摘要
目的 复习膀胱癌肉瘤 (CB)的组织学发生、临床和病理学特征。方法 回顾分析 2例CB患者的临床和病理资料并复习有关文献。结果 肉眼血尿为主要症状。 2例患者 (T2 N0 M0 )均行膀胱部分切除 ,术后随访 9个月和 5年。该肿瘤在显微镜下主要由高分化移行细胞癌和肉瘤成分组成 ,后者包括软骨肉瘤、骨肉瘤、横纹肌肉瘤和未分化梭形细胞成分。免疫组化结果 :在所有的肿瘤中 ,癌成分至少对一种CK反应呈阳性 ;小细胞成分对NSE和CGA反应阳性。肉瘤样成分对Vimentin反应阳性 ;软骨肉瘤病灶区对S 10 0呈持续阳性反应。结论 CB是一种高度恶性肿瘤 ,好发于老年男性 ,对分期较晚的病例 ,根治性切除是最佳治疗方案。CB的预后与肿瘤分期密切相关 ,而与组织学表现似乎没有关系。
Objective To discuss the histogenesis,clinical and pathologic characteristics of carcinosarcoma of the bladder(CB).Methods Clinical and pathological data of 2 cases of CB were retrospectively studied,and the literature was reviewed.Results Gross hematuia was the main prestenting symptoms.Partial cystectomy was performed in two patients(T 2N 0M 0) who have been well during the 9 months and 5 years of postoperative follow up.Microscopically,the tumors composed mostly of high grade transitional cell carcinoma mixed with sarcomatous components consisting of chondrosarcoma,osteosarcona,rhabdomyosarcoma and undifferentiated spindle cell.Immunohistochemically,in all tumors,the carcinomatous component reacted with at least one anticytokeratin antibody.The small cell component was positive for NSE and CGA.The sarcomatous component was consistently positive for vimentin.Chondrosarcomatous foci were consistently positive for S 100 protein.Conclusion CB is a highly malignant type of neoplasm,occured in elderly males redominantly.Radical operation appeared to be the best treatment of choice in the advanced stage of the disease.The prognosis of CB is related to tumor stage and seems to be no relations with histologic appearance and outcome.
