Miller Jeremy S, Epstein Jonathan I
Department of Pathology, The Johns Hopkins Hospital, Baltimore, MD 21231, USA.
Am J Surg Pathol. 2009 Aug;33(8):1241-8. doi: 10.1097/PAS.0b013e3181a1ff41.
Noninvasive urothelial carcinoma (UC) with glandular differentiation in the absence of infiltrating carcinoma is a rare entity that has not been well characterized. We retrieved 24 cases of noninvasive UC of the bladder with glandular differentiation on biopsy (n=20) or transurethral resection (n=4) without an associated invasive component. The cases were identified from the consult files of one of the authors between 1992 and 2008. Mean patient age at diagnosis was 70 years (range: 48 to 87 y) and 75% were male. Half of the cases were pure noninvasive UC with glandular differentiation; half were associated with either carcinoma in situ or high-grade noninvasive papillary carcinoma. The glandular component consisted of 1 or more patterns: papillary (46% of cases), glandular (42%), cribriform (33%), and flat (25%). Mitoses, apoptosis, and necrosis were identified in 83%, 67%, and 17% of the biopsies, respectively. One case was a recent diagnosis, and 5 patients either refused treatment or were lost to follow-up. Of the 18 patients with available follow-up information, 9 (50%) did not develop invasive carcinoma; the remaining 9 (50%) eventually developed an invasive bladder tumor. Of these, 2 were small cell carcinoma, 3 were poorly-differentiated UC (2 of these developed widespread metastases), and 4 were UC, not otherwise specified. In both instances of eventual small cell carcinoma, and in 2 of the 3 cases of poorly-differentiated UC, the initial biopsy consisted of pure noninvasive UC with glandular differentiation without carcinoma in situ or noninvasive papillary carcinoma. Of note, none of the patients in the study developed invasive adenocarcinoma.
无浸润性癌的非侵袭性尿路上皮癌（UC）伴腺性分化是一种罕见的实体，其特征尚未得到充分描述。我们检索了24例膀胱非侵袭性UC伴腺性分化的病例，这些病例通过活检（n = 20）或经尿道切除术（n = 4）确诊，且无相关侵袭成分。这些病例来自其中一位作者在1992年至2008年期间的会诊档案。诊断时患者的平均年龄为70岁（范围：48至87岁），75%为男性。一半的病例为单纯的非侵袭性UC伴腺性分化；另一半与原位癌或高级别非侵袭性乳头状癌相关。腺性成分由1种或多种模式组成：乳头状（46%的病例）、腺性（42%）、筛状（33%）和平坦状（25%）。分别在83%、67%和17%的活检标本中发现有丝分裂、凋亡和坏死。1例为近期诊断，5例患者拒绝治疗或失访。在有随访信息的18例患者中，9例（50%）未发生浸润性癌；其余9例（50%）最终发生了浸润性膀胱肿瘤。其中，2例为小细胞癌，3例为低分化UC（其中2例发生广泛转移），4例为未另行指定的UC。在最终诊断为小细胞癌的2例病例以及3例低分化UC中的2例中，最初的活检均为单纯的非侵袭性UC伴腺性分化，无原位癌或非侵袭性乳头状癌。值得注意的是，该研究中的患者均未发生浸润性腺癌。
