Carcinoma de célula pequeña neuroendocrino de vejiga. Revisión de la literatura y presentación de un caso.

OBJECTIVE: A case of small cell neuroendocrine carcinoma of the urinary bladder is described. Treatment was by transurethral resection of the bladder tumor in two steps and adjuvant chemotherapy with cisplatin (CDDP) plusetoposide (VP-16) and radiotherapy. To date, 152 cases have been reported. The literature on this type of lesion is reviewed METHODS/RESULTS: A 54-year-old male was referred to our Service with a complaint of gross hematuria. The radiologic examination showed a lesion on the right aspect of the bladder, close to the bladder neck. Urethroscopy revealed a non-papillary broadbased tumor involving the right lateral wall. TUR of the bladder tumor was performed and an initial diagnosis of small cell neuroendocrine carcinoma was made. Complementary studies showed no widespread disease. The patient refused major open surgery and accepted treatment planning at the preoperative diagnosis of T 2 - 3 N 0 M 0 as described above. The patient remains disease-free 28 months after the operation. We also report our experience in a patient free of disease diagnosed at stage pT 3 B N 0 M 0 and 84 months' follow-up, treated with partial cystectomy and adjuvant M-VAC chemotherapy. CONCLUSIONS: Small cell neuroendocrine carcinoma is an uncommon, usually aggressive neoplasia of the bladder. Patients that are treated have a median survival of 13 months. Cisplatin-based chemotherapy appears to be the only factor associated with a better survival. Relationship between clinical stage and survival has not been demonstrated, which suggests that micrometastatic disease is usually present at presentation in clinically localized tumors and systemic metastases are the major cause of mortality. We believe that partial cystectomy with adjuvant chemotherapy is a valid procedure in favorable cases that allows preservation of the bladder and a high quality of life.