多發性泌尿上皮癌與罕見食道轉移

Multifocal Urothelial Carcinoma with Esophageal Stenosis and Mimicking Esophageal Cancer Observed by Chest-abdomen Computed Tomography: A Case Report and Literature Review

食道轉移本身較為少見，而泌尿道上皮癌鮮少轉移至食道，大多數都是轉移到肺部、肝臟及骨頭。因此當我們面對轉移到食道的泌尿道上皮癌時，我們對於這種少見的情形治療選擇較為有限。這裡我們分享一個多發性泌尿道上皮癌且經歷過腎切除、經尿道膀胱鏡切除膀胱腫瘤手術、及膀胱內化療，且經系統性化療仍然復發之個案。復發後我們使用免疫療法其病灶有不同的反應，肺部轉移病灶有縮小但是食道轉移卻發生了，且伴隨著吞嚥困難的症狀，因此我們輔助以MVAC的化學療法及放射治療，並達到縮小食道轉移及吞嚥困難症狀的效果。因此即便文獻指出化療後復發的泌尿上皮癌對於免疫療法有很好的反應，但在食道轉移這樣的少見狀況，免疫療法可能對部分病灶有效但對於食道病灶可以輔以化學療法以及放射治療。

Urothelial carcinoma arises from transitional cells in the urothelial tract. To the best of our knowledge, the common distant metastasis locations of urothelial carcinoma include the lungs, liver, and bones. However, esophageal metastases are rare, with limited treatment choices. The most common primary cancer with esophageal metastases is lung cancer (45.5%), followed by breast cancer (12.5%) and gastric neoplasms (11.6%) (in order of proportion of all esophageal metastases) (1). The most common clinical symptom of esophageal metastasis is dysphagia (1, 2). Palliation of dysphagia can improve quality of life and avoid malnutrition. We describe a case of esophageal metastasis from advanced urothelial carcinoma treated with nephrectomy, transurethral resection of bladder tumor (TURBT), and intravesical chemotherapy, but with disease progression and multiple pulmonary metastasis even after chemotherapy with carboplatin and gemcitabine. Subsequently, there was a mixed response to immunotherapy in which the pulmonary metastatic lesions regressed but metastasis to the esophagus occurred. Esophageal metastasis is a rare site of distant metastasis for urothelial carcinomas. It is important to consider the possibility of a mixed response of the metastatic lesions of urothelial carcinoma in cases where patients receive immunotherapy with pembrolizumab despite a higher response rate than chemotherapy. Radiotherapy could be an option because esophageal metastasis is advanced urothelial carcinoma.