Gordetsky Jennifer, Epstein Jonathan I
Departments of Pathology and Urology, The University of Alabama, Birmingham, AL, USA.
Departments of Pathology, Urology and Oncology, The Johns Hopkins Medical Institutions, Baltimore, MD, USA.
Histopathology. 2015 Sep;67(3):325-30. doi: 10.1111/his.12661. Epub 2015 Mar 8.
Intestinal metaplasia (IM) of the bladder is a benign glandular proliferation, where the urothelium becomes lined by intestinal-type epithelium. There is no association between IM and an increased risk for the development of adenocarcinoma. However, in rare cases IM shows dysplasia, similar to that of the gastrointestinal tract. We evaluated the significance of urothelial IM with dysplasia.
Consultation cases were searched for IM of the bladder with dysplasia. We identified 20 cases, including 17 males and females, aged 31-85 years (mean 60 years). Twelve (60%) patients had low-grade dysplasia and eight (40%) patients had high-grade dysplasia. Focal dysplasia was found in eight (40%) patients and non-focal dysplasia in 12 (60%) patients. IM with dysplasia was found with concurrent adenocarcinoma in eight (40%) cases. Five of these patients (63%) had disease recurrence and three (38%) patients died from their disease. IM with dysplasia was found with concurrent urothelial carcinoma in one case. Eleven patients had IM with dysplasia without evidence of malignancy. Of these, one went on to develop non-invasive, high-grade papillary urothelial carcinoma.
Clinical follow-up is recommended in cases of IM with dysplasia, as a significant number of these cases are associated with concurrent carcinoma.
膀胱肠化生（IM）是一种良性腺性增生，其中尿路上皮被肠型上皮所覆盖。IM与腺癌发生风险增加之间并无关联。然而，在罕见情况下，IM会出现类似于胃肠道的发育异常。我们评估了伴有发育异常的尿路上皮IM的意义。
检索会诊病例中伴有发育异常的膀胱IM。我们共识别出20例，包括17名男性和女性，年龄在31 - 85岁之间（平均60岁）。12例（60%）患者为低级别发育异常，8例（40%）患者为高级别发育异常。8例（40%）患者存在局灶性发育异常，12例（60%）患者存在非局灶性发育异常。8例（40%）伴有发育异常的IM病例同时合并腺癌。其中5例（63%）患者疾病复发，3例（38%）患者死于疾病。1例伴有发育异常的IM病例同时合并尿路上皮癌。11例伴有发育异常的IM患者无恶性肿瘤证据。其中1例随后发展为非侵袭性高级别乳头状尿路上皮癌。
对于伴有发育异常的IM病例，建议进行临床随访，因为这些病例中有相当一部分与同时存在的癌症相关。
