膀胱软斑病1例报告

1病例摘要 患者女，53岁。无痛性肉眼血尿2个月入院治疗。临床检查：右肾积水，左肾缺如。膀胱镜检查见膀胱内炎性肉芽组织增生，行手术切除。术中见膀胱黏膜为一层黄白色絮状物质所覆盖，肿物与膀胱黏膜无明显黏连。可行剥离，剥离面可见出血点。絮状物切除送病理检查。病理检查所见：镜下见被覆移行上皮黏膜组织，黏膜下可见弥漫性增生的上皮样组织细胞，胞浆嗜酸或嗜双色性，其内可见散在圆形或卵圆形包涵体（MG）小体，嗜碱件，呈同心圆状钙化小体，分散在间质及组织细胞内。间质内可见多数炎细胞浸润及淋巴组织增生，伴有生发中心形成。MG小体PAS，铁及钙染色阳性。病理诊断：膀胱软斑病。     

前列腺软斑病1例报告并文献复习

目的 探讨诊治前列腺软斑病的方法 和效果.方法 回顾我院诊治的1例前列腺软斑病患者,并进行文献复习.结果 本例患者经病理检查明确诊断,并行经尿道前列腺汽化电切术及抗生素治疗后痊愈.该例发热并有排尿困难及尿痛症状,细菌培养阳性,病理切片可见软斑细胞及M-G小体.结论 前列腺软斑病是一种可治愈的炎症性疾病,多伴随免疫功能障碍,诊断上需病理检查明确并与前列腺癌相鉴别,治疗上可行经尿道前列腺电切术或开放前列腺摘除术,以及敏感抗菌素等药物治疗.     

肾脏软斑病侵犯降结肠合并膀胱软斑病1例报告

软斑病是一种主要发生于泌尿系统的罕见肉芽肿性病变, 而肾脏软斑病侵犯降结肠同时合并膀胱软斑病更罕见, 本研究报道1例。影像学检查示左肾大片状混杂密度影, 增强扫描病灶呈不均匀强化, 行CT引导下肾穿刺活检术, 术后病理结果示肾脏软斑病。行经尿道膀胱镜检查, 活检病理证实为膀胱软斑病。予抗生素保守治疗, 效果欠佳。患者行根治性肾切除术+左半结肠切除术, 术后病理确诊为肾脏软斑病, 病变累及肠管黏膜及整个肌层。术后随访6个月, 行CT检查未见复发。     

脐尿管软斑病累及膀胱1例报告

软斑病是一种罕见的慢性肉芽肿性病变, 临床误诊率极高, 本文报道1例脐尿管软斑病累及膀胱。患者外院检查发现膀胱前上方与腹壁间占位性病变, 行增强CT检查示脐尿管病灶累及膀胱顶壁, 膀胱顶壁不规则样增厚、强化。行脐尿管肿瘤根治术+膀胱部分切除术, 术后予抗菌药物治疗。病理诊断为脐尿管、膀胱软斑病。术后随访18个月, 无局部复发及转移。     

膀胱内翻型乳头状瘤69例诊疗分析

目的探讨膀胱内翻型乳头状瘤的临床特点及病理学特征。方法分析69例膀胱内翻型乳头状瘤病人的临床资料包括病因、病理学特征、临床表现、影像学检查、治疗方式及预后状况。结果 69例病人中大多数因血尿(59.4%)就诊,肿瘤最常发生于膀胱颈及三角区(49.3%)。病人术前均接受影像学检查(B超、CT、MRI、膀胱镜),但最终依靠病理检查确诊。全部病人均接受经尿道膀胱肿瘤电切术。结论膀胱内翻型乳头状瘤是一种少见的膀胱良性肿瘤,术前诊断困难,主要依靠术后病理检查确诊。治疗首选经尿道膀胱肿瘤电切术,术后肿瘤复发及进展可能性小,预后良好,但需术后4~5年内随访监测。     

泌尿系统软斑病4例诊疗分析及文献回顾

目的:探讨泌尿系统软斑病的诊断、鉴别诊断和治疗策略。方法:分析南京医科大学第一附属医院于2019年1月至2020年12月收治的4例泌尿系统软斑病患者的临床资料并复习相关文献。结果:2例软斑病患者病变位于膀胱,2例位于腹膜后。膀胱软斑病患者的症状主要为尿路刺激症状,腹膜后软斑病患者的症状主要为发热、腰痛。4例患者均伴有免...     

