- 期刊
Primary Small Cell Carcinoma of the Ureter-A Case Report and Review of the Literature
原發輸尿管小細胞癌－病例報告與文獻回顧
摘要
前言：小細胞癌通常起源於肺內，但也可以起源於肺外的許多位置上。肺外的小細胞癌很少見，只佔了所有小細胞癌的千分之一到四，而且原發在非常多樣的器官上。泌尿系統的小細胞癌最常見在膀胱，起源於輸尿管更是極為罕見。病例報告：一個五十六歲的男性，因為兩個月前開始有右腹側痛而來住院。腹部電腦斷層在右側骨盆腔，發現起源於右側輸尿管的浸潤性的腫瘤，約8.5 cm x 7.6cm大，伴隨著嚴重的右側水腎以及右側輸尿管積水。病人接受了三個療程，配方為順鉑與健擇的前導性化學治療，接著接受右側手輔助式後腹腔鏡腎輸尿管切除術。術後加做輔助性同步化學放射治療。化學治療的部份為三個療程的順鉑（Cisplatin）與依托泊甙（Etoposide），放射線治療的部份在腫瘤原發病灶處給予64.8 Gy。討論：原發輸尿管小細胞癌最常見的症狀是肉眼性血尿與腹側疼痛。而此疾病的分期依據小細胞肺癌。原發輸尿管小細胞癌的治療目前仍沒有完整建立。儘管有輔助性治療，大部份的病人後來都有遠端轉移且預後不好。為了改善預後，積極的治療是需要的，但是要考慮到病人的耐受性。
並列摘要
Introduction: Small cell carcinoma usually arises in the lung but can also originate in a wide range of extrapulmonary sites. Extrapulmonary small cell carcinoma is rare, encompassing approximately 0.1-0.4 percent of all small cell carcinomas, and has been described in a variety of organs. Small cell carcinoma of the genitourinary tract is often found in the urinary bladder, and is extremely rare in the ureter. Case report: A 56-year-old man was admitted with a two-month history of the right flank pain. An abdominal computed tomography demonstrated an infiltrative mass lesion with size of about 8.5 × 7.6 cm in the right pelvis, arising from the right ureter, with severe right hydronephrosis and hydroureter. The patient received neoadjuvant chemotherapy with cisplatin and gemcitabine for 3 cycles, followed by right side hand-assisted retroneoscopic nephroureterectomy. Then adjuvant concurrent chemo-radiotherapy was given. The chemotherapy regimens were cisplatin and etoposide for 3 cycles. The irradiation course consisted of 64.8 Gy/36 fractions to the tumor bed. Discussion: The most common symptoms of this disease are gross hematuria and flank pain. The staging of this disease is according to small cell carcinoma of the lung. The treatment of ureter small cell carcinoma is not well established. Despite adjuvant chemotherapy or radiotherapy, most patients develop metastatic disease resulting in poor prognosis of this disease. Aggressive treatment is warranted to improve the outcome. However, the tolerance of the patients is still needed to be considered.