背景:膀胱肿瘤内的骨形成可以在3种情况下遇到。这些可能包括间充质肿瘤中的恶性骨形成;混合的间充质和上皮肿瘤;以及具有间质骨化生(SOM)的上皮肿瘤。这最后一个是相对罕见的。根据英国文学,据报道,原发性肿瘤仅12例,膀胱原发性转移沉积7例。在这里,我们提出了一个额外的案例。
方法:一名83岁男子13年前因前列腺腺癌入院,根治性前列腺切除术治疗。术后2年检测到生化复发(前列腺特异性抗原(PSA)水平:4.60ng/mL),并在辅助放疗和每年注射亮丙瑞林(enantoneR)后逐渐恢复正常(<1.0ng/mL)。8年后他因血尿被转诊,PSA水平略有增加(0.60ng/ml)。膀胱镜检查显示膀胱壁有结节状生长,在计算机断层扫描(CT)上可视化为钙化肿瘤,并通过经尿道切除术切除。组织学上,肿瘤由非肌肉浸润性高级别乳头状尿路上皮癌和基质内化生性骨组成。免疫组织化学分析特别显示CD56在成骨细胞上的阳性表达,破骨细胞上的CD68。MDM2和CDK4对类骨组织和骨组织均呈阴性。已经施用了六个疗程的卡介苗(BCG)疗法。在免疫治疗后的8个月随访期间,发生了两次局部复发,并接受了六个疗程的卡介苗治疗。在一个月的随访中,患者情况良好,没有残留症状。
结论:SOM是一种罕见的良性疾病,其发病机制尚不完全明确。肉瘤原癌是影响治疗程序的主要鉴别诊断。预后主要取决于癌成分的程度。
BACKGROUND: The bone formation within bladder tumors could be encountered in 3 conditions. These might consist of malignant bone formation in mesenchymal tumors; mixed mesenchymal and epithelial tumors; and epithelial tumors with stromal osseous metaplasia (SOM). This last is relatively rare. According to the English literature, only 12 cases have been reported in primary tumor and 7 in metastatic deposits of bladder primaries. Herein, we presented an additional case.
METHODS: An 83-year-old man was admitted 13 years ago for prostatic adenocarcinoma, treated with radical prostatectomy. Biochemical recurrence was detected 2 years after surgery (prostate-specific-antigen (PSA) level: 4.60 ng/mL) and progressively normalized (<1.0 ng/mL) after adjuvant radiotherapy and annual injection of leuprorelin (enantoneR). He was referred after 8 years for hematuria, PSA level having slightly increased (0.60 ng/ml). Cystoscopy showed a nodular growth in the bladder wall, visualized as a calcified tumor on computed tomography (CT) and removed with transurethral resection. Histologically, the tumor consists of a non-muscle-invasive high grade papillary urothelial carcinoma with metaplastic bone within the stroma. Immunohistochemical analysis particularly demonstrated positive expression of respectively CD56 on osteoblasts, and CD68 on osteoclasts. MDM2 and CDK4 were negatives on osteoid and bone tissue. Six courses of Bacillus Calmette-Guerin (BCG) therapy have been administered. Two local recidives have occurred during an 8-month follow-up period after immunotherapy and were treated with six further courses of BCG therapy. At one-month follow-up, the patient was well without remaining symptoms.
CONCLUSIONS: SOM is a rare benign condition whose pathogenesis remains uncompletely defined. Sarcomatoïd carcinoma represents the main differential diagnosis that influences therapeutic procedures. Prognosis depends essentially on the extent of the carcinomatous component .