膀胱尿路上皮癌HER2表达及临床病理分析

目的 探讨膀胱尿路上皮癌(bladder urothelial carcinoma, BUC)中HER2的表达情况,并分析其临床意义。方法 收集膀胱非浸润性低级别BUC 27例、非浸润性高级别BUC 5例、浸润性高级别BUC 60例,采用免疫组化MaxVision法法检测各组织样本中HER2蛋白的表达,并分析HER2表达与临床病理特征的关系。通过GEPIA数据库或直接在肿瘤基因组图谱(The Cancer Genome Atlas, TCGA)中分析HER2(ERBB2)表达与BUC的关系。结果 浸润性高级别BUC中HER2 2+/3+表达率(26.67%,16/60)显著高于非浸润性低级别BUC(7.41%,2/27)和非浸润性高级别BUC(0,0/5)(P<0.05)。多灶性浸润性高级别BUC中HER2 2+/3+表达率(75.00%,6/8)显著高于单灶性患者(19.23%,10/52)(P<0.05)。各组织学亚型中HER2 2+/3+表达率差异有统计学意义(P<0.05),其中普通型为30%(6/20)、腺样分化型为57.14%(4/7)、微乳头型为66.6...     

乳腺浸润性乳头癌1例及文献复习

乳腺浸润微乳头状癌（imvasive micropapillary carcinoma,IMC)是一种特殊类型浸润性导管癌。IMC有独特的形态学特点和高度的淋巴侵袭性，但预后不比普通乳腺癌差。对临床和病理医师而方，加强对此独立的亚型肿瘤的正确认识并与预后好的乳腺癌鉴别十分必要。现将本科在活检中遇到的1例IMC，结合文献复习报道如下。     

基于免疫组化的膀胱浸润性尿路上皮癌的分子分型

目的 探讨用免疫组化法对膀胱浸润性尿路上皮癌进行分子分型的可操作性诊断方法和标准.方法 对197例膀胱浸润性尿路上皮癌行CK7、GATA3、FOXA1、CK20、CK14、CD44、CK5/6、p53、Ki-67等9种尿路上皮癌常用免疫组化染色,分析各项免疫组化标记表达的相关性,以及与各组织学变异的相关性,从中选择可用...     

膀胱浸润性微乳头状癌1例的病理形态学观察

目的观察膀胱浸润性微乳头状癌(invasive micropap-illary carcinoma,IMPC)的病理形态学特征,并分析其发病机制。方法回顾性分析1例IMPC病理形态学特征并复习相关文献。结果大体位于膀胱左侧壁的无蒂息肉状,组织学表现为尿路上皮下方浸润性生长的位于空白收缩裂隙内的微乳头芽结构,且浸润膀胱肌层,伴髂血管淋巴结转移,周围膀胱黏膜呈腺性膀胱炎改变,为膀胱原发性IMPC。结论微乳头结构的存在预示着高分级、高分期、进展快及预后差,病理医师在日常工作中应关注和重视各器官的微乳头型病变,有利于对该型病变的进一步研究。     

尿路上皮癌组织学变异型的病理特征及诊断

肾盏、肾盂、输尿管、膀胱及尿道均由尿路上皮衬覆，各部位发生的癌大多有相似的组织病理学特征。如膀胱恶性肿瘤90％-95％是尿路上皮癌（urothelial carcinoma，UC），而其余5％～10％是间叶性肿瘤和其他罕见型上皮性肿瘤，后者虽罕见但同样起源于尿路上皮，说明尿路上皮细胞具有多能性或异向分化能力，由此发生的肿瘤被称为UC伴异向分化（UCwith divergent differentiation）。特别是高核级或高分期的UC，最常见的是伴有灶性鳞状分化或腺上皮分化区，偶可伴骨和软骨等间叶性成分。     

