■炎性肌纤维母细胞瘤(IMT)是一种具有恶性潜能的罕见肿瘤。膀胱IMT更罕见，主要通过手术切除治疗。膀胱部分切除或根治性切除会影响患者的生活质量,而经典的TURBT则难以避免术中并发症，包括闭孔神经反射和出血等。因此,安全有效的手术入路选择对膀胱IMT至关重要。
■一名42岁男性患者因持续无痛性肉眼血尿10天以上而未出现高血压而入院。术前尿常规红细胞检查为7738.9/HPF(正常值≤3/HPF)。CTU提示膀胱左后壁占位（6.0cm×5.0cm），排泄期不均匀强化。MRI还显示膀胱肿瘤，膀胱左后壁T1WISI略等，T2WI混合高SI（6.0cm×5.1cm×3.5cm）。使用1470nm二极管激光对膀胱IMT进行整块切除，并结合通过切碎器系统去除去核肿瘤。术后病理检查提示膀胱IMT，IHCKi-67阳性（15-20%），CKAE1/AE3,SMA,膀胱IMT的结蛋白和膀胱IMT的ALK阴性以及ALK基因重排的FISH阴性。在6周内使用1470nm二极管激光进行第二次TUR，以降低术后复发的风险，这是由于IHC染色中Ki-67高表达（15-20％）和ALK阴性的高度恶性潜力。第二例术后病理报告示慢性炎症伴膀胱粘膜水肿，无膀胱IMT，此外，在膀胱固有肌层未观察到肿瘤。24个月随访期间无复发。
■En膀胱IMT整块切除术结合随后的第二次经尿道切除与1470nm二极管激光是一种安全有效的手术方法，具有高度恶性潜力的巨大膀胱IMT。
UNASSIGNED: Inflammatory myofibroblastic tumor (IMT) is a rare neoplasm with malignant potential. Bladder IMT is even rarer and mainly treated by surgical resection However, partial or radical cystectomy would affect the quality of life of patients due to major surgical trauma, and classical TURBT is hard to avoid intraoperative complications including obturator nerve reflex and bleeding etc. Therefore, the safe and effective better choice of surgical approaches become critical to bladder IMT.
UNASSIGNED: A 42-year-old male patient was admitted to the department of urology with persistent painless gross hematuria for more than 10 days without the presentation of hypertension. Preoperative routine urine examination of red blood cells was 7738.9/HPF (normal range ≤ 3/HPF). CTU indicated a space occupying lesion (6.0 cm×5.0 cm) in the left posterior wall of the bladder with heterogeneous enhancement in the excretory phase. MRI also indicated bladder tumor with slightly equal SI on T1WI and mixed high SI on T2WI (6.0 cm×5.1cm×3.5cm) in the left posterior wall of the bladder. En bloc resection of bladder IMT with 1470 nm diode laser in combination of removing the enucleated tumor by the morcellator system was performed. Postoperative pathological examination revealed bladder IMT, with IHC positive for Ki-67 (15-20%), CK AE1/AE3, SMA, and Desmin of bladder IMT and negative for ALK of bladder IMT as well as FISH negative for ALK gene rearrangement. Second TUR with 1470 nm diode laser was performed within 6 weeks to reduce postoperative risk of recurrence due to highly malignant potential for the high expression of Ki-67 (15-20%) and negative ALK in IHC staining. The second postoperative pathology report showed chronic inflammation concomitant with edema of the bladder mucosa without bladder IMT, furthermore no tumor was observed in muscularis propria layer of bladder. No recurrence occurred during the period of 24-month follow-up.
UNASSIGNED: En bloc resection of bladder IMT in combination of the following second transurethral resection with 1470 nm diode laser is a safe and effective surgical approach for the huge bladder IMT with highly malignant potential.
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