Department of Pathology, The Johns Hopkins Medical Institutions, Baltimore, MD, USA.
Am J Surg Pathol. 2009 Oct;33(10):1540-6. doi: 10.1097/PAS.0b013e3181aec42a.
Technical advances in endoscopic equipment have led to increased ureteroscopic biopsies of the upper urinary tract, resulting in limited biopsy material. We retrospectively reviewed 76 consecutive mid-upper ureter and renal pelvis biopsies submitted for consultation from January 2004 to January 2009, where follow-up was obtainable. There were 49 (64.5%) males and 27 (35.5%) females. Thirty-nine (51.3%) of the biopsies were from the ureter with the remaining 37 (48.7%) from the renal pelvis. The mean age was 70 years for males and 71 for females (range: 24 to 89). At consultation, the most common diagnoses were benign urothelium (n=25, 32.9%); atypical (n=17, 22.4%); low-grade noninvasive papillary urothelial carcinoma (n=10, 13.2%); and high-grade noninvasive papillary urothelial carcinoma (n=8, 10.5%). In cases where a definitive diagnosis could not be reached on expert review, it was mainly because of the limited size of the biopsy, absence of papillary fronds, crush artifact, and distorted architecture. There were 7 major discrepancies between the outside and second opinion diagnosis, where all of the cases were initially diagnosed as an urothelial neoplasm, yet was non-neoplastic upon review. Strips of urothelium without well-developed fibrovascular cores, polypoid ureteritis/pyelitis, and reactive urothelium mimicked urothelial neoplasms. In 5 of these 7 cases, there was no gross lesion suspicious of a tumor present according to the urologist. Overall, 33 of the 44 (75%) cases with a mass noted by the urologist or by radiography was found to have a neoplasm at follow-up. Conversely, 24 of the 32 (75%) cases without a grossly suspected tumor had no neoplasm at follow-up. The association between the histologic presence of a neoplasm at follow-up and the presence of a clinically suspected tumor was highly significant (P<0.0001). Pathologists need to recognize that in almost 1 of the 4 renal pelvic/ureteral biopsies a definitive diagnosis cannot be made because of the inadequate tissue. Caution must be exercised in the evaluation of these limited specimens, especially in the absence of a clinically suspected tumor.
内镜设备的技术进步导致上尿路输尿管镜检查活检的增加，导致活检标本有限。我们回顾性分析了 2004 年 1 月至 2009 年 1 月期间因随访而获得的连续 76 例中上部输尿管和肾盂活检，其中 49 例（64.5%）为男性，27 例（35.5%）为女性。39 例（51.3%）活检来自输尿管，其余 37 例（48.7%）来自肾盂。男性的平均年龄为 70 岁，女性为 71 岁（范围：24 至 89 岁）。在会诊时，最常见的诊断是良性尿路上皮（n=25，32.9%）；非典型（n=17，22.4%）；低级别非浸润性乳头状尿路上皮癌（n=10，13.2%）；高级别非浸润性乳头状尿路上皮癌（n=8，10.5%）。在专家审查无法得出明确诊断的情况下，主要是由于活检标本有限、缺乏乳头状叶、压碎伪影和结构扭曲。外部和第二意见诊断之间有 7 个主要差异，所有病例最初均被诊断为尿路上皮肿瘤，但经审查后均为非肿瘤。没有发育良好的纤维血管核心的尿路上皮条带、息肉状输尿管炎/肾盂炎和反应性尿路上皮模仿尿路上皮肿瘤。在这 7 例中有 5 例中，泌尿科医生或放射科医生根据大体检查没有发现可疑肿瘤的病变。总的来说，泌尿科医生或放射影像学检查发现肿块的 44 例（75%）中有 33 例在随访中发现有肿瘤。相反，32 例（75%）中没有大体可疑肿瘤的病例在随访中没有肿瘤。随访时存在肿瘤与存在临床可疑肿瘤之间的相关性具有统计学意义（P<0.0001）。病理学家需要认识到，在近 1/4 的肾盂/输尿管活检中，由于组织不足，无法做出明确诊断。在评估这些有限的标本时必须谨慎，特别是在没有临床可疑肿瘤的情况下。