浆细胞样尿路上皮癌10例临床病理分析

目的 探讨浆细胞样尿路上皮癌(plasmacytoid urothelial carcinoma, PUC)的临床病理学特征、诊断及鉴别诊断。方法 回顾性分析10例PUC的临床病理学特征、免疫表型、分子检测结果及随访。结果 10例中男性7例,女性3例,年龄60～85岁,平均77岁。肿瘤位于输尿管1例,膀胱9例,肿块直径2～6 cm。镜下见肿瘤组织弥漫排列,呈实性巢团状、条索状或梁状排列,黏附性较差,细胞小至中等大,胞质丰富、透亮或嗜酸性,细胞核大,偏位或居中,圆形或不规则,核分裂象易见,类似于浆细胞特点。免疫表型：CKpan(10/10)、CK7(10/10)、EMA(10/10)、UroplakinⅢ(9/10)、GATA3(8/10)、CK20(7/10)、p63(9/10)、p53(9/10)和CD138(7/10)均阳性;E-cadherin、CD38、CD45、Kappa/Lambda、S-100、CgA、Syn、HMB-45、Melan-A和ALK均阴性。6例行端粒酶逆转录酶(hTERT)mRNA检测：其中3例阳性,该3例阳性者行TERT基因突变检测为1例外显子突变,2例野...     

膀胱尿路上皮癌中LRG1和TGF-β1的表达及临床病理意义

目的 探讨富亮氨酸α2糖蛋白1（leucine-rich alpha-2-glycoprotein 1, LRG1）及转化生长因子beta 1（transforming growth factor-beta 1, TGF-β1）在膀胱尿路上皮癌（bladder urothelial carcinoma, BUC）组织中的表达及意义。方法 采用免疫组化SP法检测LRG1、TGF-β1及Ki-67在64例BUC组织及25例癌旁组织中的表达,分析LRG1、TGF-β1在各组间表达的差异及相关性。结果 LRG1在BUC组织中强阳性27例（42.19%）,癌旁组织中强阳性仅2例（8.00%）,两组相比差异有统计学意义（P<0.05）;TGF-β1在BUC组织中阳性49例（76.56%）,在癌旁组织中阳性10例（40.00%）,差异有统计学意义（P<0.05）;相关性分析显示,LRG1与TGF-β1表达呈正相关（r²=0.658 2,P<0.05）;LRG1、TGF-β1表达均与BUC病理学分级、浸润深度及Ki-67增殖指数相关（P<0.05）。结论 ...     

乳腺浸润性微乳头状癌1例及文献复习

乳腺浸润性微乳头状癌(invasive micropapillary carcinoma, IMC)是一种特殊类型浸润性导管癌.IMC有独特的形态学特点和高度的淋巴侵袭性,但预后不比普通乳腺癌差.对临床和病理医师而言,加强对此独立的亚型肿瘤的正确认识并与预后好的乳腺癌鉴别十分必要.现将本科在活检中遇到的1例IMC,结合文献复习报道如下.     

乳头浸润性汗管瘤样腺瘤临床病理分析

目的:探讨乳头浸润性汗管瘤样腺瘤的临床病理学特征。方法:对1例与乳腺浸润性导管癌并发的乳头浸润性汗管瘤样腺瘤进行临床病理和免疫组织化学分析,并结合文献讨论其诊断与鉴别诊断。结果:肿瘤位于乳头部皮下纤维结缔组织内,由形态温和的上皮细胞排列呈小管、少数呈条索和巢状,并向周围间质内浸润。部分小管呈"逗点/蝌蚪"状并形成角化囊肿。免疫组织化学染色显示:小管内衬细胞表达细胞角蛋白(cytokeratin,CK),CK5/6,小管CAM5.2阳性,小管细胞不表达雌激素受体,孕激素受体,CerbB2,CK8/18,P53和囊泡病液体蛋白15;小管外层细胞呈P63和平滑肌肌动蛋白散在阳性;Ki67约1%。结论:乳头浸润性汗管瘤样腺瘤是一种易与乳腺恶性肿瘤相混淆的罕见良性肿瘤,了解其临床病理特征可避免误诊及过度治疗。     

膀胱浆细胞样尿路上皮癌1例

患者男性,70岁.无明显诱因出现肉眼血尿4个月余,伴尿频、尿痛,遂于2019年4月就诊于我院.男性泌尿系超声示膀胱壁低回声伴环状钙化,增强CT示膀胱左侧后壁局部不均匀增厚隆起(图1);腹膜后大血管旁多发淋巴结肿大.膀胱镜检查见膀胱左侧壁有一宽基息肉状新生物,膀胱内广泛滤泡样及鱼鳞样改变,侵及膀胱颈口及双侧输尿管开口.     

