Lopez-Beltran Antonio, Montironi Rodolfo, Vidal Alfredo, Scarpelli Marina, Cheng Liang
Department of Surgery and Pathology, Cordoba University Medical School, Cordoba, Spain.
Institute of Pathological Anatomy and Histopathology, Polytechnic University of the Marche Region, Ancona, Italy.
Anal Quant Cytopathol Histpathol. 2013 Jun;35(3):121-9.
The 2004 World Health Organization classification system for urothelial neoplasia identifies urothelial dysplasia (low-grade intraurothelial neoplasia) as a premalignant lesion of the urothelium. Although diagnostic criteria of urothelial dysplasia have been improved in recent years, there is a frequent lack of interobserver reproducibility. Follow-up studies suggest that dysplasia is a marker for urothelial instability and disease progression in up to 19% of patients, thus supporting an active clinical follow-up in these patients. The main differential diagnosis of urothelial dysplasia includes flat urothelial lesions with atypia, mainly flat (simple) urothelial hyperplasia, reactive urothelial atypia, urothelial atypia of unknown significance, and urothelial carcinoma in situ (high-grade intraurothelial neoplasia). In most cases, morphologic features alone suffice for diagnosis. Some cases may require a panel of immunohistochemical antibodies consisting of cytokeratin 20, p53 and CD44 for diagnosis. We present pathologic features and clinical significance of urothelial dysplasia with emphasis on differential diagnosis from common flat urothelial lesions with atypia.
2004年世界卫生组织尿路上皮肿瘤分类系统将尿路上皮发育异常（低级别尿路上皮内瘤变）确定为尿路上皮的一种癌前病变。尽管近年来尿路上皮发育异常的诊断标准有所改进，但观察者间的可重复性常常不足。随访研究表明，发育异常是高达19%患者尿路上皮不稳定和疾病进展的一个标志物，因此支持对这些患者进行积极的临床随访。尿路上皮发育异常的主要鉴别诊断包括伴有异型性的扁平尿路上皮病变，主要是扁平（单纯）尿路上皮增生、反应性尿路上皮异型性、意义不明的尿路上皮异型性以及原位尿路上皮癌（高级别尿路上皮内瘤变）。在大多数情况下，仅形态学特征就足以诊断。有些病例可能需要一组由细胞角蛋白20、p53和CD44组成的免疫组化抗体来进行诊断。我们阐述尿路上皮发育异常的病理特征和临床意义，重点是与常见的伴有异型性的扁平尿路上皮病变进行鉴别诊断。