滑膜软骨瘤11例临床分析

目的总结探讨关节滑膜软骨瘤的临床特征、影像学表现、病理特点及诊治要点。方法 11例滑膜软骨瘤患者临床症状、影像学表现、病理。结果及诊治过程进行回顾性分析结果本组11例患者均接受手术切除病变滑膜并摘除游离体,术后均恢复良好,随访6个月～5年,治愈9例,好转2例,未出现复发。结论本病诊断需结合临床表现、影像学及病理,通过病变滑膜切除并游离体摘除术能够达到很好的治疗效果。     

局限性膀胱淀粉样变1例报告并文献复习

目的:探讨局限性膀胱淀粉样变病因、临床表现、影像学诊断方法、病理特征及诊疗方法。方法:回顾分析1例局限性膀胱淀粉样变患者的临床资料,总结复习相关文献。结果:患者经抗感染、止血、对症治疗,效果较好,随访7个月未复发血尿。结论:膀胱淀粉样变为少见病,主要表现为无痛性肉眼血尿,膀胱侧壁和三角区为好发部位,确诊主要依靠膀胱镜下活检,病理学检查刚果红染色后偏振光显微镜下呈现出苹果绿色双折射光。治疗以手术切除为主,术后辅以二甲基亚砜膀胱灌注,疗效及预后良好。     

系统性硬化症合并膀胱软斑病1例报告

系统性硬化症是一种罕见而复杂的自身免疫病,而软斑病是一种罕见的慢性肉芽肿性炎性病变,系统性硬化症合并膀胱软斑病更罕见。本文报道1例系统性硬化症合并膀胱软斑病,患者为中年女性,以血尿和膀胱刺激征为主要临床表现,合并严重腹泻,行经尿道膀胱肿物电切术,术后病理证实为膀胱软斑病。术后服用小剂量泼尼松龙和甲氨蝶呤治疗系统性硬化症...     

膀胱软斑症1例报告并文献复习

目的:提升临床对罕见病膀胱软斑症的认识和探讨对该病诊断治疗方法。方法:通过报告本院收治的1例膀胱软斑症的临床资料、诊治经过,结合国内外文献资料对该病予以讨论,分析该病可能存在的病因,常见的临床表现、诊断方法以及治疗方法的合理选择。结果:经膀胱病损部分电切术+抗生素+膀胱灌注(膀胱黏膜保护剂)治疗,已无明显血尿,尿路刺激征明显改善。嘱患者出院后定期复查尿常规、尿液细菌培养,必要时复查膀胱镜检。结论:膀胱软斑症确诊有赖于膀胱镜活组织病理检查;治疗以长期敏感抗生素为主,手术、免疫疗法也是重要的治疗手段,必要时行联合治疗可以取得更为理想的治疗效果。     

Malakoplakia of urinary bladder following cadaveric renal transplantation

Malakoplakia of the urinary bladder following cadaveric renal transplantation in a twenty-two-year-old woman is reported. Urinary tract infection with Escherichia coli persisted postoperatively. Three years later, gross hematuria and fever occurred. Yellow-tan mucosal plaques or nodules were observed cystoscopically, and histologic examination revealed malakoplakia of the urinary bladder with characteristic foamy histiocytes containing Michaelis-Gutmann bodies.     

Malakoplakia occurring in association with Colon carcinoma

Malakoplakia, characterized by histiocytes with Michaelis-Gutmann bodies, is a rare entity. It is particularly so in the gastrointestinal tract, where it has been described in association with colon cancer, with about 20 cases described worldwide. The significance of this condition lies in its potential effect upon the preoperative staging and treatment of associated colorectal cancer. Its presence may lead to preoperative clinical and radiological over staging and more extensive resection, as well as the use of neoadjuvant therapy or a decision to undertake palliative care. This condition is more common in males. We present the case of the oldest reported patient with this association. The patient was a 90-year-old female who was treated with a sigmoid resection for an obstructing sigmoid lesion. At operation, the left ureter was embedded within an inflammatory pericolic mass but was not grossly involved with tumor. The tumor was a Dukes’ stage B adenocarcinoma and occurred in association with malakoplakia.     

Urinary and gastrointestinal malakoplakia in a 12-year-old girl

Malakoplakia is a rare chronic inflammatory disease that was originally described in the urinary bladder but can involve many other organs and soft tissues. It is believed to be caused by an alteration in the bacterial phagocytic system. Clinically, it is described as single or multiple tumors that can appear in any part of the body. Histologically, the presence of Michaelis-Gutmann bodies is pathognomonic. Malakoplakia in children is rare. Few pediatric cases in the urinary tract, kidney, or gastrointestinal tract have been published. We present a case of urinary and gastrointestinal malakoplakia in a 12-year-old girl.     

