Journal of Clinical Urology
关键词
膀胱
纤维组织细胞瘤
恶性
bladder
fibrous histiocytoma
malignancy
