Venyo Anthony Kodzo-Grey
Department of Urology, North Manchester General Hospital, Delaunays Road, Crumpsall, Manchester, UK.
Adv Urol. 2014;2014:192720. doi: 10.1155/2014/192720. Epub 2014 Jan 22.
Background. Nested variant of urothelial carcinoma was added to the WHO's classification in 2004. Aims. To review the literature on nested variant of urothelial carcinoma. Results. About 200 cases of the tumour have been reported so far and it has the ensuing morphological features: large numbers of small confluent irregular nests of bland-appearing, closely packed, haphazardly arranged, and poorly defined urothelial cells infiltrating the lamina propria and the muscularis propria. The tumour has a bland histomorphologic appearance, has an aggressive biological behaviour, and has at times been misdiagnosed as a benign lesion which had led to a significant delay in the establishment of the correct diagnosis and contributing to the advanced stage of the disease. Immunohistochemically, the tumour shares some characteristic features with high-risk conventional urothelial carcinomas such as high proliferation index and loss of p27 expression. However, p53, bcl-2, or EGF-r immunoreactivity is not frequently seen. The tumour must be differentiated from a number of proliferative lesions of the urothelium. Conclusions. Correct and early diagnosis of this tumour is essential to provide early curative treatment to avoid diagnosis at an advanced stage. A multicentre trial is required to identify treatment options that would improve the outcome of this tumour.
背景。尿路上皮癌巢状变异型于2004年被纳入世界卫生组织分类。目的。回顾关于尿路上皮癌巢状变异型的文献。结果。迄今为止已报道了约200例该肿瘤病例，其具有以下形态学特征：大量小的融合性不规则巢状结构，由外观温和、紧密排列、杂乱无章且边界不清的尿路上皮细胞组成，浸润固有层和肌层。该肿瘤具有温和的组织形态学外观，具有侵袭性生物学行为，有时被误诊为良性病变，这导致正确诊断的建立出现显著延迟，并促使疾病进展至晚期。免疫组织化学方面，该肿瘤与高危传统尿路上皮癌具有一些共同特征，如高增殖指数和p27表达缺失。然而，p53、bcl-2或表皮生长因子受体免疫反应性并不常见。该肿瘤必须与多种尿路上皮增生性病变相鉴别。结论。对该肿瘤进行正确和早期诊断对于提供早期治愈性治疗以避免晚期诊断至关重要。需要进行多中心试验以确定可改善该肿瘤治疗结果的治疗方案。
