Bladder smooth muscle tumors

　　1. Etiology

　　Smooth muscle sarcoma is a malignant tumor composed of smooth muscle cells or mesenchymal cells that differentiate into smooth muscle cells. Its occurrence is related to Epstein-Barr virus infection, and the incidence is higher in patients with HIV virus infection and those who have received organ transplantation.

　　2. Pathogenesis

　　Tumors can occur at any location within the bladder, but are most common at the top and lateral walls of the bladder and around the ureteral orifice. There are also reports of tumors occurring within bladder diverticula. Tumors located in the bladder wall can protrude into the lumen or extraluminal space. Grossly, the sarcoma appears as submucosal nodular or ulcerative masses. The tumor size can reach more than 10 centimeters, and the tumor section shows a fishy texture, with a grayish or gray-red color, tough texture, and common focal hemorrhage or necrosis.

　　Cancer involving the ureteral orifice can cause obstruction, leading to hydronephrosis in the renal pelvis at the obstruction site. In severe cases, due to significantly increased intracystic pressure, glomerular filtration rate may decrease, causing obstruction of creatinine and urea nitrogen excretion, and even leading to renal insufficiency. If infection is present, hematuria may worsen, and symptoms such as frequent urination, urgency, and fever may appear. Patients with persistent hematuria may also develop anemia due to blood loss.

　　1. Gross hematuria and difficulty in urination: Hematuria is mostly gross hematuria, and difficulty in urination progresses progressively, with increased frequency of urination as the bladder capacity decreases.

　　2. Physical examination: Abdominal palpation reveals a solid mass with an irregular surface, hard texture, no tenderness, unclear boundaries, and poor mobility.

　　As the etiology of bladder smooth muscle tumors is not yet fully clear, the preventive methods are mainly:

　　1. Try to reduce infections, avoid contact with radiation and other harmful substances, especially drugs that suppress the immune function;

　　2. Appropriate exercise, enhance physical fitness, and improve their own ability to resist diseases.

　　It is mainly to prevent various factors that may lead to bladder smooth muscle tumors. It is currently believed that the loss of normal immune surveillance function, the tumorigenic effect of immunosuppressants, the activity of potential viruses, and the long-term use of certain physical (such as radiation) and chemical (such as antiepileptic drugs, adrenal cortical hormones) substances can all lead to the proliferation of lymphoreticular tissue, eventually resulting in bladder smooth muscle tumors. Therefore, attention should be paid to personal and environmental hygiene, drug abuse should be avoided, and personal protection should be paid attention to when working in harmful environments.

　　Urine routine examination shows gross hematuria or microscopic hematuria.

　　1. Ultrasound shows an irregular mass shape, with unevenly low echo inside and multiple liquid shadow areas.

　　2. CT shows a solid mass in the bladder area, and enhanced scanning shows obvious enhancement.

　　3. Cystoscopy and biopsy can assist in diagnosis.

　　What foods should bladder smooth muscle tumor patients avoid eating:

　　1. Avoid spicy and hot foods: such as chicken, mutton, dog meat, sparrow meat, eggs, crucian carp, and other kinds of food that cause heat.

　　2. Avoid rich and greasy, sweet foods: such as alcoholic beverages, sugar, and high-fat foods (such as fatty pork, fried pork chop, fried beef chop) and various fried foods.

　　3. Avoid spicy and stimulating foods: such as chili, chili sauce, chili oil, pepper, fennel, mustard, curry, ginger, and various stir-fried dishes with chili.

　　I. Treatment

　　1. Partial resection of the bladder is possible when the tumor is small, and radical cystectomy is performed when the tumor is large or infiltrative.

　　2. Bladder smooth muscle tumors are not sensitive to chemotherapy, and even if combined with chemotherapy or radiotherapy after surgery, the survival rate of patients does not improve.

　　II. Prognosis

　　The malignancy of this disease is high, and the prognosis of high stage or high-grade bladder smooth muscle tumors is poor, most of them die within 3 years of onset. However, there are reports of spontaneous regression of bladder smooth muscle tumors, and adjuvant radiotherapy or chemotherapy does not help much in the prognosis.