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.     

Transition between urothelial carcinoma in situ and non-invasive micropapillary carcinoma as a pivot connection between diverse morphologies of bladder carcinoma: a case report of urothelial carcinoma with villoglandular differentiation

Urothelial carcinoma has numerous histological variants, and these variants may coexist in a single case. Here, we present a case of a 70-year-old man with urothelial carcinoma of the bladder with a maximal diameter of 5 mm that involved micropapillary and plasmacytoid variants, with villoglandular differentiation. The presence of these variants was confirmed by pathological examination of a transurethral resection specimen, and high-grade urothelial carcinoma was found as a minor component. Although this bladder carcinoma was classified as pT1, cystoprostatectomy, urethrectomy, and lymphadenectomy were performed due to the presence of the micropapillary and plasmacytoid variants, which are known to be aggressive. Examination of a surgically resected specimen revealed no carcinoma. A transition between urothelial carcinoma in situ and non-invasive micropapillary carcinoma was found to be a pivot point connecting the diverse morphologies of this bladder carcinoma, from which there existed two pathways. One pathway was from urothelial carcinoma in situ to the plasmacytoid variant through invasive high-grade urothelial carcinoma, and the other was from non-invasive micropapillary carcinoma to urothelial carcinoma with villoglandular differentiation or to the micropapillary variant. This is the 16th reported case of urothelial carcinoma with villoglandular differentiation in the literature. As urothelial carcinoma with villoglandular differentiation is often associated with aggressive variants, as shown in our case, it should be reported whenever encountered in routine pathological practice.     

Micropapillary carcinoma of the urinary bladder: report of a case and review of its cytologic features

Micropapillary carcinoma (MPC) is an aggressive variant of urothelial carcinoma. MPC has a propensity to invade lymphovascular spaces and detrusor muscle early in the disease that often leads to upstaging and/or lymph node metastasis in many cases at cystectomy. Its association with the usual high-grade urothelial carcinoma provides an easy recognition of malignancy in cytology specimens without attempt at separating or identifying the MPC component. This may be related to our limited familiarity of its cytologic features with only 4 cases described in the literature. We report another case of MPC and highlight its features in cytologic preparations including the presence of singly scattered tumor cells with high nuclear to cytoplasmic ratio and pleomorphic nuclei, clustered cells devoid of fibrovascular core (micropapillae), 3-dimensional cell aggregates, cytoplasmic vacuoles, and micropapillae exhibiting some features of low-grade urothelial neoplasm. Appreciation of these features may help facilitate its early diagnosis and hopefully a better outcome for these aggressive tumors.     

Micropapillary urothelial carcinoma: Clinico-pathologic review

Micropapillary carcinoma is a rare distinct variant of high grade urothelial carcinoma, which has specific morphological characteristics and is almost always associated with muscularis propria and vascular invasion. No currently defined imaging techniques can reliably diagnose some types of deeply invasive urothelial carcinoma of urinary bladder, in particular its micropapillary variant. Therefore, the pathological findings are crucial in making the diagnosis. Micropapillary carcinoma (MPC) is a tumor with an aggressive clinical course, an advanced stage of disease at the time of presentation, and usually a poor outcome. Metastatic micropapillary carcinoma to bladder should always be included in the differential diagnosis. Correct histological diagnosis of this aggressive neoplasm would allow timely, albeit intense, radical treatment of the disease. The current most generally favored treatment option for all patients who present with MPC is immediate radical cystectomy.     

A case report of urothelial carcinoma with combined micropapillary and plasmacytoid morphology in the urinary bladder

