膀胱癌肉瘤1例

患者男 ,5 9岁。出现全程血尿半年 ,有大量血块 ,伴尿频、尿急等膀胱刺激症。膀胱检查发现膀胱内有大量菜花状肿物 ,手术见巨大肿瘤位于膀胱三角区 ,约 9ｃｍ× 8ｃｍ大小 ,行膀胱全切及双侧输尿管腹壁造口术。　　病理检查　膀胱呈圆形 ,大小 19ｃｍ× 12ｃｍ× 8ｃｍ ,表面光滑 ,切面见一肿物 ,大小为 9ｃｍ× 7ｃｍ× 2ｃｍ ,无包膜 ,呈灰白色、菜花状 ,可见明显坏死。镜检 :瘤组织有两种结构混合而成 ,大部分瘤细胞呈多角形、圆形 ,核呈卵圆形 ,有异型 ,胞浆较丰富 ,细胞间界限清楚 ,并见棘细胞及角化现象(图 1) ,此类细胞ｋｅｒａｔｉ…     

膀胱癌肉瘤一例

患者男，３６岁。半年前无诱因小便终末带血，量不多，２～３天后症状好转，近１０余天来，症状加重，门诊纤维膀胱镜检查，诊断为膀胱肿瘤，于１９９６年３月２９日收入院。实验室检查：尿红色混浊，白细胞（＋＋）／ＨＰＦ，红细胞（＋＋）／ＨＰＦ，潜血试验强阳性。Ｘ...     

黏液纤维肉瘤3例临床病理分析

目的 探讨黏液纤维肉瘤(myxofibrosarcoma,MFS)的临床病理学特点、免疫学表型及鉴别诊断.方法 对3例MFS进行临床病理学和免疫组化分析,并复习相关文献.结果 2例为男性,1例为女性,年龄分别为63岁、74岁及40岁;2例为左大腿包块,1例发生于头顶部;镜下黏液背景中肿瘤细胞多结节状分布,瘤细胞梭形,其间可见空泡状假脂母细胞和细长弓形血管,3例分别为低度、中度及高度恶性.免疫组化显示瘤细胞除vimentin弥漫强阳性外,MSA、α-SMA、Myoglobin、desmin、S-100、CD34、CD57、CD68、PCK、EMA及Bcl-2均为阴性.结论 MFS是一种纤维母细胞性恶性肿瘤,可以根据病理形态及免疫组化加以诊断及鉴别诊断.     

子宫颈癌肉瘤4例临床病理分析

目的探讨子宫颈癌肉瘤(uterine cervical carcinosarcoma, UCS)的临床、影像学特征、病理学形态、免疫表型及其鉴别诊断和治疗。方法对4例UCS行HE及免疫组化染色,结合文献分析其临床表现、影像学、组织学形态及免疫表型特征,观察分析其治疗和预后。结果 4例患者平均年龄56岁,3例表现为阴道不规则出血,1例为接触性出血;影像学(彩超及CT)均发现实质性肿块;组织学上,4例均见恶性上皮和恶性间叶成分,3例恶性上皮肿瘤细胞呈不规则巢、片状,瘤细胞异型性明显,见丰富嗜酸性或透亮胞质,见灶性角化及单个细胞角化,1例恶性上皮成分呈不规则腺样结构,恶性间叶细胞梭形,伴明显异型,具有肉瘤形态,且有明显的黏液样背景,其中1例间叶成分为软骨肉瘤。免疫表型:所有恶性上皮成分CKpan(+),鳞状细胞癌p63、p40、CK14(+),子宫内膜样腺癌EMA、CK8/18、CK7(+),恶性间叶成分vimentin(+),软骨肉瘤S-100(+)。结论 UCS罕见,临床分期早,预后差。组织学以非角化性鳞状细胞癌+纤维肉瘤/未分化肉瘤成分常见,免疫组化标记对诊断及鉴别诊断有帮助。     

涎腺癌肉瘤临床及病理分析

目的：探讨涎腺癌肉瘤的临床病理学特点及其鉴别诊断。方法：对3例涎腺癌肉瘤患者的临床资料进行回顾性研究并复习相关文献，对全部病例的组织学标本重新进行镜下观察。结果：涎腺癌肉瘤临床表现常为迅速增大的颜面部肿物并伴疼豢。光匀下组织学观察常可见肉瘤和癌两种成分并存，癌多为鳞状细胞癌和腺癌，肉瘤以骨或软骨肉瘤为主。结论：涎腺癌肉瘤的临床特点与涎腺其他恶性肿瘤较难区别，但涎腺癌肉瘤的恶性程度极高。     

