Loghin Andrada, Chibelean Călin, Orsolya Mártha, Nechifor-Boilă Adela, Nechifor-Boilă Alin, Borda Angela
Department of Urology, University of Medicine and Pharmacy of Tirgu Mures, Romania;
Rom J Morphol Embryol. 2014;55(3):939-45.
Micropapillary urothelial carcinoma (MPC) is a rare variant of urothelial carcinoma (UC) with an aggressive clinical course, an advanced stage at first presentation and a high metastatic potential. The aim or our study is to present five illustrative cases of MPC, diagnosed among the 21 patients with UC treated by radical cystectomy in the Department of Urology, County Hospital of Tirgu Mures, Romania, between January 1, 2011 and December 31, 2013. The morphological and immunohistochemical features of this rare and aggressive variant of UC, as well as a brief review of the literature are all presented. All five cases were associated with lymph node metastases with micropapillary features, regardless of the microscopic aspect of the tumor on the surgical specimens [transurethral resection (TUR) or cystectomy]. Three of them had a micropapillary component in the TUR, on the cystectomy specimen, or in both, along with lymph nodes metastases. In two cases, the MPC features were present only in the lymph node metastasis, with a conventional UC on the TUR and on the cystectomy. Immunohistochemical staining demonstrated that both micropapillary and associated conventional UC were positive for CK7 and CK20. Ki67 was expressed in 40% of tumor cells and CD34 was positive in the endothelial cells and negative in the flattened spindled cells lining the retraction spaces around tumor cell nests. MPC is a highly aggressive variant of UC with specific morphological characteristics. Any amount of micropapillary component found in UC is significant, and should be reported because it encompasses an aggressive clinical behavior and a poor prognosis.
微乳头型尿路上皮癌（MPC）是尿路上皮癌（UC）的一种罕见变体，临床病程侵袭性强，初诊时多为晚期，且具有较高的转移潜能。我们研究的目的是呈现5例MPC的典型病例，这些病例是在2011年1月1日至2013年12月31日期间，罗马尼亚特尔古穆列什县医院泌尿外科对21例接受根治性膀胱切除术的UC患者中诊断出来的。本文呈现了这种罕见且侵袭性强的UC变体的形态学和免疫组化特征，并对相关文献进行了简要回顾。所有5例均伴有具有微乳头特征的淋巴结转移，无论手术标本[经尿道切除术（TUR）或膀胱切除术]上肿瘤的微观表现如何。其中3例在TUR标本、膀胱切除标本或两者中均有微乳头成分，并伴有淋巴结转移。在2例中，MPC特征仅存在于淋巴结转移中，而TUR和膀胱切除标本上为传统型UC。免疫组化染色显示，微乳头型及相关的传统型UC对CK7和CK20均呈阳性。Ki67在40%的肿瘤细胞中表达，CD34在内皮细胞中呈阳性，而在肿瘤细胞巢周围退缩间隙内衬的扁平梭形细胞中呈阴性。MPC是UC的一种高度侵袭性变体，具有特定的形态学特征。在UC中发现的任何数量的微乳头成分都具有重要意义，应予以报告，因为它预示着侵袭性的临床行为和不良预后。
