Urothelial Cancer With Occult Bone Marrow Metastases and Isolated Thrombocytopenia.
Urothelial Cancer With Occult Bone Marrow Metastases and Isolated Thrombocytopenia.
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具有隐匿性骨髓转移和孤立性血小板减少症的尿路上皮癌。
DOI：
10.1016/j.eucr.2015.01.007
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发表时间：
2015
影响因子：
0.5
通讯作者：
Mehra,Rohit
中科院分区：
文献类型：
--
作者：
Alva,Ajjai;Davis,Elizabeth;Chinnaiyan,ArulM;Dhanasekaran,Saravana;Mehra,Rohit
膀胱癌临床上很少表现为弥漫性骨髓浸润的骨髓增生异常，尤其是在没有可检测到的骨转移的情况下。一个75岁的男子提出了新诊断的膀胱尿路上皮细胞癌。经尿道膀胱肿瘤切除术的病理显示肌肉浸润性疾病。治疗前影像学检查（包括腹部/骨盆CT、CXR和骨扫描）显示与转移性疾病相关的肝脏病变，但无骨骼转移。值得注意的是，实验室检查发现孤立性血小板减少症、高钙血症和急性肾损伤，导致住院治疗。血液学检查包括骨髓穿刺和活检显示尿路上皮癌弥漫性浸润骨髓。该病例说明了对临床局限性尿路上皮癌患者进行根治性手术前充分调查其他无法解释的临床结果的重要性。
Bladder cancer rarely presents clinically with a myelophthisic picture from diffuse bone marrow infiltration especially in the absence of detectable skeletal metastases. A 75-year old man presented with newly diagnosed urothelial cell carcinoma of the bladder. Pathology from transurethral resection of bladder tumor demonstrated muscle-invasive disease. Pre-therapy imaging including CT abdomen/pelvis, CXR and bone scan demonstrated liver lesions concerning for metastatic disease but no skeletal metastases. Labs were notable for isolated thrombocytopenia, hypercalcemia and acute kidney injury prompting hospitalization. Hematologic work-up including bone marrow aspiration and biopsy revealed diffuse infiltration of the bone marrow by urothelial cancer. The case illustrates the importance of fully investigating otherwise unexplained clinical findings in patients with clinically localized urothelial cancer prior to curative intent surgery.