Cazorla Arnault, Sibony Mathilde, Pedron Philippe, Munz-Beaugrand Cécile
Service de neuropathologie, CH Sainte-Anne, 1, rue Cabanis, 75014 Paris, France.
Service de pathologie, AP-HP Cochin, 27, rue du faubourg Saint-Jacques, 75679 Paris, France.
Ann Pathol. 2016 Oct;36(5):347-350. doi: 10.1016/j.annpat.2016.06.016. Epub 2016 Sep 15.
We report the case of a 43-year-old woman, who was admitted for intense pelvic pains. Biological investigations showed an increase of β-HCG level. The abdomino-pelvic computed tomography revealed a voluminous mass infiltrating the bladder. A transurethral resection was performed. The histopathological examination evidenced an invasion of the bladder by a massive carcinomatous proliferation composed of clear epithelial cells with in some places syncytiotrophoblastic cells and rarely cytotrophoblastic cells. Immunohistochemical analyses revealed a staining of GATA-3 by the two components, an expression of p63 by the clear cell urothelial component and the immunoreactivity of β-HCG by the trophoblastic component. Ki-67 labeling index was very high. The diagnosis of mixt urothelial carcinoma with clear cells and trophoblastic differentiation was proposed. This is a rare difficult histopathological diagnosis which should be known by pathologists. It is correlated to a poor clinical outcome with a high tendency to lymph node or visceral metastases.
我们报告了一例43岁女性病例，该患者因剧烈盆腔疼痛入院。生物学检查显示β-HCG水平升高。腹盆腔计算机断层扫描显示一个巨大肿块浸润膀胱。进行了经尿道切除术。组织病理学检查证明膀胱被大量癌性增殖侵犯，该增殖由透明上皮细胞组成，在某些部位有合体滋养层细胞，很少有细胞滋养层细胞。免疫组织化学分析显示两种成分均有GATA-3染色，透明细胞尿路上皮成分有p63表达，滋养层成分有β-HCG免疫反应性。Ki-67标记指数非常高。提出了混合性透明细胞尿路上皮癌伴滋养层分化的诊断。这是一种罕见的、困难的组织病理学诊断，病理学家应该了解。它与不良临床结果相关，有很高的淋巴结或内脏转移倾向。
