膀胱肿瘤组织学分类

1膀胱上皮性肿瘤1．l良性1．1．l尿路上皮（移行细胞）乳头状瘤1．1．2尿路上皮（移行细胞）乳头状瘤,内翻型1．1．3鳞状细胞乳头状瘤1．1．4绒毛状腺瘤1．2乳头状尿路上皮（移行细胞）瘤形成伴低度恶性潜能1．3恶性肿瘤1．3．l尿路上皮（移行细胞）癌1．3．1．l乳头状尿路上皮（移行细胞）癌1．3．1．2浸润性尿路上皮（移行细胞）癌1．3．1．3尿路上皮（移行细胞）原位癌1．3．1．4非典型增生／结构不良l．3．1．5各种不同的尿路上以（移行细胞）癌1．3．2鳞状细胞癌1．3．2．l疣状癌1．3．3腺癌,非脐尿管型l·3．4脐尿管型癌1．3．5透明…     

膀胱癌的术前放疗

泌尿系中的恶性肿瘤膀胱癌为第一位,95％的膀胱癌为移行细胞癌,因此本文着重讨论膀胱移行细胞癌。绝大多数浸润性膀胱移行细胞癌是高分级的,具有进展和远处转移的危险。目前浸润性膀胱移行细胞癌的标准术式仍是根治性膀胱全切术,单纯手术治疗后总的5年生存率约为50%。本文回顾性分析了术前放疗治疗浸润性膀胱移行细胞癌治疗中的应用价值。     

术后单次与多次膀胱灌注丝裂霉素C预防非肌层浸润性膀胱癌复发的效果比较

目的比较非肌层浸润性膀胱癌行经尿道膀胱肿瘤电切术（transurethral resection of bladder tumors,TURBT）术后即刻单次与术后1周开始多次膀胱灌注丝裂霉素C预防非肌层浸润性膀胱癌复发的效果。方法将67例行TURBT术术后的非肌层浸润性膀胱癌患者按随机数字表法分为2组。单次灌注组34例,采用丝裂霉素C 40 mg加入生理盐水40 mL中行TURBT术术后即刻膀胱灌注,共1次。多次灌注组33例,采用丝裂霉素C40 mg加入生理盐水40 mL中在TURBT术术后1周行膀胱灌注,每周1次,共8次。随后每个月1次,共22次。观察2组患者术后3年非肌层浸润性膀胱癌的复发,以及病理学分级为G1、G2＋G3非肌层浸润性膀胱癌的复发等情况。结果单次灌注组、多次灌注组术后3年复发率分别为44.1%、30.3%,2组比较差异无统计学意义（P〉0.05）。单次灌注组、多次灌注组病理学分级为G1复发率分别为18.8%、29.4%,2组比较差异无统计学意义（P〉0.05）;单次灌注组、多次灌注组病理学分级为G2＋G3复发率分别为66.7%、31.3%,2组比较差异有统计学意义（P〈0.05）。结论单次灌注组与多次灌注组预防非肌层浸润性膀胱癌复发的总体效果相当。但对于病理学分级（G2＋G3）较高的非肌层浸润性膀胱癌,多次灌注比单次灌注能更好的减少术后复发。     

膀胱原发性透明细胞腺癌临床病理观察

目的 分析膀胱原发性透明细胞腺癌的病理形态、免疫组化特点和鉴别诊断。方法 运用组织病理学、组织化学、免疫组化方法进行观察，并结合文献资料进行探讨。结果 瘤细胞呈实性片状、腺管状、灶性乳头状排列，细胞质丰富，透明；部分细胞胞质嗜酸性，呈鞋钉样。免疫组化显示AEI／AE3、CK7、EMA、p53强（＋），200个细胞中Ki-6730％-60％（＋）（平均38％阳性）；CA125散在（＋）、CK20、AFP、CEA、Cga、Vim（-）。组织化学PAS（＋），阿尔辛蓝显示腺腔及囊腔内酸性黏液。结论 膀胱原发性透明细胞癌是膀胱癌中的一种罕见的特殊类型，多来源于化生的移行上皮癌变、也可来源于苗勒管上皮及肾源性腺瘤恶变。     

介入治疗在预防膀胱移行细胞癌复发中的初步应用

膀胱移行细胞癌（ＢＴＣＣ）在泌尿系统肿瘤中发病率最高,且有上升趋势,具有复发性与多发性二大特点。我院自１９９６年２月起对膀胱移行细胞癌行膀胱部分切除术后,经病理切片诊断为膀胱移行细胞乳头状癌Ⅱ～Ⅲ级病人进行联合应用抗癌药物、动脉介入治疗,以降低膀胱癌...     