子宫癌肉瘤26例临床病理及预后影响因素分析

目的探讨子宫癌肉瘤的临床病理特征及预后影响因素。方法收集1997年1月-2004年12月在复旦大学附属妇产科医院诊治的26例子宫癌肉瘤患者的临床病理资料,进行预后影响因素分析。结果26例患者平均年龄59．5岁,20例（76．9％）患者已绝经,主要症状是异常阴道流血。手术时,21例（80．8％）患者未发现残留病灶,其中10例（47．6％）术后出现复发,平均缓解期为15个月,平均生存时间18个月。26例患者均获得随访,总5年生存率26．5％,中位生存时间（33±7．33）个月,其中临床分期Ⅰ、Ⅱ、Ⅲ、Ⅳ期患者的5年生存率分别为79．1％、37．5％、13．3％、0,且Ⅰ＋Ⅱ期的5年生存率明显高于Ⅲ＋Ⅳ期（P=0．006）。单因素分析显示：肿瘤大小、肌层浸润深度、有无淋巴结转移、有无残留病灶以及临床病理分期均与预后相关。多因素分析显示：临床病理分期是独立的预后影响因素（P=0．035）。结论子宫癌肉瘤是侵袭性肿瘤,易发生子宫外播散、转移。临床病理分期是独立的预后影响因素,提高早期检出率,改进治疗措施对提高子宫癌肉瘤的生存率有重要意义。     

小肠平滑肌肉瘤15例临床病理分析

小肠平滑肌肉瘤１５例临床病理分析１董来华２叶春辉１材料和方法收集绍兴卫校附属医院、绍兴市中医院和绍兴市人民医院１９７８～１９９５年间经手术切除和病理证实的小肠平滑肌肉瘤１５例。全部组织标本均用１０％福尔马林固定，常规脱水，石蜡包埋，每例各取３～５张切...     

肾肉瘤样癌5例临床病理分析

目的：观察肾肉瘤样癌形态特征。方法：５例肾肉瘤样癌进行光镜观察及免疫组化染色。结果：以肉瘤样成分为主３例，血管外皮瘤样为主１例及破骨细胞瘤样巨细胞瘤１例，５例肉瘤样成分角蛋白阳性，４例波形蛋白阳性。结论：肾肉瘤样癌的形态特征为癌细胞具有双重分化，具有向间叶性肿瘤转分化的过渡方式。     

膀胱肉瘤样癌1例

患者女性 ,74岁。因无痛性全程肉眼血尿伴血块 ,不能自行排尿 ,尿憋胀半年余 ,加重 1日入院。Ｂ超示膀胱内可见 4 3ｃｍ× 1 9ｃｍ不均质强回声团块。膀胱镜直视下实施手术。手术中见膀胱壁近膀胱颈部偏右侧可见一 3ｃｍ× 3ｃｍ× 2ｃｍ大小菜花样肿物 ,上有一根小血管向外喷血 ,肿物为广基。用ＬＯＯＰ电切刀将部分肿物切除 ,切除组织送病检。病理检查　眼观 :灰白、灰褐色不整形破碎组织一堆 ,总体积 1 5ｃｍ× 1 0ｃｍ× 1 0ｃｍ ,质地较硬 ,无明显包膜。镜检 :肿瘤组织中有低分化的腺癌成分 ,又可见由梭形和多形异型细胞构成的肉瘤样成…     

原发性膀胱腺癌26例临床病理分析

目的 探讨原发性膀胱腺癌的临床病理特征、诊断及鉴别诊断。方法 对26例确诊原发性膀胱腺癌进行HE、组织化学和免疫组化染色标记。结果 原发性膀胱腺癌的细胞形态、组织结构与其它部位腺癌极其相似,黏液组化及免疫组化染色显示半数以上的肿瘤具有胃肠癌的分化特征。免疫表型：CK7强阳性(18／26),CK20弱阳性(14／26),PSAP阳性(10／26),CEA阳性(21／26),CA19-9阳性(12／26),PSA阴性。结论 膀胱原发性腺癌与膀胱转移性腺癌具有相似的组织学形态,诊断时需排除其它部位腺癌,PSAP、PSA、CK7、CK20标记对鉴别诊断具有重要参考价值。     

Bladder carcinosarcomas: three cases with diverse histogenesis

Carcinosarcomas of the bladder are rare. We describe three such tumours, including an apparently unique case in which the components comprised liposarcoma and poorly-differentiated transitional cell elements. A second example included chondrosarcomatous elements. These two tumours showed architectural and immunocytochemical features which suggested that they had originated as carcinomas but had subsequently differentiated along both epithelial and mesenchymal pathways. The third tumour contained both carcinoma and osteosarcoma and may represent a collision tumour.     

