Jozwicki Wojciech, Domaniewski Jan, Skok Zdzislaw, Wolski Zbigniew, Domanowska Ewa, Jozwicka Grazyna
Department of Clinical Pathology, The Ludwik Rydygier Collegium Medicum, Nicolaus Copernicus University, Torun, Poland.
Urology. 2005 Nov;66(5):1122-6. doi: 10.1016/j.urology.2005.06.134.
To examine the histologic homogeneity of muscle-invasive urothelial cell carcinoma of the bladder, with conventional and nonconventional (eg, squamous, glandular, or variants) differentiation, to assess its influence on prognosis.
With organ mapping, we investigated 38 cystectomy specimens. Each entire bladder was cut into 88 slices according to an identical topographic scheme. From all the bladder slices, 1231 slices that included tumor were chosen for the histologic study. We examined the diagnostic significance, extension, and number of histologic differentiation types.
The extension of nonconventional differentiation, with any proportion of histologic type, had an unfavorable impact on survival time. The number of nonconventional differentiation types increases in the presence of a sarcomatoid, an undifferentiated, a nested, or a micropapillary pattern. The increased number of differentiation types had an unfavorable influence on survival time. Patients with a more than 80% classic urothelial cell carcinoma pattern had a favorable prognosis, which increased further with increasing percentages of this differentiation type.
Muscle-invasive urinary bladder cancers are not a homogenous group of tumors. Our results suggest that a precise assessment of the extension and number of histological differentiation types may be an individual prognostic factor. Conventional differentiation with at least 80% extension seems to be prognostically favorable. Nonconventional differentiation, especially with greater extension and a greater number of types, could imply a worse prognosis.
研究具有传统和非传统（如鳞状、腺性或变异型）分化的膀胱肌层浸润性尿路上皮细胞癌的组织学同质性，评估其对预后的影响。
采用器官绘图法，我们研究了38例膀胱切除术标本。按照相同的地形学方案将每个完整的膀胱切成88片。从所有膀胱切片中，选取1231片包含肿瘤的切片进行组织学研究。我们检查了组织学分化类型的诊断意义、范围和数量。
任何组织学类型比例的非传统分化范围对生存时间有不利影响。在出现肉瘤样、未分化、巢状或微乳头模式时，非传统分化类型的数量增加。分化类型数量的增加对生存时间有不利影响。经典尿路上皮细胞癌模式占比超过80%的患者预后良好，随着这种分化类型百分比的增加，预后进一步改善。
膀胱肌层浸润性癌并非一组同质的肿瘤。我们的结果表明，精确评估组织学分化类型的范围和数量可能是一个个体预后因素。至少80%范围的传统分化在预后方面似乎是有利的。非传统分化，尤其是范围更大和类型更多时，可能意味着预后更差。
