Guarch Troyas R, Jiménez Calvo J, Reparaz Romero B, Gómez Dorronsoro M L
Servicio de Anatomía Patológica, Hospital Virgen del Camino, Pamplona, Navarra.
Actas Urol Esp. 2003 Apr;27(4):297-300. doi: 10.1016/s0210-4806(03)72924-6.
A wide spectrum of glandular epitheliales metaplastic changes may be seen in the bladder. Extensive replacement of the urotelium with an epithelium resembling intestinal mucosa is recognised as a premalignant condition. However, the natural history of intestinal metaplasia of the urinary bladder and long-term outcome are unknown. We report a case of glandular cystitis with intestinal metaplasia in a young patient. Cystoscopy revealed a tumour well circumscribed measuring 4 cm on the trigone. Microscopic examination showed numerous glands lined by intestinal type epithelium without atipia, conforming to the appearance of the intestinal variant of cystitis glandularis. This case had prominent foci of basophilic mucin in the stroma. Rounded aggregates of mucin were occasionally surrounded by compressed connective tissue cells, simulating mucinous cyst. This case illustrates the extent to which cystitis glandularis may mimic a neoplasm on gross evaluation and the propensity of mucin extravasation to cause diagnostic difficulty, a finding documented only rarely previously, and we discuss its biologic significance.
膀胱可见多种腺上皮化生改变。尿路上皮被类似肠黏膜的上皮广泛取代被认为是一种癌前病变。然而,膀胱肠化生的自然病程及长期预后尚不清楚。我们报告一例年轻患者的腺性膀胱炎伴肠化生。膀胱镜检查发现三角区有一个边界清楚、大小为4 cm的肿物。显微镜检查显示大量由肠型上皮衬覆的腺体,无异型性,符合腺性膀胱炎肠型的表现。该病例间质中有明显的嗜碱性黏液灶。黏液圆形聚集体偶尔被压缩的结缔组织细胞围绕,类似黏液囊肿。该病例说明了腺性膀胱炎在大体评估时可在多大程度上酷似肿瘤,以及黏液外渗导致诊断困难的倾向,这一发现此前仅有很少的文献记载,我们还讨论了其生物学意义。