CAJ | 학술논문

目的探讨原发性非脐尿管型膀胱黏液腺癌的临床及病理学特点.方法原发性非脐尿管型膀胱黏液腺癌患者9例.男6例,女3例.平均年龄62(55～78)岁.间歇性、无痛性全程肉眼血尿8例,其中黏液血尿4例;体检发现1例.B超及CT检查均提示膀胱占位性病变;膀胱镜检发现膀胱肿物9例,取活检5例.病理报告均为膀胱黏液腺癌.肿瘤直径平均3.1(1.9～4.7)cm.手术治疗8例,其中膀胱部分切除术4例,膀胱全切加尿流改道3例,TURBt 1例.TURBt 1例术后6个月肿瘤复发,再行膀胱全切加尿流改道.1例体弱患者未手术.结果 9例病理报告均为原发性非脐尿管型膀胱黏液腺癌,病理分期T_(2a)5例、T_(2b) 2例、T_(3a)2例.病理分级高分化5例、中分化4例.9例平均随访16.5(3～60)个月.术后1年内死亡4例,1例未手术者随访4个月死于心功能衰竭;1例行TURBt患者,再行根治术术后3个月死于肺转移;2例行膀胱部分切除术者分别于术后9、11个月死于肿瘤转移.其余5例未见肿瘤复发及转移.结论原发性非脐尿管型膀胱黏液腺癌少见,预后差.手术为主要的治疗手段,对复发或转移患者,配合放疗或化疗等综合治疗可延长患者生存期.
목적 탐토원발성비제뇨관형방광점액선암적림상급병이학특점.방법 원발성비제뇨관형방광점액선암환자9례.남6례,녀3례.평균년령62(55～78)세.간헐성、무통성전정육안혈뇨8례,기중점액혈뇨4례;체검발현1례.B초급CT검사균제시방광점위성병변;방광경검발현방광종물9례,취활검5례.병리보고균위방광점액선암.종류직경평균3.1(1.9～4.7)cm.수술치료8례,기중방광부분절제술4례,방광전절가뇨류개도3례,TURBt 1례.TURBt 1례술후6개월종류복발,재행방광전절가뇨류개도.1례체약환자미수술.결과 9례병리보고균위원발성비제뇨관형방광점액선암,병리분기T_(2a)5례、T_(2b) 2례、T_(3a)2례.병리분급고분화5례、중분화4례.9례평균수방16.5(3～60)개월.술후1년내사망4례,1례미수술자수방4개월사우심공능쇠갈;1례행TURBt환자,재행근치술술후3개월사우폐전이;2례행방광부분절제술자분별우술후9、11개월사우종류전이.기여5례미견종류복발급전이.결론 원발성비제뇨관형방광점액선암소견,예후차.수술위주요적치료수단,대복발혹전이환자,배합방료혹화료등종합치료가연장환자생존기.
Objective To discuss the pathologic and clinical features of primary non-urachal mucinous adenocarcinoma of the bladder.Methods Nine cases(6 men and 3 women;mean age,62 years)of primary non-urachal mucinous adenocarcinoma of the bladder were reviewed and analyzed.Intermittent macrohematuria without pain was found in 8 cases,with muco-hematuria in 4 cases;1 case was found by routine health examination.Both Ultrasound and CT showed occupying lesion in bladder.Cystoscopy found tumor in 9 cases,biopsy in 5 cases and showed mutinous adenocarcinoma of the bladder.The tumors diameter was 3.1 cm in average.Eight cases received operation,among which 3 had undergone radical cystectomy and 4 with partial cystectomy,1 case with TURBT primary and then with radical cystectomy after tumor recurrence.One case didn't receive operation.Results Nine cases were pathologically diagnosed as primary non-urachal mucinous adenocarcinoma of the bladder.Histological staging was T_(2a) 5 cases,T_(2b) 2 cases,T_(3a)2 cases.Histological grading was well-differentiated in 5 cases,moderately differentiated in 4 cases.Four cases died in 1 year after treatments,1 case who didn't receive operation died of cardiac function failure after 4 months;1 case treated with TURBT died of lung metastasis;2 cases treated with partial eysteetomy died of metastasis after surgery in 9 month and 11 month respectively.The other 5 cases were alive without recurrence and metastasis.Conclusions Primary non-urachal mucinous adenocarcinoma of the bladder is rare,but with a poor prognosis.Surgery is the main treatment for primary non-urachal mucinous adenocarcinoma of the bladder,comprehensive therapy such as radiotherapy or chemotherapy should be applied to those patients with metastatic or tumor recurrence.