Young R H
Department of Pathology, Massachusetts General Hospital, Boston 02114.
Histol Histopathol. 1990 Oct;5(4):505-12.
Spindle cell proliferations of diverse types which vary greatly in their behavior may occur in the urinary bladder. Some of them such as the inflammatory pseudotumor and the postoperative spindle cell nodule are reactive and clinically benign although they may be responsible for significant symptoms. On the other hand, certain other lesions such as sarcomatoid carcinomas are typically highly malignant tumours. The features of the inflammatory pseudotumor and postoperative spindle cell nodule have only recently been defined. The tendency of the former to occur in young patients and the association of the latter with a recent operative procedure are important pieces of clinical information which may prevent their mis-diagnosis. The diagnosis of sarcomatoid carcinoma should always be considered when a malignant spindle cell proliferation is encountered in the urinary bladder. Careful search for minor foci of obvious epithelial differentiation is important in establishing the diagnosis which may also be aided by immunohistochemical staining for epithelial markers. Sarcomatoid carcinoma should be distinguished from the rare transitional cell carcinoma with pseudosarcomatous stroma and from carcinosarcoma. The final lesions briefly reviewed here are mesenchymal tumors both benign and malignant, which generally do not pose the same degree of diagnostic difficulty as non-neoplastic mesenchymal proliferations and sarcomatoid carcinomas.
膀胱可能会出现多种类型的梭形细胞增殖，其行为差异很大。其中一些，如炎性假瘤和术后梭形细胞结节，是反应性的，临床上为良性，尽管它们可能会引起明显症状。另一方面，某些其他病变，如肉瘤样癌，通常是高度恶性肿瘤。炎性假瘤和术后梭形细胞结节的特征直到最近才被明确。前者倾向于发生在年轻患者中，后者与近期手术相关，这些都是重要的临床信息，可防止误诊。当膀胱出现恶性梭形细胞增殖时，应始终考虑肉瘤样癌的诊断。仔细寻找明显上皮分化的微小病灶对于确立诊断很重要，免疫组化检测上皮标志物也有助于诊断。肉瘤样癌应与罕见的伴有假肉瘤性间质的移行细胞癌以及癌肉瘤相鉴别。这里简要回顾的最后一类病变是间质性肿瘤，包括良性和恶性，一般来说，它们不会像非肿瘤性间质性增殖和肉瘤样癌那样带来同等程度的诊断困难。
