Bladder grape-like sarcoma

　　1. Etiology

　　The etiology is not clear and may be related to certain genetic factors.

　　2. Pathogenesis

　　According to the tissue structure, cell morphology, and molecular level of the tumor, it is often divided into 3 types:

　　1. Embryonal rhabdomyosarcoma (RMS), the most common type, accounting for about 50%, mostly occurs in infants and young children under 3 years old. Grossly, the tumor has unclear boundaries, is grayish-white, and has a soft texture. RMS under the bladder mucosa often forms polypoid masses, resembling a cluster of grapes, also known as grape-like sarcoma. Under the microscope, it can be seen that there are myoblasts at different stages of development, well-differentiated ones show a large number of cytoplasmically red-stained striped myoblasts, and striations can be seen. At the molecular level, there is often a heterozygous deletion in the 11p15 region.

　　2. Alveolar rhabdomyosarcoma (alveolar RMS), less common, accounting for 30%. It often occurs during two peaks at the ages of 3 and 15, and it has a poor response to chemotherapy. Under the microscope, it mainly consists of relatively primitive rhabdomyoblasts, with tumor cells being round or oval. The tumor cells are often divided into nests and acinar shapes by irregular fibrous septa, and there are often chromosomal translocations at the molecular level, such as t(2;13)(q35;q14) and t(1;13)(p36;q14).

　　3. Pleomorphic rhabdomyosarcoma (pleomorphic RMS), rare, mostly occurs in adults, with males being slightly more common. Under the microscope, the pleomorphism of rhabdomyoblasts is very obvious, and nuclear division is frequent. It mainly affects the limbs and has a poor prognosis.

　　1. Multiple neurofibromatosis: It is an autosomal dominant genetic disease caused by a disorder in ectodermal and mesodermal tissues. It is characterized by multiple systems and organs involved, with the central nervous system being most prominent.

　　2. Basal cell nevus syndrome: It is the most common type of skin cancer, with a high incidence rate, accounting for the first place among eyelid malignant tumors (more than 50%).

　　3. Adenoma: Adenoma disease is a chronic pulmonary tumor infection caused by a virus. It is characterized by progressive weight loss, dyspnea, moist cough, watery nasal discharge, and the formation of gland-like tumors in the lungs.

　　4. Other complications: neurocutaneous melanoma.

　　1. Hematuria and difficulty in urination are the main manifestations, often accompanied by dysuria, frequency, and short-term progression to urinary retention.

　　2. Palpable mass can be felt above the pubic symphysis, and anemia and hydronephrosis may occur in the late stage.

　　Since the etiology of patients with bladder papillary sarcoma is not yet fully clear, the methods of prevention are not much different:

　　1. Minimize infection and avoid contact with radiation and other harmful substances, especially drugs that suppress the immune function;

　　2. Engage in appropriate exercise to enhance physical fitness and improve one's ability to resist diseases.

　　It mainly focuses on preventing various factors that may lead to bladder papillary sarcoma. It is currently believed that the loss of normal immune surveillance function, the tumor-promoting effect of immunosuppressants, the activity of potential viruses, and the long-term use of certain physical (such as radiation) and chemical substances (such as antiepileptic drugs, adrenal cortical hormones) can all lead to the proliferation of lymphoreticular tissue, ultimately resulting in bladder papillary sarcoma. Therefore, attention should be paid to personal and environmental hygiene, avoiding drug abuse, and personal protection in harmful environments.

　　Urinalysis may show gross hematuria or microscopic hematuria.

　　The most common site for tumor examination by cystoscopy is the bladder trigone area. Tumors may appear polypoid, with a mucinous appearance, often occurring multifocally and projecting into the bladder lumen in a cluster of grapes-like, semi-transparent shape. Tumors can fill the entire bladder lumen, hence it was also called grape cluster sarcoma.

　　2. Ultrasound, CT, and MRI scans can clearly identify bladder space-occupying lesions and are conducive to the clinical staging of tumors. Ultrasound often shows mixed echo areas within the bladder; CT shows mixed density clusters, typically in grape-like clusters.

　　1. The diet should focus on light and nutritious food. Eat more vegetables (such as cabbage and cauliflower), radishes, sour plums, soybeans, beef, mushrooms, asparagus, coix seed, and other foods containing anticancer substances. Fruits, milk, and turtle are rich in various amino acids, vitamins, proteins, and easily digestible tonifying foods.

　　2. Tumor patients have high energy consumption, so their diet should be 20% more than that of normal people in terms of protein.

　　3. Eat less greasy and heavy foods; eat less dog meat, lamb, and other warm-nourishing foods; eat less shellfish, bamboo shoots, taros, and other allergenic foods that are easy to cause allergies; eat less drinks and snacks containing chemicals, preservatives, and additives. Avoid over-acid, spicy, salty, and stimulating substances such as alcohol and tobacco.

　　I. Treatment

　　1. According to the location, size, and infiltration range of the tumor, local tumor resection, partial resection or total resection of the bladder can be performed, followed by adjuvant radiotherapy after surgery. Due to the poor effect of local surgical treatment, it is emphasized to perform radical total cystectomy including the prostate early.

　　2. Chemotherapy can be used as adjuvant treatment before and after surgery, and for those who cannot undergo surgery or palliative surgery, chemotherapy becomes the main treatment method. Commonly used drugs include vincristine, actinomycin D, doxorubicin, cyclophosphamide, etc. Chemotherapy can significantly improve the efficacy after surgery.

　　3. The role of radiotherapy is not clear. Some people advocate high-dose radiotherapy, but its complications should not be ignored. The recommended dose is 40-60 Gy of radiation to the pelvic lymph node region.

　　II. Prognosis

　　The malignancy of bladder rhabdomyosarcoma is very high. In the past, due to the lack of effective treatment methods, the survival rate of patients was low. In recent years, due to the development of chemotherapy and radiotherapy, the survival rate of patients has been improved. Currently, the treatment principle is to start with chemotherapy, followed by surgical treatment, complete resection followed by chemotherapy, 3-4 times of chemotherapy per year; for those with visible tumor remnants, adjuvant chemotherapy and radiotherapy are recommended, with a long-term survival rate of 54% to 75%.