- 期刊
Vaginal Cancer Complicated with Obstructive Uropathy-A Case Report
陰道癌合併電療及化療併發阻塞性腎病變－個案報告
摘要
目的： 報告一少見型陰道癌因行合併電療及化療而併發阻塞性腎病變。 病例報告： 一位56歲女病人，G2P2，在10年前因子宮腺肌症及嚴重子宮內膜異位症已接受子宮及兩側輸卵管卵巢切除，最近因陰道出血求診而被診斷為陰道癌。我們內診發現其陰道壁有小塊腫瘤併出血，而陰道超音波及電腦斷層顯示在陰道斷端向腹腔內長有一約3公分複雜腫塊。腫瘤指數皆正常。手術發現腫瘤與膀胱及直腸沾粘厲害，於是做部份腫瘤切除及兩側淋巴腺摘除。病理報告為線癌及淋巴腺轉移。在手術後追加電療及化療時不幸造成嚴重腹瀉及血尿進而併發阻塞性腎病變。 結論： 大多數的陰道癌是由轉移而來。這個個案為原發性腺癌，因腫瘤位置及治療過程中對追加的電療及5316療過度反應而併發阻塞性腎病變。
並列摘要
We report a rare type of vaginal malignancy and its complication after chemoradiation. A 56-year-old female, G2P2, post-hysterectomy and bilateral salpingoophorectomy 10 years ago due to adenomyosis and severe endometriosis, visited our department for persisted vaginal spotting. Pelvic examination showed multiple nodules with touched bleeding over the upper third of the vagina and biopsy showed malignancy. During operation, there was a fixed solid mass noted over the apex of the vaginal cuff. Besides, lymphadenopathy was noted over the left internal and obturator area. Staging surgery and partial tumor excision was done. The final pathological report showed poorly differentiated adenocarcinoma with lymph nodes (LNs) metastasis. Unfortunately, severe radiation hemorrhagic cystitis and diarrhea occurred on the 3(superscript rd) week of concurrent chemoradiation. Bilateral percutaneous nephrostomy were done due to obstructive uropathy. Although metastatic tumor is the most common malignancies in vagina, the case we present here is a primary vaginal adenocarcinoma, complicated by severe ureteral stricture, hemorrhagic cystitis and obstructive uropathy, which were caused by the chemoradiation.