Renal malakoplakia: an underestimate cause of renal failure

Malakoplakia is an inflammatory granulomatous disease induced by defective phagocytic activity of macrophage. Malakoplakia is histologically characterized by the presence of Michaelis-Gutmann bodies in macrophages. Although not uncommon in the genito-urinary tract, isolated malakoplakia of the kidney is rarely found. Its main clinical presentation associates acute renal failure and acute pyelonephritis. The clue for diagnosis of renal malakoplakia is based on renal biopsy showing Michaelis-Gutmann bodies. Establishing the diagnosis of renal malakoplakia is essential as it determines the choice of antibiotics and duration of treatment. Prognosis remains poor, leading frequently to chronic renal failure. In this paper, we report four cases of renal malakoplakia and discuss clinical presentation, biological and pathological features, treatment and prognosis of this disease.     

原发性膀胱淀粉样变1例报告并文献复习

目的 探讨原发性膀胱淀粉样变的临床、影像学、病理学特征以及诊疗方法。方法：回顾性分析1例原发性膀胱淀粉样变患者的临床资料。结果：行经尿道电切（TUR）术,术后辅以50％二甲基亚砜（DMSO）膀胱灌注,随访1年未出现肉眼血尿。结论：原发性膀胱淀粉样变临床及其罕见,极易与膀胱癌混淆,确诊需依据临床表现、影像学检查、病理学检查及特殊染色。治疗以手术尽可能切除病变组织为主,术后辅以DMSO膀胱灌注,疗效及预后良好。     

Malacoplaquia testicular: aportación de un nuevo caso y revisión de la literatura científica

Malakoplakia is a uncommon chronic granulomatous condition of a benign nature preferentially occurring in the genitourinary tract. Testes are affected in 12% of cases, and the first case of testicular malakoplakia was reported in 1958. Forty cases have been reported worldwide since that date. We report a new case of testicular and epididymal malakoplakia in a 68-year-old male patient diagnosed of complicated orchiepididymitis who underwent orchidectomy to rule out a malignant tumor. The histopathological study demonstrated a chronic inflammatory infiltrate with histiocytes with an eosinophilic cytoplasm containing the characteristic Michaelis-Gutmann bodies diagnostic of malakoplakia.In connection with this new case and because of its unusual presentation, the literature on testicular malakoplakia is reviewed.     

Metastatic Breast Carcinoma in Cerebrospinal Fluid: A Cytopathological Review of 15 Cases

The incidence of metastatic carcinoma to the meninges (“meningeal carcinomatosis” [MC]) is increasing due to longer survival of patients and improved imaging techniques. Currently, MC is best diagnosed by cytopathological evaluation of cerebrospinal fluid (CSF). Breast primaries are the commonest cause of MC; although cytopathological features thereof have not been, as yet, fully characterized. In this study of meningeal mammary carcinomatosis, relevant clinicopathological data and archived cytopathological preparations of all “suspicious” and “positive” CSF specimens (1992–2015), from patients with a history of breast carcinoma, were retrieved and reviewed. Twenty‐three “positive” CSF specimens, derived from 15 patients formed the basis of this study. All specimens were processed as Cytospin preparations, and stained by Papanicolaou and Diff‐Quik techniques. All patients were female, with a mean age of 57 (range: 32–85) years. Mean interval between initial diagnosis of breast carcinoma and “positive” CSF was 32 (range 6–84) months. All 23 specimens (100%) were “cellular” (>10 carcinoma cells). Eighteen (78%) specimens showed only isolated nonclustered cells, and 5 (22%) specimens showed both cell clusters and isolated cells. In most “positive” cases, metastatic breast carcinoma cells showed variation in cell size, with hyperchromatic nuclei, irregular nuclear membranes, prominent nucleoli and cytoplasmic vacuolization. The background in some CSF samples showed red blood cells and fibrin admixed with rare lymphocytes and histiocytes. One specimen showed necrotic debris. Papanicolaou and Diff‐Quik‐stained Cytospin preparations were equally diagnostic, as the aforementioned findings were present in both types of preparation.     