经尿道电切术辅以膀胱内化疗治疗表浅性膀胱肿瘤

大约 70 %的膀胱移行细胞癌表现为浅表性肿瘤[1] ,与浸润性肿瘤相对应 ,浅表性膀胱癌包括Ｔａ(局限于黏膜层 ,乳头状 )、Ｔ1(乳头状或结节状并侵犯黏膜下 )、Ｔｉｓ(局限于膀胱黏膜 ,无突起或称原位“平坦癌”) [2 ] 。复发与进展是浅表性膀胱肿瘤的两个重要特征。大约 5 0 %～     

CDH1基因3''''非编码区单核苷酸多态性与食管癌、贲门癌的关系

目的：探讨CDH1基因3’非编码区（untranslated region，UTR）＋54C／T单核苷酸多态性与中国北方人食管鳞状细胞癌、贲门腺癌易感性和淋巴结转移的关系。方法：采用聚合酶链反应-限制性片段长度多态性分析方法检测了333例食管鳞状细胞癌患者、239例贲门腺癌患者和343名健康对照的CDH1＋54C／T单核苷多态性的基因型。结果：CDH13’UTR＋54C等位基因在食管鳞状细胞癌、贲门腺癌患者组和健康对照组中的分布有统计学差异（P=0．046和0．000）。与T／T基因型相比，携带C等位基因（C／T＋C／C基因型）可显著增加食管鳞状细胞癌和贲门腺癌的发病风险。根据个体吸烟状况和上消化道肿瘤家族史进行分层分析发现，与T／T基因型相比，携带C等位基因（C／T＋C／C基因型）可使非吸烟个体食管鳞状细胞癌和贲门腺癌的发病风险增加约2～3倍以及家族史阴性个体食管鳞状细胞癌和贲门腺癌的发病风险增加约2倍。本研究未发现该单核苷多态性对食管鳞状细胞癌和贲门腺癌淋巴结转移的影响。结论：CDH13’UTR＋54C／T多态性可能与食管鳞状细胞癌和贲门腺癌的易感性相关。     

尿路上皮癌肺转移的临床病理学特征、Her-2蛋白表达和HER2基因扩增

<正>膀胱癌在男、女肿瘤发病率中分别居第7位和第17位,男女之比为5∶1~([1])。全球每年约14500人死于膀胱癌~([2])。尿路上皮癌(又称移行细胞癌)是膀胱癌中最常见的组织学类型,约占膀胱癌总发病人数的90%。尿路上皮癌往往被分为两种类型:非浸润性膀胱癌和突破固有肌层的浸润性膀胱癌~([3])。非浸润性膀胱癌一般不威胁生命,表现为乳头状和多灶性生长,因此,能够通过经尿道电切术(简称TUR)、膀胱内化学药物灌注以及膀胱内卡介苗灌注等方法治疗,并保留患者的膀胱。但是,非浸润性膀     

宫颈液基细胞学联合人乳头状瘤病毒检测筛查宫颈病变临床分析

目的探讨宫颈液基细胞学（TCT）联合13种高危型人乳头状瘤病毒（HR-HPV）检测对宫颈疾病的筛查能力。方法对2002年6月至2010年5月于我院门诊进行宫颈疾病筛查患者2800例,进行TCT和13种HR-HPV（以下简称HPV）检测,对TCT检查异常、HPV（＋）及阴道镜下怀疑病变的324例患者行组织活检,以病理检查结果为标准。结果筛查者平均年龄38.4岁,11.6%的患者TCT≥不典型鳞状细胞（ASCUS）,33.1%的患者HPV感染（＋）。在阴道镜下多点活检结果：TCT和HPV均（-）者,无高度病变的发生;TCT（-）和HPV（＋）者中,≥CINⅡ级的检出率为11.8%（4/34）,TCT异常和HPV（＋）同时存在的病例中,≥CINⅠ级的检出率最高32.7%（76/232）;仅TCT异常而HPV（-）者25%（12/48）,且12例均为CINⅡ级,无原位癌和浸润癌的发生。结论 TCT联合HPV检测是宫颈疾病筛查的有效方法。     

