Asano K, Abe K, Kato N, Miki K, Furuta N, Kiyota H, Onishi T, Furusato M, Onodera S, Oishi Y
Department of Urology, Jikei University School of Medicine.
Nihon Hinyokika Gakkai Zasshi. 1999 Apr;90(4):514-20. doi: 10.5980/jpnjurol1989.90.514.
Inverted papilloma of the urinary tract is believed to be a benign neoplasm based on its histologic morphology and clinical behavior. In recent years, however, several investigators have warned against too optimistic an approach, emphasizing the possibility of malignant cellular transformation within the lesion, or its eventual association with other urothelial tumors such as transitional cell carcinoma or carcinoma in situ. We here report on 35 clinicopathologically diagnosed cases of inverted papilloma, and present the clinical significance attributed to these lesions in view of the current literature.
From 1976 to 1997, 35 cases of inverted papilloma of the urinary tract were treated at our hospital. This report presents the clinical features of these cases, the results of prognosis research, an investigation of the cases in which inverted papilloma and transitional cell carcinoma were found to co-exist, and a discussion of the recurrent cases of inverted papilloma found in previous literature.
The patients ranged from 24 to 77 years of age, with a mean of 54 years, and included 4 women and 31 men. The most frequently occurring symptom was grosshematuria, and more than 90% of the 35 cases occurred in the bladder. In 2 of the 35 cases, transitional cell carcinoma coexisted with the inverted papilloma, at a different location in the bladder in one case and within the same neoplasm in the ureter in the other case. Clinical courses after treatment were followed in 29 of the 35 cases, with a follow-up period of from 8 months to 19 years (mean follow-up, 5 years and 4 months). Of these 29 cases, 2 showed recurrence, one at 16 and one at 30 months after the initial resection. Many previous reports show that the association of inverted papilloma and transitional cell carcinoma is stronger in the upper urinary tract and recurrence of inverted papilloma almost always happens with 2 years.
This study suggests that some cases of urinary inverted papilloma show recurrence or malignant potential. Our results indicate that all cases of urinary inverted papilloma should be treated and followed as cases of low-grade transitional cell carcinomas. Consequently, all cases must be followed for two years or more after the initial operation.
基于其组织形态学和临床行为，泌尿道内翻性乳头状瘤被认为是一种良性肿瘤。然而，近年来，一些研究者警告不要过于乐观，强调病变内恶性细胞转化的可能性，或其最终与其他尿路上皮肿瘤如移行细胞癌或原位癌的关联。我们在此报告35例经临床病理诊断的内翻性乳头状瘤病例，并根据当前文献阐述这些病变的临床意义。
1976年至1997年，我院共治疗35例泌尿道内翻性乳头状瘤。本报告介绍了这些病例的临床特征、预后研究结果、对内翻性乳头状瘤与移行细胞癌共存病例的调查，以及对既往文献中内翻性乳头状瘤复发病例的讨论。
患者年龄在24岁至77岁之间，平均年龄54岁，其中女性4例，男性31例。最常见的症状是肉眼血尿，35例中超过90%发生在膀胱。35例中有2例，移行细胞癌与内翻性乳头状瘤共存，1例在膀胱的不同部位，另1例在输尿管的同一肿瘤内。35例中有29例在治疗后进行了临床病程随访，随访期为8个月至19年（平均随访5年4个月）。在这29例中，2例复发，1例在初次切除后16个月复发，另1例在30个月复发。许多既往报告显示，内翻性乳头状瘤与移行细胞癌的关联在上尿路更强，内翻性乳头状瘤几乎总是在2年内复发。
本研究表明，部分泌尿道内翻性乳头状瘤病例表现出复发或恶性潜能。我们的结果表明，所有泌尿道内翻性乳头状瘤病例都应作为低级别移行细胞癌病例进行治疗和随访。因此，所有病例在初次手术后必须随访两年或更长时间。
