Department of Gynecology and Obstetrics, Cantonal Hospital Frauenfeld, Frauenfeld, Switzerland; Institute of Pathology (SR), Medical University Graz, Austria.
Department of Gynecology and Obstetrics, Cantonal Hospital Frauenfeld, Frauenfeld, Switzerland; Institute of Pathology (SR), Medical University Graz, Austria.
J Urol. 2015 Jun;193(6):1994-2000. doi: 10.1016/j.juro.2015.01.036. Epub 2015 Jan 14.
ESSIC identifies mast cell infiltrates of detrusor muscle as a diagnostic criterion for bladder pain syndrome/interstitial cystitis. However, an increased mast cell count is also characteristic of overactive bladder syndrome. The lack of uniformity in mast cell detection methods hampers data comparison. Using state-of-the-art techniques we investigated whether mast cells differ among bladder conditions.
We analyzed bladder biopsies from 56 patients, including 31 with bladder pain syndrome/interstitial cystitis with (12) or without (19) Hunner lesions, 13 with overactive bladder syndrome and 12 without bladder symptoms to determine the quantity, location, distribution and activation of mast cells using immunohistochemistry with anti-mast cell tryptase. Patients were allocated to study groups by key bladder symptoms commonly used to define conditions (pain and major urgency).
Subepithelial mast cell localization (p <0.001) and an increased detrusor mast cell count (p = 0.029) were characteristic of bladder pain syndrome/interstitial cystitis with Hunner lesions. The optimal cutoff of 32 detrusor mast cells per mm(2) achieved only 68% accuracy with 38% positive predictive value. No difference was observed between bladder pain syndrome/interstitial cystitis without Hunner lesions and overactive bladder syndrome. Patient groups differed in lymphocyte infiltration (p = 0.001), nodular lymphocyte aggregates (p <0.001) and urothelium integrity (p <0.001).
Subepithelial mast cell distribution was characteristic of bladder pain syndrome/interstitial cystitis with Hunner lesions. Detrusor mastocytosis had poor predictive value for bladder pain syndrome/interstitial cystitis. Mast cell assessment did not distinguish bladder pain syndrome/interstitial cystitis without Hunner lesions from overactive bladder syndrome.
ESSIC 将逼尿肌中的肥大细胞浸润鉴定为膀胱疼痛综合征/间质性膀胱炎的诊断标准。然而，肥大细胞计数增加也是膀胱过度活动症的特征。肥大细胞检测方法的不一致性阻碍了数据比较。我们使用最先进的技术研究了膀胱疾病中肥大细胞是否存在差异。
我们分析了 56 名患者的膀胱活检标本，包括 31 名有膀胱疼痛综合征/间质性膀胱炎伴（12 名）或不伴（19 名）Hunner 病变，13 名膀胱过度活动症患者和 12 名无膀胱症状患者，使用抗肥大细胞 tryptase 的免疫组织化学方法确定肥大细胞的数量、位置、分布和激活。患者根据用于定义疾病的主要膀胱症状（疼痛和主要尿急）分配到研究组。
上皮下肥大细胞定位（p <0.001）和逼尿肌肥大细胞计数增加（p = 0.029）是伴 Hunner 病变的膀胱疼痛综合征/间质性膀胱炎的特征。32 个逼尿肌肥大细胞/平方毫米的最佳截断值仅达到 68%的准确性，阳性预测值为 38%。在无 Hunner 病变的膀胱疼痛综合征/间质性膀胱炎和膀胱过度活动症之间未观察到差异。患者组在淋巴细胞浸润（p = 0.001）、结节性淋巴细胞聚集（p <0.001）和尿路上皮完整性（p <0.001）方面存在差异。
上皮下肥大细胞分布是伴 Hunner 病变的膀胱疼痛综合征/间质性膀胱炎的特征。逼尿肌肥大细胞增多症对膀胱疼痛综合征/间质性膀胱炎的预测价值较低。肥大细胞评估不能区分无 Hunner 病变的膀胱疼痛综合征/间质性膀胱炎和膀胱过度活动症。