膀胱癌脆性组氨酸三体FHIT蛋白表达缺失及其意义

目的探讨膀胱癌中脆性组氨酸三体(FHIT)基因蛋白表达状况及其与临床病理的关系。方法采用兔抗人FHlT蛋白抗体和枸橼酸-微波-SP免疫组化方法，检测膀胱移行细胞癌、癌旁组织、乳头状增生病变和正常膀胱组织标本中FHIT的表达状况，并分析其与组织学分级的关系。结果5l例膀胱移行细胞癌组织FHIT表达20例( )，31例(-)；51例癌旁组织FHIT表达48例( )，3例(-)；15例乳头状增生病变和10例膀胱正常组织FHIT均为( )；乳头状增生的移行上皮细胞FHIT均为( )，而Ⅰ级乳头状癌则阳性和阴性细胞混合存在。FHIT阳性表达癌Ⅰ级53．3％，Ⅱ级50％，Ⅲ-Ⅳ级20％；Ⅰ-Ⅱ期癌46．7％，Ⅲ-Ⅳ期癌28．6％。结论FHIT表达可能与膀胱癌的发生和分化有关，FHIT阴性表达可能成为膀胱癌诊断的一项辅助性新指标。     

CEUS in the differentiation between low and high-grade bladder carcinoma

IntroductionBladder cancer ranks 4th overall in the number of newly diagnosed cancers and 10th in causes of cancer deaths. More than 90% of all cases of bladder cancer are transitional cell carcinoma (TCC). The goal of this study is to confirm the usefulness of low mechanical index contrast-enhanced ultrasonography (CEUS), also in association with time–intensity curves, in the differentiation between high- and low-grade bladder malignant lesions.Materials and methodsFrom February 2006 to February 2012 we recruited 144 patients. All patients underwent grayscale ultrasonography (US), color-Doppler ultrasonography (CDUS) and contrast-enhanced ultrasonography (CEUS). Subsequently all patients underwent cystoscopy and TURB.ResultsHistological diagnoses were: 88 high-grade carcinomas (61.1%), and 56 low-grade carcinomas (38.9%). Sensitivity and specificity of CDUS were 87.5% (126/144) and 60%, respectively. Sensitivity and specificity of CEUS were 90.9% and 85.7%, respectively. Sensitivity and specificity of TIC were 91.6% (132/144) and 85.7%, respectively.Discussion and conclusionsCEUS is a reliable noninvasive method for differentiating low- and high-grade bladder carcinomas since it provides typical enhancement patterns as well as specific contrast-sonographic perfusion curves.     

尿核基质蛋白22是膀胱移行细胞癌诊断及检测复发的指标

目的：探讨检测尿中核基质蛋白22（nuclear matrix proteins22,NMP22）含量对膀胱移行细胞癌（BTCC）诊断及检测复发的意义。方法：用NMP22试剂盒（ELISA）检测24例BTCC患者手术前、后48份尿标本及15份泌尿系良性疾病患者的尿标本。结果：24例BTCC术前尿NMP22含量中位数为71．5U/ml；15例泌尿系良性疾病对照组为11．0U／ml，两者差异非常显著（P＜0．01）。以尿NMP22 18U/ml为cut off值，诊断BTCC的灵敏度为95．8％（23／24），特异性为86．7％（13／15）。24例BTCC患者术后尿NMP22中位数为45．0U/ml，与术前比较明显下降（P＜0．01）。随访发现术后肿瘤复发组和无复发组尿NMP22的中位数分别为60．0U／ml和12．0U/ml，两组差异显著（P＜0．01）。结论：尿NMP22测定是一种无创伤性、灵敏度高、特异性好的BTCC辅助诊断指标，并可望用于判断术后有无复发。     

尿环氧化酶-2蛋白诊断膀胱移行细胞癌的价值

目的:分析比较尿环氧化酶-2(Cox-2)蛋白检测与尿脱落细胞学检查诊断膀胱移行细胞癌的临床价值。方法:选择35例膀胱移行细胞癌和30例作为对照组的前列腺增生症患者,分别行尿Cox-2蛋白和尿脱落细胞学检查,比较2种方法的敏感性、特异性和阳性预测值。结果:尿Cox-2蛋白和尿脱落细胞学的敏感性分别为82.9%和25.7%,差异有显著性(P<0.01),特异性分别为79.1%和100.0%,阳性预测值分别为60.4%和100.0%。结论:尿Cox-2蛋白检测是一种简单、敏感性高、无创的早期诊断膀胱移行细胞癌的方法,适合于膀胱移行细胞癌的诊断与随访。     

Comparison of cytokeratin 20 RNA and angiogenin in voided urine samples as diagnostic tools for bladder carcinoma

