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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 clinical diagnosis and prognosis of bladder malignant fibrous histiocytoma (MFH). Methods: 1 case of bladder MFH, female, 71 years old. Due to painful hematuria with recurrent fever for 2 months admitted to hospital. CT showed the right anterior wall of the local thickening of the bladder, showing irregular soft tissue density shadow, the size of about 4.9cm × 3.4cm, CT value of about 47HU, which see the calcification within; enhanced CT prompt lesions were significantly enhanced lesions breakthrough serosa Layer, with the anterior abdominal wall adhesion unclear. Cystoscopy see the right side of the top of the bladder a 3.5cm × 3.5cm size of new creatures, basal wide, surface necrosis. Cystoscopy biopsy, pathological report of bladder cancer. Radical cystectomy. Retrieve relevant documents for review and discussion. Results: The pathological manifestations of bladder, peritoneal adhesions tumor size 7.5cm × 6.5cm, gray fish-like tissue tender, cutaneous hemorrhagic necrosis. Microscopic examination revealed a large number of spindle muscle cell wall hyperplasia of the bladder wall, arranged in a bundle or mylar pattern, with a large number of nuclear weird and foam-like multinucleated giant cells, pathological mitosis is easy to see. Immunohistochemistry: CD68 +, S-100 +, Lys +, Calponin-, ALK-, SMA-, CK-, EMA-, HMB45-, Ki-67 60% +. Pathological diagnosis of bladder MFH, see the tumor peritoneal tissue invasion. Pathological staging pT4bN0Mx. Postoperative use of gemcitabine combined with paclitaxel (GT) chemotherapy 4 cycles. Follow-up 6 months, no tumor recurrence and metastasis. Conclusion: Bladder MFH rare, the diagnosis mainly depends on the pathological and immunohistochemical examination confirmed, surgical resection assisted radiotherapy and chemotherapy combined treatment is the main treatment. Malignant bladder MFH, easy to relapse, metastasis, low survival rate.