膀胱尿路上皮癌倒置变异型：三例报告及一种新的临床病理实体的提议

Inverted variant of urothelial carcinoma of the urinary bladder: a report of three cases and a proposal for a new clinicopathologic entity.

作者信息

Terada Tadashi

机构信息

Department of Pathology, Shizuoka City Shimizu Hospital, Shizuoka, Japan.

出版信息

Int J Clin Exp Pathol. 2013;6(4):766-70. Epub 2013 Mar 15.

PMID:23573325

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC3606868/

Abstract

Inverted urothelial carcinoma (UC) without papillary areas is very rare; only 31 cases of three papers have been reported. The author herein reports three additional cases, and proposes the term "inverted variant" (IV) of UC. The materials were 3 cases of IV of UC, 5 cases of inverted papilloma (IP), and two cases of nested variant (NV) of UC. The three cases of IV of UC consisted of 56-year-old woman, 63-year-old man, and 78-year-old man. Presenting symptoms were hematuria in all cases. The cystoscopic findings were elevated tumors without papillary proliferations in all cases. The treatment was transurethral tumor resection (TUR-BT) in all cases. The sizes was 0.6 cm, 0.5 cm, and 3 cm. Microscopically, IV of UC showed inverted growth of atypical cells without papillary proliferations. Compared to IP, the inverted growth pattern was similar, but cytological atypia and thick trabeculae were noted in IV of UP while they were absent in IP. Compared to NV of UC, the growth pattern is different; NV of UC showed nested and vague tubular pattern. The cellular atypia is more pronounced in IV of UC than NV of UC. Immunohistochemically, p53 expression was seen in all the cases of IV of UC and in all the cases of NV of UC, while p53 expression was negative in all the cases of IP. Ki-67 labeling index was 25, 30 and 40% in IV of UC, 15 and 30% in NV of UC, and 3, 5, 6, 7, 9% in IP. Invasive features were seen in 1 case of IV of UC and 2 cases of NV of UC. In all cases of IV of UC, IP, and NV of UC, the TUR-BT, but one case of IV of UC, showed no recurrence after TUR-BT, while one case of IV of UC showed a recurrence. In conclusion, the IV and UC were structurally and cytologically very different from the NV of UC. The IV of UC was structurally similar to IP, but cellular atypia and thickened trabeculae were seen in IV and UC. p53 expression and Ki-67 labeling status were entirely different between in IV of UC and IP. The author proposes the term of IV of UC as a new clinicopathological entity.

摘要

无乳头区域的倒置性尿路上皮癌（UC）非常罕见；仅有3篇文献报道了31例。本文作者报告另外3例，并提出UC的“倒置变体”（IV）这一术语。材料包括3例UC的IV、5例倒置性乳头状瘤（IP）和2例UC的巢状变体（NV）。3例UC的IV分别为1名56岁女性、1名63岁男性和1名78岁男性。所有病例的主要症状均为血尿。所有病例的膀胱镜检查结果均为肿瘤隆起，无乳头样增生。所有病例的治疗均为经尿道肿瘤切除术（TUR - BT）。肿瘤大小分别为0.6 cm、0.5 cm和3 cm。显微镜下，UC的IV显示非典型细胞呈倒置生长，无乳头样增生。与IP相比，倒置生长模式相似，但UC的IV可见细胞学非典型性和粗大的小梁，而IP中则无。与UC的NV相比，生长模式不同；UC的NV呈巢状和模糊的管状模式。UC的IV中细胞非典型性比UC的NV更明显。免疫组化方面，UC的IV所有病例及UC的NV所有病例均可见p53表达，而IP所有病例p53表达均为阴性。UC的IV中Ki - 67标记指数分别为25%、30%和40%，UC的NV中为15%和30%，IP中为3%、5%、6%、7%、9%。1例UC的IV和2例UC的NV有浸润性特征。UC的IV、IP和UC的NV所有病例均行TUR - BT，但1例UC的IV在TUR - BT后未复发，而1例UC的IV出现复发。总之，UC的IV在结构和细胞学上与UC的NV有很大不同。UC的IV在结构上与IP相似，但UC的IV可见细胞非典型性和小梁增粗。UC的IV和IP之间p53表达及Ki - 67标记状态完全不同。作者提出UC的IV这一术语作为一种新的临床病理实体。