BACKGROUND: We evaluated the diagnostic efficacy of urinary angiogenin (ANG) and cytokeratin 20 (CK-20) mRNA in comparison with voided urine cytology in the detection of bladder cancer patients. OBJECTIVES AND METHODS: A total of 97 Egyptian patients provided a single voided urine sample for ANG, CK-20 and cytology before cystoscopy. Of the 97 cases, 63 were histologically diagnosed as bladder cancer; 33 with transitional cell carcinoma (TCC) and 30 with squamous cell carcinoma (SCC), whereas the remaining 34 had benign urological disorders. A group of 46 healthy volunteers were also included in this study. Voided urine was centrifuged and the supernatant was used for estimation of ANG by EIA and confirmed by Western blotting (WB). The urine sediment was used for cytology and RNA extraction. CK-20 RNA was detected by RT-PCR. RESULTS: The best cutoff value for ANG was calculated by a ROC curve as 322.7 ng/mg protein. The median urinary ANG level in bladder carcinoma, benign urological disorders and healthy volunteer groups was: 802.7, 425 and 33 pg/mg protein, respectively. The positivity rate for urinary CK-20 mRNA of the control, benign and malignant groups was 0%, 2.9% and 82.3%, respectively (P = 0.000); while the rates for ANG were 11.6%, 54.8% and 75.4%, respectively (P = 0.000). There was no significant difference in positivity rates of CK-20 and ANG with respect to sex, smoking, schistosomiasis, urine cytology, tumor grade, tumor stage, hematuria or pus cells. The overall sensitivity and specificity were 71.4% and 90% for voided urine cytology, 75.4% and 70.3% for ANG, and 82.3% and 98.8% for CK-20. Combined sensitivity of voided urine cytology with ANG and CK-20 together (98.2%) was higher than either the combined sensitivity of voided urine cytology with ANG (96.5%) or with CK-20 (91.6%) or than that of the biomarker alone. We demonstrated significant positive correlation between CK-20 positivity with age (P = 0.043) and nodal involvement (P = 0.037); however, there was no significant correlation between CK-20 and ANG with the other clinicopathological parameters. CONCLUSIONS: Our data indicate that CK-20 and ANG in voided urine had higher sensitivities compared to voided urine cytology. However, when specificity was considered, CK-20 alone had superior sensitivity and specificity compared to ANG and voided urine cytology.     

THE NEOPLASTIC POTENTIALITIES OF MOUSE EMBRYO TISSUES : III. THE TUMORS ELICITED FROM GASTRIC EPITHELIUM

Epithelial tumors have been readily obtained by the implantation of embryo stomach tissue together with olive oil containing methylcholanthrene (with or without Scharlach R) in adult mice of homologous strain. The implanted tissue from the squamous portion of the stomach rapidly encysted the oil, and benign and malignant papillomas and squamous cell carcinomas soon arose from the stratified squamous lining of the cysts. Bits of the glandular portion of the stomach also formed cysts, but the gland cells underwent metaplasia in response to the carcinogen, altering first to transitional epithelium and then to a stratified squamous layer. So swiftly did these changes take place that nearly all of the tumors took origin from epithelium that had already become stratified and squamous, and the growths themselves were of this type. A single transitional cell carcinoma and an adenoacanthoma were procured, but no adenocarcinomas; nor did any benign papillomas develop, though they often resulted from the action of methylcholanthrene on the squamous portion of the embryo stomach. Search failed to disclose any distinctive precancerous changes in the gastric tissue. Five of the cancers were transplanted and they grew in every host. No tumors arose from any of the numerous control implants. Those consisting of glandular tissue formed cysts lined partly with columnar epithelium secreting mucus and partly with tubular glands equipped with chief and parietal cells in good condition. Pepsin and rennin were found in the fluid contained in these cysts, but no free hydrochloric acid. The enzymes were present also when the cysts contained methylcholanthrene and the glands had not yet been wholly replaced by metaplastic epithelium. The tumors appeared months sooner than when methylcholanthrene is injected into the stomach of adult animals or given by mouth; some of them were well established after 5 or 6 weeks. They arose regularly when the requisite experimental conditions were provided. The utilization of transplanted embryo tissue provides a means whereby gastric tumors free from bacterial infection can be procured swiftly and easily.     

