膀胱内翻生长型尿路上皮癌临床病理分析

目的探讨膀胱内翻生长型尿路上皮癌的临床病理表现、诊断和鉴别诊断要点。方法对4例膀胱内翻生长型尿路上皮癌的临床资料、病理学表现、免疫组化表型和术后随访情况进行分析并复习文献。结果①4例内翻生长型尿路上皮癌患者临床表现无特异性,全程无痛性肉眼血尿及尿痛伴排尿乏力为主要症状,或于影像学检查时偶然发现膀胱占位性病变。②病理学检查肿瘤呈灰白色息肉状或菜花状;镜下见肿瘤细胞呈内翻性生长,局灶可见外生性乳头成分,上皮条索较粗且宽度不一,实性上皮巢不规则增生,瘤细胞具有一定的异型性,容易查见核分裂。③免疫组化仅1例内翻生长型尿路上皮癌CK20弱阳性表达,尤其在表面增厚的尿路上皮呈全层表达;Ki-67和p53在4例内翻生长型尿路上皮癌中的阳性表达细胞数分别为1%～4%和10%～50%。④术后随访,4例患者至今仍无瘤健在。结论内翻生长型尿路上皮癌是较为少见的膀胱恶性肿瘤,病理诊断主要需与内翻性乳头状瘤鉴别,免疫组化标记及荧光原位杂交有助于明确诊断。

Clinicopathologic analysis of urothelial carcinoma with an endophytic growth pattern

Objective To investigate the clinicopathologic features of urothelial carcinoma with an endophytic growth pattern. Methods The clinical data,pathologic characteristics,immunophenotype and postoperative follow-up of 4 cases of urothelial carcinoma with an endophytic growth pattern were analysed,and available literatures were reviewed. Results There were no specific findings in clinical manifestation of the 4 cases of urothelial carcinoma with an endophytic growth pattern.The present symptoms were illustrated as painless gross haematuria,odynuria accompanied by urination fatigue,and occupying lesion of bladder detected incidentally.Grossly,the mass showed an appearance like polyp or cauliflower.Microscopically,it was characterized by tumour cells with an endophytic growth pattern,and exophytic papilla could be found focally.Urothelial carcinoma with an endophytic growth pattern exhibited thick columns and varying width of the cords.Proliferative solid epithelial nests were irregular,and both cytologic atypia and mitosis were easily observed.Immunohistochemistry detection revealed that CK20 was weakly positive in only one case,especially in the whole superficial incrassate urothelium.Ki-67 and p53 positively stained 1% to 4% and 10% to 50% nuclei of the tumor cells in total 4 cases.All of the four postoperative patients remained well till now. Conclusions Urothelial carcinoma with an endophytic growth pattern was a rare malignant tumor of bladder.It’s necessary to distinguish this tumour from inverted papilloma.Immunohistochemistry staining and fluorescence in situ hybridization were helpful to establish the precise diagnosis.