- 期刊
Tibial Bone Metastasis of Ureteral Transitional Cell Carcinoma with Low Back Pain-A Case Report
泌尿道移形上皮細胞癌脛骨轉移痛合併下背痛：病例報告
摘要
上泌尿道的移行上皮癌在臨床上是較為罕見的腫瘤。而輸尿管的移行上皮癌大約佔所有上泌尿道的移行上皮癌的25%。典型的輸尿管的癌症的症狀，以不痛的血尿及腰痛為主。而輸尿管移行上皮癌的骨骼轉移大多以直接侵犯鄰近的脊椎骨、骨盆及髖關節為主。遠端骨骼轉移，像是脛骨轉移在臨床上較為罕見。 本案為一63歲女性，於民國92年因左側早期輸尿管癌(pT1N0M0)接受左腎併膀胱袖口切除術。後來於民國94年，病患抱怨下背痛復發且合併右側下肢出現疼痛及無力，懷疑為椎間盤突出導致神經根壓迫。因此接受保守治療。因為病人復健效果不佳，以及有癌症病史，懷疑脊椎轉移，因此安排一系列檢查，最後證明為轉移自移行上皮細胞癌的腫瘤。在手術及化學治療後，下肢疼痛已改善且追蹤三年無復發。 臨床上當病人有下背痛合併下肢疼痛，需鑑別診斷的疾病，如椎間盤突出合併神經根疼痛或者癌症的骨轉移。臨床上詳細的病史、身體檢查及神經學檢查是很重要的。當病人對於保守治療無效時，必須作進一步的檢查及鑑別診斷。尤其病患有癌症的病史，特別是上泌尿道系統的癌症。
並列摘要
Of the upper urinary tract (UUT) transitional cell carcinomas (TCCs), only about 25% are ureteral TCC. Typical ureteral carcinoma symptoms are painless hematuria and flank pain. Bone metastasis of ureteral cancer is always directly invasive to nearby bone structures such as the spine, pelvis, and hip bone. Distal bone metastasis such as that in the tibial bone, however, is rare. This report describes a female patient who initially presented with left early stage ureteral transitional cell carcinoma (pT1N0M0) after nephroureterectomy and bladder cuff excision in MK 92. She complained of low back pain and suspected combined radicular pain in MK94. Due to poor response to initial conservative treatment, the patient was eventually diagnosed with right tibial bone metastasis. Three years after surgical intervention chemotherapy to treat the metastasis, follow-up examination revealed stable condition. In clinical practice, accurate differential diagnosis is essential in patients with low back pain and low leg pain, HIVD with radicular pain, and metastatic bone lesions. Detailed patient history and physical and neurological examinations are essential. Further survey for other etiologies is indicated in patients who respond poorly to conservative treatment, particularly those with history of urinary tract cancer.
延伸閱讀
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