Preliminary report of the clinical performance of a new urinary bladder cancer antigen test: comparison to voided urine cytology in the detection of transitional cell carcinoma of the bladder

We compared the ability of a new urinary bladder cancer antigen (UBC) test with conventional cytology for the detection of transitional cell carcinoma of the bladder using voided urine samples. The UBC was measured and corrected for the creatinine concentration in the urine of 61 patients with transitional cell carcinoma of the bladder (group 1), 23 patients without recurrent bladder tumors during follow-up (group 2), 28 patients with benign prostatic hyperplasia (group 3), nine patients with prostate cancer (group 4), and 90 healthy volunteers free of urological diseases (group 5). The UBC concentrations were 408.8+/-578.5, 18.8+/-26.6, 23.9+/-32.7, 17.5+/-18.6 and 4.6+/-6.7 ngmg(-1) creatinine (mean+/-S. D.) for groups 1-5, respectively. The level for group 1 was significantly higher than for any other group. The sensitivity and specificity, which were optimized using receiver-operating characteristic curves for groups 1 and 2 were 82.0% and 82.6%, respectively, at a threshold value of 39 ngmg(-1) creatinine. The sensitivity and specificity of cytology for these same groups were 60.7% and 86.9%, respectively. The sensitivity of the UBC was significantly higher than that of cytology, not only for total bladder tumors (82.0% vs. 60.7%, P<0.02) but also for grade I transitional cell carcinoma of the bladder (76.5% vs. 11.8%, P<0. 001). While offering a similarly high specificity, the UBC test might have an advantage over cytology in terms of superior sensitivity, particularly for low-grade tumors.     

尿Cox-2蛋白和Survivin蛋白诊断膀胱移行细胞癌的临床价值

目的 探讨尿Cox-2蛋白、尿Survivin 蛋白和尿脱落细胞学检查诊断膀胱移行细胞癌的临床价值。方法 选择60例膀胱移行细胞癌和30例非膀胱肿瘤患者，同时行尿Cox-2蛋白、尿Survivin蛋白和尿脱落细胞学检查。结果 尿Cox-2蛋白、尿Survivin 蛋白和尿脱落细胞学的敏感性分别为88.3%，68.3%，21.7%；特异性分别为93.3%、80.0%和100%；Youden指数分别为81.6%、48.3%和21.7%。尿Cox-2的敏感性和Youden指数高于尿Survivin (P<0.05)，同时尿Survivin的敏感性和Youden指数高于尿脱落细胞学(P<0.05)。结论 尿Cox-2蛋白和尿Survivin蛋白是诊断和随访膀胱移行细胞癌的一种高敏感性和高特异性的指标，非常适合于复发率很高的膀胱癌的诊断与随访。     

膀胱鳞状细胞癌的诊治-附10例报告

目的:探讨膀胱鳞状细胞癌的诊治方法。方法:回顾分析1992～2006年诊治10例鳞状细胞癌患者的临床资料。结果:10例患者中男性7例,女性3例;年龄45～81岁;9例因血尿、尿频等尿路症状就诊,1例因膀胱结石行膀胱切开取石治疗后1年复查时CT提示膀胱壁明显增厚发现。B超检查8例患者提示膀胱内占位,2例患者膀胱无法充盈观察;9例膀胱镜检发现肿瘤直径2.0～6.5cm,单发6例,多发3例。4例患者首次就诊行根治性全膀胱切除,尿流改道术;1例患者因盆腔淋巴结广泛转移行肿瘤旷置,尿流改道术;2例患者分别于术后11个月,18个月发现局部复发或远处转移;3例患者首次就诊行膀胱部分切除术,2例分别术后6个月,1年复发;2例患者行经尿道膀胱肿瘤电切术,术后3个月、6个月复发。8例患者获得随访,随访时间1～10年。2年生存率50%(4/8),5年生存率16.7%(1/6)。其中首次行全膀胱切除患者2年生存率67%(2/3),5年生存率50%(1/2);首次行膀胱部份切除患者2年生存率33%(1/3),5年生存率0%;首次行经尿道膀胱肿瘤电切术患者获得随访2例,2年生存率0%。结论:膀胱鳞状细胞癌是一种高度恶性肿瘤,预后差,早期、综合治疗对延长患者生存时间有重要意义。     

VB4-845, a conjugated recombinant antibody and immunotoxin for head and neck cancer and bladder cancer

Viventia Biotech Inc, under license from the University of Zurich, is developing VB4-845, comprising a Pseudomonas exotoxin fused to an anti-epithelial cell adhesion molecule single-chain antibody fragment, for the potential treatment of head and neck cancer (intratumoral) and bladder cancer (intravesical). VB4-845 is currently undergoing phase II and III clinical trials in patients with head and neck squamous cell carcinomas, as well as phase II clinical trials for the treatment of superficial transitional cell carcinoma of the bladder.