Shimada Keiji, Nakamura Mitsutoshi, Konishi Noboru
Department of Pathology, Nara Medical University School of Medicine, Kashihara, Nara, Japan.
Diagn Cytopathol. 2009 Apr;37(4):272-6. doi: 10.1002/dc.21018.
We present very rare variants of urothelial carcinoma featuring nested, plasmacytoid, and lipoid cell morphology in an 80-year-old female who was admitted to our hospital with mictritional pain and bilateral hydronephrosis. Abdominal computed tomography showed diffuse thickening of the urinary bladder, indicating probable invasion into the surrounding adipose tissue. Cytological tests on a urine specimen revealed medium-sized cancer cell clusters with hyperchromatic nuclei and dense cytoplasm, small clusters of dyshesive cells with eccentric or crescent nuclei, and abundant or vacuolated cytoplasm mimicking plasma cells or lipoblasts. Histopathological findings of the bladder tumor revealed that the nested urothelial carcinoma variants were mainly located in the lamina propria, whereas the plasmacytoid and lipoid-cell variants had deeply infiltrated into cells with a myxoid background. Immunohistochemically, the cancer cells were positive for cytokeratin, epithelial membrane antigen, but not for vimentin, S-100, or hematopoietic markers of plasma cells such as CD79alpha and CD38. The patient received no radiosurgical therapies because of the advanced stage of her disease and died a few months after the initial diagnosis. To our knowledge, this is the first cytological and histological examination of urothelial carcinoma consisting of nested, plasmacytoid, and lipoid-cell variants of the urinary bladder.
我们报告了一例80岁女性的尿路上皮癌罕见变体，其具有巢状、浆细胞样和类脂质细胞形态。该患者因腰痛和双侧肾积水入院。腹部计算机断层扫描显示膀胱弥漫性增厚，提示可能侵犯周围脂肪组织。尿液标本的细胞学检查发现中等大小的癌细胞团，核深染，细胞质浓密；小的散在细胞团，核偏心或呈新月形，细胞质丰富或呈空泡状，类似浆细胞或成脂细胞。膀胱肿瘤的组织病理学检查发现，巢状尿路上皮癌变体主要位于固有层，而浆细胞样和类脂质细胞变体已深入浸润到具有黏液样背景的细胞中。免疫组织化学检查显示，癌细胞细胞角蛋白、上皮膜抗原呈阳性，但波形蛋白、S-100或浆细胞的造血标志物如CD79α和CD38呈阴性。由于疾病分期较晚，该患者未接受放射外科治疗，在初次诊断后几个月死亡。据我们所知，这是首次对膀胱巢状、浆细胞样和类脂质细胞变体的尿路上皮癌进行细胞学和组织学检查。
