Sarcomatoid Urothelial Carcinoma of Ureter and Kidney Presenting as Fever and Epigastric Pain: A Case Report

以發燒及上腹痛為表現的左側輸尿管及腎臟類肉瘤泌尿上皮細胞癌之病例報告

吳榮倫(Jung-Lun Wu) ； 易志成(Chih-Cheng Yi) ； 陳俊文(Chun-Wen Chen) ； 陳拓安(Tuo-An Chen) ； 凃世凱(Shih-Kai Tu)

《台灣家庭醫學雜誌》 31卷3期 (2021/09) Pp. 227-233

https://doi.org/10.3966/168232812021093103006

摘要

Sarcomatoid urothelial carcinoma (SaUC) of the ureter and kidney is a rare variant of urothelial carcinoma (UC) as it is both epithelial and mesenchymal. Due to rapid progression and widespread metastasis, the prognosis of SaUC is extremely poor. We report a rare case of SaUC involving the left ureter and kidney of a 51-year-old woman. Microscopic hematuria and anemia were noted for the past 7 years. The patient reported a history of taking Chinese herbal medicine since the age of 2. Initially, she visited our gastrointestinal outpatient department due to fever and upper abdominal pain radiating to her back for more than 2 weeks. On abdominal ultrasound she was found to have a tumor on her left kidney. She was referred to our genitourinary outpatient department. Computed tomography imaging of the abdomen revealed a large tumor on her left kidney with scattered calcifications. Subsequently, left nephroureterectomy, adrenalectomy, and bladder cuffectomy were performed. A pathologic diagnosis of SaUC of the left ureter and kidney was established. Unfortunately, the disease progressed rapidly, and due to intraperitoneal carcinomatosis and diffuse lung metastasis, the patient died on the 32nd day after surgery. Risk factors such as genetic susceptibility, environmental carcinogens of aristolochic acid, diagnosis process and treatment recommendations were discussed. This case highlights that kidney tumors may occur when microscopic hematuria and chronic anemia are discovered. A further evaluation with abdominal US and CT are required.

關鍵字

renal tumor ； sarcomatoid urothelial carcinoma ； urothelial carcinoma

並列摘要

輸尿管和腎臟的類肉瘤泌尿上皮細胞癌是泌尿上皮癌的罕見變體，因為它同時包含上皮及間葉細胞。由於進展迅速和廣泛的轉移，類肉瘤泌尿上皮細胞癌的預後極差。我們介紹一名51歲女性診斷為罕見的輸尿管和腎臟的類肉瘤泌尿上皮細胞癌。在過去的7年中，健檢報告發現有微觀血尿和貧血。病史詢問得知她從2歲起有服用中草藥的習慣。最初，她因發燒和上腹部疼痛並向後背輻射等症狀超過2週而去了我們的胃腸科門診。透過超音波發現左腎腫瘤。隨後對腹部進行電腦斷層掃描成像研究，發現巨大的左腎腫瘤伴有散在鈣化。後續病人住院接受左側腎臟及輸尿管切除術，左側腎上腺和膀胱袖口切除術。病理診斷為左側輸尿管和腎臟的類肉瘤泌尿上皮細胞癌。不幸的是，病程進展迅速，並且由於腹膜內癌變和瀰漫性肺轉移，病人在手術後第32天死亡。後續討論了危險因子諸如遺傳易感性，環境致癌物馬兜鈴酸，診斷過程和治療建議等。該病例提醒基層醫師，當發現微觀血尿和慢性貧血時，需考慮腎臟腫瘤的可能性，安排腹部超音波或腹部電腦斷層掃描以進行進一步評估。

並列關鍵字

腎腫瘤 ； 類肉瘤泌尿上皮細胞癌 ； 泌尿上皮癌

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