Carcinosarcoma of the urinary bladder

Summary A case of urinary bladder carcinosarcoma (UBCS) is reported with light, immunohistochemical and electron microscopical findings. The tumour consisted of a squamous cell carcinoma, variable spindle cell stromal elements compatible with fibrosarcoma, and rhabdomyoblasts. Intermediate filament co-expression of cytokeratin and vimentin was shown by immunohistochemistry. Electron microscopy (EM) confirmed the nature of the three components, and indicated some similarities between the three cell-types present. Comparisons with the previous UBCS in the literature are made.     

膀胱内翻性乳头状瘤60例临床病理分析

目的探讨膀胱内翻性乳头状瘤(inverted papilloma of the bladder)的临床病理特点、诊断和鉴别诊断。方法复习60例膀胱内翻性乳头状瘤患者的临床、病理及随访资料,采用HE及SP法免疫组化染色并观察分析。结果膀胱内翻性乳头状瘤好发于男性,男女发病之比为5∶1~7∶1,主要临床表现为血尿。全部病例组织学分型为:小梁型47例,腺体型13例。48例随访0·5~8年,无1例复发。40例行免疫组化染色:①p53(-)34例,( )5例,()1例;②PCNA( )22例,()13例,()5例。结论膀胱内翻性乳头状瘤是一种少见的预后好、复发少的良性肿瘤,确诊须排除低度恶性潜能乳头状瘤、尿路上皮癌和内翻性生长的尿路上皮癌。     

Carcinosarcoma with rhabdoid features of the urinary bladder in a 2-year-old girl: possible histogenesis of stem cell origin

A case of carcinosarcoma of the urinary bladder in a 2-year-old girl is reported. The tumor, measuring 34 x 20 x 18 mm, was located in the peri-trigone area of the urinary bladder with polypoid features. Histologic examination revealed transitional cell carcinoma at the tumor surface with downward invasion. Concurrently, a sarcomatous area was found beneath the carcinoma, with these two different malignant components sharing on apparent transition without distinct boundaries. Sarcomatous components included immature round cells focally showing rhabdoid features. No rhabdomyomatous component was observed. Immunohistochemistry disclosed vimentin and cytokeratin-double positive cells at the transposition between carcinoma and sarcomatous components. In addition, ultrastructural analysis revealed that the epithelial cells had a distinct junctional complex, and the sarcomatous cells occasionally had a meshwork of cytoplasmic intermediate filaments, indicating bidirectional cytodifferentiation to epithelial and mesenchymal elements. The extremely young age at which this case of carcinosarcoma occurred suggests that the tumor may be of mesodermal stem cell origin.     

膀胱假肉瘤性肌纤维母细胞增生临床病理分析及文献复习

目的 探讨膀胱假肉瘤性肌纤维母细胞增生的临床病理特征.方法 3例膀胱肌纤维母细胞增生光镜和免疫组化检查.结果 3例均为男性,年龄分别45、46、55岁,主要临床症状为无痛性血尿和排尿困难,无外伤史,随访3～6个月无复发.组织学检查:病变主要由松散排列的梭形细胞区,可见节细胞样细胞和致密条束状梭形细胞区,黏液样间质内弥漫分布急慢性炎细胞.分裂象3～5/10 HPF,无不典型核分裂.病变主要发生在膀胱壁浅层,病变累及固有肌,出血明显.免疫表型:3例梭形细胞Vim和SMA弥漫阳性,MSA2/3例+>70%、Des+50%、CK+>70%、EMA+30%、ALK-1蛋白+70%、Ki-67+5%～20%、CD68、S-100蛋白、CD34均-.结论 膀胱假肉瘤性肌纤维母细胞增生为一种良性非肿瘤性病变,复发率4.5%,要避免误诊为恶性.     

