唔好意思,雖然你係醫生,但有唔少位我係想修正。
首先,樓主個醫生睇完病理報告彈去婦科而唔係繼續泌尿科,斷估係婦科腫瘤相關,唔似腎走落去嘅Renal Cell Carcinoma。推理如下﹕
1. 如果係由腎轉移過去的話個病理報告會著RCC+, CA9+, PAX8+, etc.; 如果係由子宮轉移,Cervix的話會著p16, PAX8+, Uterus會著ER+, PAX8+; 佢咁肯定彈過婦科好可能係睇完病理報告後發現冇著RCC+, CA9+; 同埋個病理報告實會寫清楚個histology個type, 譬如Squamous & Adenocarcinoma etc., RCC主要嘅type係Clear Cell or Non-clear Cell; 同婦科腫瘤係有分別,相信病理報告會寫好清楚,而主診醫生應該都唔會唔識分或搞錯;
2. 跟據UpToDate所講,"
Secondary tumors account for approximately 15 percent of malignant bladder tumors. Cancers extending from the colon or rectum, prostate, and uterine cervix are most common and are most frequently identified in the bladder neck and trigone. Metastatic lesions from melanomas and stomach, breast, and lung cancers are less frequent." 當中只提到大概率係子宮頸癌有較大概率轉移過膀胱,但冇提及腎轉移膀胱。所以傾向相信係子宮轉移而非腎。
其次,子宮癌的話唔止adenocarcinoma;而膀胱原生癌亦唔只Transitional Cell Carcinoma.
子宮分子宮頸癌同子宮內膜癌
子宮頸癌 70-80%係Squamous, 20-25%係Adenocarcinoma , 仲有Adenosquamous, glassy cell, carcinoid, neuroendocrine, small cell...
子宮內膜癌 Endometrioid 80%, Papillary Serous 5-7%, Clear cell 3%, 仲有viloglandular, secretory....
而膀胱原生癌亦唔只Transitional Cell Carcinoma, 事實上有兩個分支,Urothelial Cancer (Transitional Cell Carcinoma) & Non-Urothelial Cancer (Squamous cell, Adenocarcinoma, Small Cell, Sarcoma...), 見圖
再根據上述嘅推理,Urothelial似乎係可以排除(因為樓主醫生彈去婦科),樓主媽嘅相對可能嘅係Bladder Cancer入面嘅Non-Urothelial Cancer. 咁究竟會係子宮頸癌定係子宮內膜癌?我睇子宮頸癌嘅概率相對高,因為只有子宮頸癌係有同Non-Urothelial Cancer嘅相對應轉移(Squamous & Adenocarcinoma),但子宮內膜癌係冇相對應嘅轉移。