膀胱低级别平滑肌肉瘤一例报告并文献复习

doi:10.3877/cma.j.issn.1674-3253.2026.02.016

目的

报告1例膀胱低级别平滑肌肉瘤，总结临床诊疗经过和复习相关文献，讨论膀胱平滑肌肉瘤的诊断和治疗方法，提高对本病的认识。

方法

回顾性分析1例南方医科大学第三附属医院接诊的膀胱低级别平滑肌肉瘤，患者为35岁男性，因"反复尿频尿急尿痛1周余"入我院。完善影像学资料及膀胱镜肿瘤活检术，病理考虑诊断为膀胱低级别平滑肌肉瘤。

结果

经综合考虑后行膀胱部分切除术，术后病理证实为膀胱低级别平滑肌肉瘤，免疫组化示SMA（+）、Desmin（+）、IMP3强阳性，切缘阴性。术后顺利出院，未出现漏尿。随访2年，患者肿瘤未复发。

结论

膀胱平滑肌肉瘤是临床罕见的恶性肿瘤，总体侵袭性强，预后不佳，治疗多以手术为主，高级别膀胱平滑肌肉瘤以根治性切除术为主，术后辅以放化疗；低级别且肿瘤较小可行膀胱部分切除术，手术要注意保证肿瘤外2~3 cm甚至以上切缘阴性。

关键词: 膀胱肿瘤, 平滑肌肉瘤, 膀胱部分切除术

Objective

To report a case of low-grade leiomyosarcoma of the bladder, summarize the clinical diagnosis and treatment process and review relevant literature, then discuss the diagnosis and treatment of bladder leiomyosarcoma to improve the understanding of this disease.

Methods

A 35-year-old male patient with low- grade leiomyosarcoma of bladder admitted to Third Affiliated Hospital of Southern Medical University was analyzed retrospectively. He presented with " urinary frequency, urgency, and dysuria for more than one week". The imaging examinations and cystoscopic tumor biopsy were performed, and the pathological diagnosis was low-gradeleiomyosarcoma of the bladder.

Results

After comprehensive consideration, the patient underwent partial cystectomy. Postoperative pathology confirmed low-grade leiomyosarcoma of the bladder. Immunohistochemistry showed that SMA(+), Desmin(+), IMP3 was strongly positive, and the incision margin was negative. The patient was discharged without urine leakage. After two-year follow-up, the patient showed no tumor recurrence.

Conclusions

Leiomyosarcoma of the bladder is a rare malignant tumor with highly invasive and poor prognosis generally. The primary treatment is surgery. Radical resection is the main treatment for high-grade leiomyosarcoma of the bladder, followed by radiotherapy and chemotherapy. Partial cystectomy is feasible for low-grade and small tumors. During surgery, it is crucial to obtain a negative surgical margin of at least 2-3 cm around the tumor.

Key words: Bladder tumor, Leiomyosarcoma, Partial cystectomy

图1 膀胱低级别平滑肌肉瘤患者术前影像注：图a为全腹CT示膀胱右前下壁增厚，可见一软组织肿块影突向腔内，呈宽基底与膀胱壁相连，大小约4.2 cm×1.6 cm×3.3 cm，其内密度欠均（箭头示）；图b为盆腔MRI示膀胱右前壁不规则增厚并软组织肿块影，肌层欠连续，可见斑片状高信号影，DWI可见弥散受限，范围约1.4 cm×3.5 cm（箭头示）

图2 膀胱低级别平滑肌肉瘤术后病理注：图a为膀胱平滑肌肉瘤大体标本；图b~c为膀胱平滑肌肉瘤光镜下观察（HE染色，×100），可见大量梭形细胞排列成束，核异型（箭头示）；图d示免疫组化染色（SMA+）

图3 膀胱低级别平滑肌肉瘤患者术后2个月腹部影像注：图为术后全腹CT示膀胱充盈可，原右前下壁软组织肿块影未见显示，相应部位膀胱壁稍增厚、毛糙，术区未见异常密度影及异常强化灶

图4 膀胱低级别平滑肌肉瘤患者术后1年和2年盆腔影像注：a~b为患者术后1年盆腔MRI示未见肿瘤复发，c~d为患者术后2年盆腔CT示大致同前，建议随诊

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Low-grade leiomyosarcoma of the bladder: a case report and literature review

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Low-grade leiomyosarcoma of the bladder: a case report and literature review