Glandular lesions of the urinary bladder:clinical significance and differential diagnosis

Williamson S R, Lopez‐Beltran A, Montironi R & Cheng L
(2011) Histopathology  58 , 811–834
Glandular lesions of the urinary bladder: clinical significance and differential diagnosis A variety of glandular or pseudoglandular lesions may be seen in the urinary bladder, ranging from those that are entirely benign to aggressive‐behaving malignant primary and secondary tumours. Lesions with minimal to no evident premalignant potential include several proliferative and reactive processes, such as cystitis cystica and cystitis glandularis, although the possibility exists for confusion of such lesions with an infiltrative neoplasm, particularly in limited biopsy specimens. Similarly, ectopic tissues of Müllerian origin may be seen occasionally in the urinary bladder and their differentiation from a true glandular neoplasm is important to avoid improper treatment. As urothelial carcinoma has a propensity for divergent differentiation, a wide spectrum of morphological variants exists with varying degrees of glandular differentiation. Some such variants have demonstrated clinical behaviour that is more aggressive than their histology would suggest, thus deserving recognition and potentially different treatment. In this paper, we review the glandular lesions of the urinary bladder ranging from benign proliferative processes to malignant primary and secondary neoplasms, with emphasis on clinical significance and features useful in resolving their differential diagnoses.     

Micropapillary variant of urothelial carcinoma of the urinary bladder; a clinicopathological and immunohistochemical study

AIMS: To investigate whether prognosis in micropapillary urothelial carcinoma is related to the proportion of the micropapillary component (MPC), and to identify the immunohistochemical features of MPC. METHODS AND RESULTS: This study presents a clinicopathological analysis of 20 patients with micropapillary urothelial carcinoma of the bladder with cystectomy specimens for evaluation. Tumours were stratified on the extent of MPC: focal, <10%; moderate, 10-50%; extensive, >50%; and this was correlated with tumour stage and prognosis. Sixteen males and four females were aged 56-81 years (mean 69 years). All cases had high-grade morphology in the micropapillary carcinoma and typical urothelial carcinoma. All cases with extensive MPC (n = 4) were of a high pathological stage (pT3 or pT4) and died of disease (DOD) or other causes. Eighty percent with moderate MPC (eight of 10 cases) were pT3 or pT4 and 50% DOD or are alive with disease. Eighty-four percent with focal MPC (five of six cases) were pT1 or pTa. In high-stage cases, the most invasive component was MPC. High-stage cases had an 85% risk of being advanced at presentation with micropapillary carcinoma. All pT2 or lower stage cases had micropapillary carcinoma on prior transurethral resections of bladder tumour (TURB). High-stage carcinomas had 30% and 54%, respectively, of surface MPC and urothelial carcinoma in situ, in comparison with 85% and 28% in lower stage carcinomas. Immunohistochemical staining was similarly positive in MPC and typical urothelial carcinoma with cytokeratin (CK)7, CK20, epithelial membrane antigen, carcinoembryonic antigen and cytokeratin 34betaE12. CA125 staining was seen only in MPC in 43% of cases. CONCLUSIONS: Micropapillary urothelial carcinoma is a high-grade carcinoma in which the prognosis is related to the proportion and location of the MPC. Cases with moderate or extensive MPC are at high risk of being advanced at presentation. Cases with <10% MPC and surface MPC have a high chance of detection at an early stage. The morphology and immunohistochemical profile of the MPC suggest that it is a form of glandular differentiation in urothelial carcinoma.     

Carcinosarcoma of the urinary bladder: Expression of epithelial markers and different expression of heat shock proteins between epithelial and sarcomatous elements

A case of carcinosarcoma composed of both adenocarcinoma and saarcomataus elements in the non-trigone region of the urinary bladder is presented. The epithelial element was a well to pooriy differentiated adenocarcinome with focal squamous metaplasia. The sarcomatous elements disclosed spindle cell sarcoma with focal epltheliold pattern and myxold change In the stroma, together with chondrosarcomatous and rhabdomyosarcomatous elements. By Immunohistochemical examination, not onty the carcinoma element but also the sarcomatous elements showed a positive lmmunoreaction for cytokeratin (CK), epithelial membrane antigen (EMA) and carcinoembryonic antigen. Some population of sarcomatous elements expressed smooth muscle actin and muscle specific actin (MSA) and a limited portion of epitheliold area showed a positive Immunoreaction for desmin, MSA and myoglobin, Indicating leiomyosarcomatous and rhabdomyosarcomatous differentiation, respectively. Unexpectedly, tumor cells In the chondrosarcomatws element revealed a simultaneous positvity of CK and EMA as well as S-100 protein. Both epithelial and sarcomatous elements showed an Intensive positive Immunoreaction for p53 and heat shock protein (HSP) 70. However, HSP27 and HSPGO were detected in most epitheilal elements and only in a small number of tumor cells in the sarcomatous area. These findings indicate that sarcomatous elements, Including heterologous elements, may derive from epithelial elements with partial or complete loss of epithelial features, and different factors other than p53 and HSP7O may associate wtth the morphological alteration of carcinoma.