膀胱低度恶性潜能乳头状尿路上皮肿瘤12例临床病理分析

目的:结合文献复习探讨膀胱低度恶性潜能乳头状尿路上皮肿瘤(PUNLMP)临床病理学、免疫组化、鉴别诊断及预后。方法:对12例进行经尿道膀胱电切术(TURBt),经病理制片,光镜观察及免疫组化CK20、Ki-67、34!E12标记。结果:12例患者平均年龄为53.3岁,临床症状以血尿为主,膀胱镜检查病损均为<3cm。光镜观察均符合PUNLMP的诊断标准。预后10例获随访12～36月不等,均无复发。结论:膀胱PUNLMP属介于良、恶性之间肿瘤的独立类型,需长期随访,偶有复发,大多数病例不进展为癌,应与低级别癌区分。

Report of 12 Cases of Papillary Urothelial Neoplasm of Low Malignant Potential of the Urinary Bladder with Clinicopathological Analysis and Review of the Literature

Objective:To explore the clinicopathological and immunohistochemical features,differential diagnosis,and prognosis of papillary urothelial neoplasm of low malignant potential(PUNLMP),and to review the literature.Methods:Transurethral resection of bladder tumor(TURBT)was performed on all 12 cases of PUNLMP,and pathological sections were made.Microscopic and immunohistochemical evaluations were performed.Results:The average age of the 12 patients was 53.3 years.Hematuria was the chief symptom.The diameters of all lesions were less than 3 cm based on findings with a cystoscope.The features on microscopy were all consistent with the diagnostic criteria of PUNLMP.Follow-ups were obtained for 10 patients,and the durations ranged from 12 to 36 months.No recurrence was found.Conclusion:PUNLMP in the urinary bladder is a distinct type of intermediate tumor with behavior somewhere between benign and malignant tumors that needs a long period of follow-up.Recurrence is rare.Most cases do not progress into carcinoma.PUNLMP should be differentiated from the low grade carcinomas as a separate entity.