膀胱内翻生长型尿路上皮癌临床病理分析

摘要

目的 探讨膀胱内翻生长型尿路上皮癌的临床病理表现、诊断和鉴别诊断要点.方法 对 4 例膀胱内翻生长 型尿路上皮癌的临床资料、病理学表现、免疫组化表型和术后随访情况进行分析并复习文献.结果 ①4 例内翻生长型尿路 上皮癌患者临床表现无特异性,全程无痛性肉眼血尿及尿痛伴排尿乏力为主要症状,或于影像学检查时偶然发现膀胱占位性 病变.②病理学检查肿瘤呈灰白色息肉状或菜花状;镜下见肿瘤细胞呈内翻性生长,局灶可见外生性乳头成分,上皮条索较 粗且宽度不一,实性上皮巢不规则增生,瘤细胞具有一定的异型性,容易查见核分裂.③免疫组化仅 1 例内翻生长型尿路上皮 癌 CK20 弱阳性表达,尤其在表面增厚的尿路上皮呈全层表达;Ki-67 和 p53 在 4 例内翻生长型尿路上皮癌中的阳性表达细胞 数分别为 1% ～4%和 10% ～50%.④术后随访,4 例患者至今仍无瘤健在.结论 内翻生长型尿路上皮癌是较为少见的膀 胱恶性肿瘤,病理诊断主要需与内翻性乳头状瘤鉴别,免疫组化标记及荧光原位杂交有助于明确诊断.%Objective To investigate the clinicopathologic features of urothelial carcinoma with an endophytic growth pattern . Methods The clinical data, pathologic characteristics ,immunophenotype and postoperative follow -up of 4 cases of urothelial carcinoma with an endophytic growth pattern were analysed , and available literatures were reviewed. Results There were no specific findings in clinical manifestation of the 4 cases of urothelial carcinoma with an endophytic growth pattern . The present symptoms were illustrated as painless gross haematuria ,odynuria accompanied by urination fatigue ,and occupying lesion of bladder detected incidentally . Grossly, the mass showed an appearance like polyp or cauliflower . Microscopically, it was characterized by tumour cells with an endophytic growth pattern,and exophytic papilla could be found focally . Urothelial carcinoma with an endophytic growth pattern exhibited thick columns and varying width of the cords. Proliferative solid epithelial nests were irregular , and both cytologic atypia and mitosis were easily ob - served. Immunohistochemistry detection revealed that CK20 was weakly positive in only one case , especially in the whole superficial in - crassate urothelium. Ki-67 and p53 positively stained 1% to 4% and 10% to 50% nuclei of the tumor cells in total 4 cases. All of the four postoperative patients remained well till now. Conclusions Urothelial carcinoma with an endophytic growth pattern was a rare ma -lignant tumor of bladder. It's necessary to distinguish this tumour from inverted papilloma . Immunohistochemistry staining and fluores - cence in situ hybridization were helpful to establish the precise diagnosis .