Oligometastases in Genitourinary Tumors: Recent Insights and Future Molecular Diagnostic Approach

ContextAn oligometastatic state is an early event during tumor metastatic spread and is rarely reported in patients with genitourinary tumors. In this condition, the primary tumor has low capacity for distal dissemination because its aggressiveness has not yet reached a maximum.ObjectiveTo review recent findings on the diagnosis and treatment of oligometastatic disease in patients with genitourinary tumors.Evidence acquisitionTo identify relevant studies, we reviewed articles in PubMed from January 1966 to September 2017. The search was conducted by combining the words “oligometastasis” or “oligometastatic disease” with “bladder cancer”, “genitourinary tumor”, “prostate cancer”, and “renal cancer”.Evidence synthesisIn renal cell carcinoma (RCC), tumors from patients with multiple metastases showed a different gene signature compared to oligometastatic RCC. In addition, an oligometastatic state was an independent prognostic factor for overall survival (OS). Otherwise, the characteristics of oligometastases from bladder cancer remain unclear, as do the clinical and prognostic significance of metastasectomy in this setting. However, patients with oligometastatic prostate cancer have longer recurrence-free survival and OS and seem to benefit from local metastasis-directed therapies.ConclusionsEarly detection of oligometastatic disease in patients with genitourinary tumors is fundamental in improving outcomes by identifying patients who would benefit from local approaches with potentially curative rather than palliative intent.     

“Close-loop” urethral obstruction: Clinico-radiological features and management consideration in a resource-constraint environment

ObjectiveTo document our observation of “close-loop” obstruction among patients with dual urethral obstruction from BPH and urethral stricture disease.Materials and MethodsThe hospital records of all patients that presented to our centres with evidences of urethral stricture co-existing with BPH were retrospectively reviewed from January 2007 to December 2011. Among other things, the salient features in the contrast radiograph of those with “close-loop” obstruction and their treatment were documented and analysed.ResultsForty three patients were managed for radiological evidence of urethral stricture and elevated bladder base (dual obstruction). Thirty (69.7%) of these patients had open prostatectomy with easy dilatation of the urethral stricture. Twelve (27.9%) of the patients had urethroplasty for urethral stricture diseases; of these twelve, five patients presented with persistent LUTS (“close loop” obstruction). These five (11.6%) patients were aged between 50 to 80 years; they all had suprapubic cystostomy. In addition to delineating the anatomy of the urethral stricture and elevated bladder base, other salient features on the contrast radiographies included dilated prostatic urethral, visualization of the seminal vesicles and closed bladder neck on voiding cystogram. The initial treatment was urethroplasty but two each had combination therapy (with alpha adrenergic blocker and 5-alpha reductase inhibitor) and open prostatectomy respectively as further treatment while the last patient had perineal urethrostomy as first-stage redo-urethroplasty.Conclusion“Close-loop” urethral obstruction appears to be an entity that needs further evaluation.     

Intrinsic neuromuscular defects in the neurogenic bladder: X. Value and limitations of neurohistochemistry

Histochemical changes in bladder innervation have been described in various types of clinical and experimental neurogenic voiding dysfunction. Recent studies in the cat have shown that both decentralization and postganglionic “denervation” lead to ultrastructural changes in muscular innervation of the bladder base. The present study was conducted to find out whether these changes can be detected histochemically. Decentralization of the bladder by unilateral sacral ventral rhizotomy, bilateral sacral ventral rhizotomy, or unilateral pelvic neurectomy was performed in 25, and postganglionic “denervation” by unilateral pelvic plexus neurectomy in 9, adult male cats. Specimens of the bladder body and bladder base were collected 2–4 and 8–10 weeks after decentralization, and 2–4 weeks and 10 weeks after “denervation.” The specimens were processed by histochemical methods to demonstrate cholinergic and adrenergic nerves. No recognizable differences from the norm were observed in cholinergic muscular innervation of either the body or base specimens of the decentralized bladder. While adrenergic muscular innervation of both regions was similar to normal in short-term samples of the same specimens, there was an obvious adrenergic hyperinnervation of both in the long-term samples. By contrast, there was an obvious, early-developing, and persistent hypoinnervation by both cholinergic and adrenergic nerves in both the body and base regions after postganglionic “denervation.” It is concluded that histochemistry (1) has no value in detecting either short- or long-term changes in cholinergic muscular innervation of the decentralized bladder and (2) is useful for revealing both short- and long-term cholinergic and adrenergic hypoinnervation of the “denervated,” as well as long-term adrenergic hyperinnervation of the decentralized vesical muscularis.