Terada Tadashi
Department of Pathology, Shizuoka City Shimizu Hospital, Shimizu, Shizuoka, Japan.
Int J Clin Exp Pathol. 2013 May 15;6(6):1150-6. Print 2013.
Various tumors can arise in the urinary bladder (UB); most common is urothelial carcinoma (UC). UC of the UB have many variants. Other types of carcinomas such as adenocarcinoma (AC) and small cell carcinoma (SmCC) can occur in UB carcinomas. Expression of KIT and PDGFRA has not been reported. A 66-year-old man admitted to our hospital because of hematuria. Cystoscopy revealed papillary invasive tumor and a transurethral bladder tumorectomy (TUR-BT) was performed. The TUR-BT showed UC, AC, SmCC, large cell carcinoma (LCC), and pleomorphic carcinoma (PC). The UC component showed plasmacytoid, spindle, nested, clear cell, acantholytic variants. The AC element showed tubular adenocarcinoma and signet-ring cell carcinoma (Sig). Immunohistochemically, all of these subtypes were positive for cytokeratin (CK) AE1/3, CK CAM5.2, CK34BE12, CK5, CK6, CK7, CK8, CK18, CK19, CK20, EMA, CEA, p63, CA19-9, p53 (positive 45%), MUC1, NSE, NCAM, KIT, PDGFRA, and Ki-67 (87%). They were negative for vimentin, chromogranin, synaptophysin, S100 protein, CD34, CD14, α-smooth muscle actin, CD31, caldesmon, CD138, CD45, κ-chain, λ-chain, MUC2, MUC5AC and MUC6. Mucin histochemistry revealed mucins in AC element including Sig. A molecular genetic analysis using PCR-direct sequencing method identified no mutations of KIT (exons 9, 11, 13, and 17) and PDGFRA (exons 12 and 18) genes. The carcinoma was highly aggressive and invaded into muscular layer. The nuclear grade was very high, and there were numerous lymphovascular permeations were seen. The surface showed carcinoma in situ involving von-Brunn's nests. This case shows that carcinoma of UB can show diverse differentiations into numerous histological types and variants, and can express KIT and PDGFRA. The both genes showed no mutations in the present case.
膀胱（UB）可发生多种肿瘤；最常见的是尿路上皮癌（UC）。膀胱UC有许多变体。其他类型的癌，如腺癌（AC）和小细胞癌（SmCC）也可发生于膀胱肿瘤中。KIT和PDGFRA的表达尚未见报道。一名66岁男性因血尿入院。膀胱镜检查发现乳头状浸润性肿瘤，并进行了经尿道膀胱肿瘤切除术（TUR-BT）。TUR-BT显示肿瘤包含UC、AC、SmCC、大细胞癌（LCC）和多形性癌（PC）。UC成分表现为浆细胞样、梭形、巢状、透明细胞、棘层松解性变体。AC成分表现为管状腺癌和印戒细胞癌（Sig）。免疫组化显示，所有这些亚型的细胞角蛋白（CK）AE1/3、CK CAM5.2、CK34BE12、CK5、CK6、CK7、CK8、CK18、CK19、CK20、EMA、CEA、p63、CA19-9、p53（阳性率45%）、MUC1、NSE、NCAM、KIT、PDGFRA及Ki-67（87%）均呈阳性。波形蛋白、嗜铬粒蛋白、突触素、S100蛋白、CD34、CD14、α-平滑肌肌动蛋白、CD31、钙调蛋白、CD138、CD45、κ链、λ链、MUC2、MUC5AC及MUC6均为阴性。黏液组织化学显示AC成分（包括Sig）中有黏液。采用聚合酶链反应-直接测序法进行分子遗传学分析，未发现KIT基因（第9、11、13和17外显子）和PDGFRA基因（第12和18外显子）有突变。该肿瘤具有高度侵袭性，侵犯至肌层。核分级非常高，可见大量淋巴管浸润。表面显示原位癌累及腺性巢。该病例表明，膀胱肿瘤可表现为多种组织学类型和变体的不同分化，并可表达KIT和PDGFRA。在本病例中，这两个基因均未发现突变。
