膀胱巢状变异型尿路上皮癌的临床特点分析

摘要

Objective To analyze the clinical features of nested variant of bladder urothelial carcinoma.Methods The clinical data of 13 patients with nested variant of bladder urothelial carcinoma treated in our hospital from July 2014 to April 2018 were retrospectively analyzed.There were 10 males and 3 females and the mean age was 64.6(37-81) years.All 13 cases had symptom of hematuria,3 cases with anemia,1 cases with urinary frequency,urgency and dysuria,1 case with all the above symptoms.Six cases underwent transurethral resection of the bladder tumor (TURBT),7 cases underwent radical cystectomy.Results All 13 cases had nested structures in pathology.Six cases did immunohistochemistry but none of them were specific.Twelve cases were high-grade invasive urothelial carcinoma,of which 2 cases were associated with carcinoma in situ,and 1 case was low-grade invasive.Two patients' pathological stages were ≤T1,4 patients in T2 phase,and 7 patients in T3-4 phase.Four patients who underwent TURBT received intravesical instillation chemotherapy,and 3 patients who underwent radical cystectomy and 1 patient with TURBT received intravenous chemotherapy.One patient with TURBT received both intravesical chemotherapy and intravenous chemotherapy.The remaining 4 patients who underwent radical cystectomy did not receive special treatment.The progression-free survival time of 13 patients was 2-39 months,of which 2 patients relapsed,1 patient metastasized,1 patient with tumor progression,and 2 patients with non-tumor specific death.Conclusions The clinical features of nested variant of urothelial carcinoma special.However,the pathology of nested variant of bladder urothelial carcinoma has a unique nested structure.At present,TURBT and radical cystectomy are still the main treatment modalities for nested variant of bladder urothelial carcinoma,and the prognosis of which is poor.%目的 分析膀胱巢状变异型尿路上皮癌的临床特点.方法 回顾性分析2014年7月至2018年4月我院收治的13例膀胱巢状变异型尿路上皮癌患者的临床资料.男10例,女3例;年龄37 ～81岁,平均64.6岁;13例均有血尿症状,其中3例合并贫血,1例合并膀胱刺激征,1例同时合并以上所有症状.13例中6例行经尿道膀胱肿瘤切除术(TURBT),7例行根治性膀胱切除术.结果 术后病理检查示13例肿瘤组织均有巢状结构;12例为高级别浸润性尿路上皮癌(其中2例伴原位癌),1例为低级别浸润性尿路上皮癌.病理分期≤T1期2例,T2期4例,T3 ～4期7例.4例行TURBT的患者术后接受膀胱灌注化疗,3例行根治性膀胱切除术和1例行TURBT的患者术后接受静脉化疗,1例行TURBT的患者术后先后接受膀胱灌注化疗和静脉化疗,余4例行根治性膀胱切除术的患者未行特殊治疗.13例无进展生存时间为2～39个月,其中2例复发,1例转移,1例肿瘤进展,2例非肿瘤特异性死亡.结论 膀胱巢状变异型尿路上皮癌的症状无特殊,病理有独特的小巢状结构,目前的治疗方式仍以TURBT和根治性膀胱切除术为主,预后不佳.