A case of combined micropapillary and plasmacytoid urothelial carcinoma (UC) of the urinary bladder is presented for a 74‐year‐old male who was admitted to the hospital with gross hematuria and multifocal papillary bladder tumors. Abdominal computed tomography showed a large enhancing mass on the left lateral and anterior wall of the urinary bladder, which was highly suspicious for extravesicular extension and focal extension of the anterior lesion to the pubic bone. In voided urine, cancer cells were scattered as micropapillae or nests as well as single cells on the low power view. On a higher power view, micropapillae or nests were composed of pleomorphic, high grade tumor cells with an inverted nuclear arrangement and with acinar structures occasionally identified. Single cells were discohesive and large with a thick cytoplasm and eccentrically located nuclei. Histologically, the tumor from the resected bladder showed diffusely infiltrating micropapillae or nests with a surrounding halo and dense singly‐scattered plasmacytoid cells. Immunohistochemically, the cancer cells were positive for cytokeratin‐7 and cytokeratin‐20 but negative for S‐100, leukocyte common antigen, and vimentin. At the time of radical cystectomy, severe adhesions and peritoneal metastases were found and the surgery was discontinued. The patient received systemic chemotherapy, but died of bladder cancer 14 months after surgery. Diagn. Cytopathol. 2016;44:124–127. © 2015 Wiley Periodicals, Inc.     

Microcystic urothelial carcinoma: a case report

Microcystic urothelial carcinoma (MUC) is a rare variant of urothelial carcinoma that is highly aggressive with poor prognosis. Due to the scarcity of cases, its histologic morphology and immunohistochemical characteristics are still not clear. This paper reports a 71-year old female patient with gross hematuria and abdominal pain. Imaging examination showed that the bladder wall was thickened, and rough. A soft tissue mass was seen in the bladder and the left lower ureter, and the boundary between the bladder and the uterus and bilateral adnexa was not clear. Multiple enlarged lymph nodes were seen around the abdominal aorta and left iliac artery. Cystoscopy showed diffuse thickening and edema of the left wall of the bladder, local rough bleeding, and histopathologic results showed that the lesions were consistent with high-grade invasive urothelial carcinoma. Radical cystectomy and bilateral ovariectomy were performed. By microscopic observation the tumor showed infiltrative growth with cystic structures of different sizes. Mitotic figures were frequent and a large amount of mucus was in the stroma. The same type of cancer was found in the left ovary. Immunohistochemistry showed CK5/6 +, p63 +, Pax-8, MUC5AC, CK7, and Ki67 was 50%. Postoperative pathology confirmed that MUC involved the left ureter with ovarian metastasis. Two months after the operation, the patient died of vascular invasion. Because tumor cells were bland in morphology and had no specific immunohistochemical markers, they were easily missed and misdiagnosed by pathologists. Here, we describe this case and analyze it with relevant literature to deepen understanding of MUC.     

Plasmacytoid urothelial carcinoma of the urinary bladder: a clinical pathological study and literature review

Purpose

Plasmacytoid carcinoma of the urinary bladder or plasmacytoid urothelial carcinoma (PUC) is a rare and only recently described histological variant of transitional cell carcinoma (TCC). We herein report the clinical and histopathological features for a new case of PUC. By combining with those reported cases, we intend to define the characteristics of PUC and to provide a therapeutic and prognostic guidance for this disease.

Materials and Methods

The index case at our institution was a patient with complaint of lower abdominal pain but without any urological symptoms. The patient underwent radical cystectomy, and the representative sections of tumor were submitted for immunohistochemical analysis. The data for this patient were collected from clinical charts, histological review and follow-up studies. We also performed an extensive literature review of PUC including clinical presentation, pathological features, therapy and prognosis.

Results

Clinically, patients with PUC are associated with nonspecific abdominal pain but absent of hematuria. Cystoscopy analysis revealed that PUC is manifested by the coarse and indurated mucosal fold. Macroscopic studies demonstrated an ulcerated firm mass which was present in the left lateral wall of the bladder. Histologically, PUC appeared to be dyscohesive, plasmacytoid cells with eccentric nuclei and abundant eosinophilic cytoplasm with characteristics of plasmacytoid morphology. The tumor cells are negative for E-cadherin, but positive for CD138 expression. This particular patient died 3 months after the radical cystectomy and one course of adjuvant chemotherapy. Literature review revealed that most PUC cases showed similar clinical and pathological features along with poor prognosis.

Conclusions

PUC is a rare tumor associated with poor prognosis due to its advanced clinical stage upon its diagnosis. The delayed diagnosis is mainly due to the late occurrence of hematuria and absence of papulary mucosal surface at cystoscopy. Diagnosis can be achieved based on its typical histological features, clinical history and immunohistochemical results. Other than radical cystectomy, postoperative adjuvant treatment could be a good approach to prolong the survival time of PUC patients.