Alsheikh A, Mohamedali Z, Jones E, Masterson J, Gilks C B
Department of Pathology, Vancouver Hospital and University of British Columbia, Vancouver, British Columbia, Canada.
Mod Pathol. 2001 Apr;14(4):267-72. doi: 10.1038/modpathol.3880300.
It has not been possible to identify those low-grade papillary transitional cell bladder tumors that will recur based on conventional histopathologic assessment. Both the new World Health Organization/International Society of Urologic Pathology (WHO/ISUP) classification of transitional cell papillary neoplasms and the pattern of tumor cytokeratin 20 (CK20) immunostaining have been suggested as means of improving prognostication in low-grade transitional cell tumors. Forty-nine low-grade, noninvasive papillary transitional cell tumors were identified for the period between 1984 and 1993. The recently described WHO/ISUP classification was applied, and the tumors were classified histologically as papilloma, papillary neoplasm of low malignant potential (LMP) or low-grade papillary carcinoma. After CK20 immunostaining, the expression pattern in the tumor was classified as normal (superficial) or abnormal. Of 49 tumors, 20 were classified as papillary neoplasms of LMP and five of these patients (25%) experienced a recurrence. Of 29 tumors classified as low-grade papillary carcinoma, 14 (48.2%) recurred. In 46 of 49 cases, the CK20 immunostaining could be evaluated. Sixteen tumors showed normal (superficial) pattern of CK20 expression, and four (25%) of these patients experienced a recurrence. In contrast, of 30 patients with abnormal CK20 staining of their tumors, 15 (50%) patients had one or more recurrences. In this study, papillary neoplasms of LMP (as per the WHO/ISUP classification system) had a lower recurrence rate than low-grade papillary transitional cell carcinoma. Similarly low-grade urothelial tumors showing a normal CK20 expression pattern recurred less frequently than tumors with an abnormal pattern of CK20 staining. Neither of these differences was statistically significant, and recurrences were observed in 20% of patients whose tumors were both classified as papillary neoplasms of LMP and showed normal CK20 immunostaining; thus they do not allow a change in our current management of patients with low-grade papillary urothelial tumors, with close follow-up for all patients.
基于传统组织病理学评估，尚无法识别那些会复发的低级别乳头状移行细胞膀胱肿瘤。世界卫生组织/国际泌尿病理学会（WHO/ISUP）对移行细胞乳头状肿瘤的新分类以及肿瘤细胞角蛋白20（CK20）免疫染色模式均被认为是改善低级别移行细胞肿瘤预后评估的方法。在1984年至1993年期间识别出49例低级别、非侵袭性乳头状移行细胞肿瘤。应用了最近描述的WHO/ISUP分类，并将肿瘤组织学分类为乳头状瘤、低恶性潜能（LMP）乳头状肿瘤或低级别乳头状癌。CK20免疫染色后，肿瘤中的表达模式被分类为正常（表面）或异常。49例肿瘤中，20例被分类为LMP乳头状肿瘤，其中5例患者（25%）复发。在29例被分类为低级别乳头状癌的肿瘤中，14例（48.2%）复发。49例病例中有46例可评估CK20免疫染色。16例肿瘤显示CK20表达正常（表面）模式，其中4例患者（25%）复发。相比之下，30例肿瘤CK20染色异常的患者中，15例（50%）有一次或多次复发。在本研究中，LMP乳头状肿瘤（根据WHO/ISUP分类系统）的复发率低于低级别乳头状移行细胞癌。同样，CK20表达模式正常的低级别尿路上皮肿瘤的复发频率低于CK20染色模式异常的肿瘤。这两种差异均无统计学意义，并且在肿瘤既被分类为LMP乳头状肿瘤且CK20免疫染色正常的20%患者中观察到复发；因此，它们不允许改变我们目前对低级别乳头状尿路上皮肿瘤患者的管理方式，所有患者均需密切随访。
