Ho Henry, Chen Y D, Tan P H, Wang M, Lau W K O, Cheng Christopher
Department of Urology, Singapore General Hospital, Singapore, Singapore.
Urology. 2006 Aug;68(2):333-6. doi: 10.1016/j.urology.2006.03.014.
To review all cases of urinary bladder inverted papilloma (IP) in our institution and determine the need for cystoscopic surveillance. IP is an uncommon benign tumor of the urinary tract. Its multiplicity, recurrence, and association with transitional cell carcinoma (TCC) suggest possible malignant potential, leading to conflicting clinical conclusions regarding the need for surveillance.
All consecutive patients from January 1991 to December 2004 with IP were included in this study. A single pathologist performed the histologic review. The patients had undergone cystoscopy and ultrasound evaluation of the kidneys every 6 months.
Of the 52 patients, 45 were men and 7 were women. The average age at presentation was 58.9 +/- 11.8 years (range 30 to 79). No patient had a synchronous or previous bladder tumor. The most common complaint was macroscopic hematuria. Ten cases were incidental findings during bladder ultrasonography or cystoscopy. All were solitary tumors, most commonly found at the bladder neck. The average follow-up period was 62 +/- 23 months, with no recurrence. One case of subsequent noninvasive papillary TCC developed 15 months later. The initial histologic findings had revealed cytologic atypia, with suspicious urine cytology findings. On review, it was more compatible with TCC with an inverted pattern.
Although our cases exhibited benign biologic behavior, the presence of cytologic atypia and suspicious urine cytology require exclusion of TCC with an inverted pattern. Thus, in histologically proven solitary bladder IP with no associated TCC, cystoscopic surveillance may not be necessary.
回顾我院所有膀胱内翻性乳头状瘤（IP）病例，并确定膀胱镜监测的必要性。IP是一种少见的泌尿道良性肿瘤。其多发性、复发性以及与移行细胞癌（TCC）的关联提示可能具有恶性潜能，这导致关于监测必要性的临床结论存在争议。
纳入1991年1月至2004年12月期间所有连续诊断为IP的患者。由一名病理学家进行组织学检查。患者每6个月接受一次膀胱镜检查及肾脏超声评估。
52例患者中，45例为男性，7例为女性。就诊时的平均年龄为58.9±11.8岁（范围30至79岁）。无患者同时患有或既往有膀胱肿瘤。最常见的症状是肉眼血尿。10例是在膀胱超声检查或膀胱镜检查时偶然发现的。所有均为单发肿瘤，最常见于膀胱颈部。平均随访期为62±23个月，无复发。1例在15个月后发生了非侵袭性乳头状TCC。最初的组织学检查发现有细胞学异型性，尿液细胞学检查结果可疑。复查时，其更符合具有内翻模式的TCC。
尽管我们的病例表现出良性生物学行为，但细胞学异型性和可疑的尿液细胞学检查结果需要排除具有内翻模式的TCC。因此，在组织学证实为单发膀胱IP且无相关TCC的情况下，可能无需进行膀胱镜监测。
