Clinical Analysis Of Inflammatory Myofibroblastic Tumor Of Urinary Bladder

ObjectiveThrough analysis and research on clinical data of patients with bladder inflammatory myofibroblastoma,in order to improve the understanding of bladder inflammatory myofibroblastoma,discuss the diagnosis and treatment process of bladder inflammatory myofibroblastoma,and provide a certain basis for clinical diagnosis and treatment.MethodsIt is planned to retrospectively analyze patients diagnosed with bladder inflammatory myofibroblastic tumor in the First Affiliated Hospital of Zhengzhou University from January 2010 to December 2019,collect clinical data of patients,and analyze their first symptoms,clinical manifestations,laboratory Analysis of tests,imaging studies,diagnostic methods,pathology and immunohistochemistry,treatment and prognosis.ResultTwelve patients were selected,including 7 males and 5 females,with a male to female ratio of 1.4:1.The age of onset ranged from 15 to 57 years old.Most patients had hematuria(75%),lower urinary tract symptoms(58.3%)and abdominal pain(33.3%)as the first symptom.The initial diagnosis accuracy was low.Auxiliary examinations(color Doppler ultrasound,CT,magnetic resonance,cystoscopy,etc.)often indicate that the tumor is locally invasive,imaging often shows malignant tumorss suggesting solid occupancy in the bladder,the lesions can be seen on each wall of the bladder,and the tumor size varies The shape varies from 0.6cmx1.5cmx2.1cm to 2.5cmx5.1cmx6.9m,10 cases are single lesions,and 2 cases are multicentric lesions.Color Doppler ultrasound and CT showed that there may be blood flow signals in the tumor body.The low density is uniform or non-uniform.Some lesions invade the bladder deep and layers,and the boundary is blurred.CT enhanced scanning of some tumors showed a phenomenon of"fast-in and slow-out",which is a sign distinguished from other bladder malignant tumors.Under cystoscopy,the mass was cauliflower-like,clump-shaped,or polypoid.There were blood vessels or ulcers on the surface,the base was wide,and the surrounding mucosa was edema.Pathological biopsy of 8 patients showed that 4 cases were bladder spindle cell tumors,2 cases were diagnosed with IMTUB,1 case was chronic mucosal inflammation with bleeding,and 1 case showed bladder epithelioid tumor,which tended to be malignant.The preoperative biopsy diagnosis rate is only 25%,which is related to the diverse and overlapping histological types of tumors,and some tumors are hidden in the bladder muscle layer.All patients underwent general anesthesia surgery:6 patients underwent transurethral resection of bladder tumors,6 patients underwent partial bladder resection,the patients' symptoms disappeared within 1 week after the operation,and no obvious surgical complications occurred after the operation.All patients improved and were discharged.The average hospital stay was 9 days(6-13 days).Without considering the long-term recurrence,a single transurethral resection of bladder tumors was superior to the bladder in terms of length of operation,intraoperative blood loss,and postoperative recovery.Patients with partial resection.The disease was diagnosed by postoperative pathology combined with immunohistochemistry.The postoperative pathological specimens showed negative cut margins,which were roughly round or irregularly lobulated with naked eyes,and the tissues were grayish white,grayish yellow,or grayish red.There was no obvious necrosis and calcification;the spindle-shaped tumor cells were bundled,braided or scattered under the microscope,and inflammatory cells such as plasma cells,lymphocytes and eosinophils were scattered in the background.Immunohistochemistry tips:Immunohistochemistry showed:anaplastic lymphoma kinase ALK(+)(8 cases 66.67%),vimentin Vimentin(+)(12 cases 100%),smooth muscle antibody SMA(+)(11 cases 91.67%),Cytokeratin CK(+)(80%in 8 cases),S-100(-)(100%in 12 cases),CD117(-)(100%).Among them,FISH detection ofALK gene breakage has high specificity,which is helpful for rapid identification with bladder malignant tumors.All patients were reviewed for color Doppler ultrasound after operation.Color Doppler ultrasound indicated that there was no abnormality in the bladder.Eight patients underwent postoperative cystoscopy:there were surgical scars in the bladder and no tumor recurrence.Telephone follow-up,3 patients complained of occasional dysuria,frequent urination,and lower abdominal pain;the remaining patients did not complain of discomfort.The symptoms of surgical treatment disappeared and the effect was satisfactory.The shortest follow-up time was 6 months and the longest was 88 months.All patients had no recurrence and distant metastasis,and no tumor survived.ConclusionIMTUB is an intermediate type tumor with malignant potential.It is rare in clinical practice.Clinical manifestations and imaging studies tend to suggest malignant lesions,which are easily misdiagnosed as bladder malignant tumors.Pathology combined with immunohistochemistry is the standard for the diagnosis of this disease.Surgical treatment is the first choice.Both TURBT and partial bladder resection are effective.The patient has a good prognosis,but the possibility of long-term recurrence and metastasis is not ruled out.Regular reexamination is still recommended after surgery.