Department of Urology, Konkuk University Hospital, Konkuk University School of Medicine, Seoul, Korea.
Department of Urology, Asan Medical Centre, University of Ulsan College of Medicine, Seoul, Korea.
Histopathology. 2017 Sep;71(3):415-424. doi: 10.1111/his.13235. Epub 2017 Jun 16.
To assess the distinct histopathological characteristics and their clinical significance between non-Hunner-type and Hunner-type interstitial cystitis (IC)/bladder pain syndrome (BPS).
We prospectively enrolled and classified IC/BPS patients, on the basis of cystoscopic findings, as having non-Hunner-type IC and Hunner-type IC. Specimens obtained from the posterior wall in non-Hunner-type IC cases during hydrodistension or from Hunner/non-Hunner lesions in Hunner-type IC cases during transurethral resection were evaluated. Stress urinary incontinence patients with microscopic haematuria were selected as controls. Biopsy specimens were obtained from 15 non-Hunner-type IC, 15 Hunner-type IC and 5 non-IC patients. Severe and moderate fibrosis was more frequently observed in non-Hunner-type IC than in Hunner-type IC and non-IC cases. However, severe and moderate inflammation was more frequently observed in Hunner-type IC than in non-Hunner-type IC cases. The remnant urothelium was significantly decreased in Hunner-type IC cases as compared with non-Hunner-type IC and non-IC cases (P < 0.05), and non-Hunner-type IC cases showed a higher number of mast cells than Hunner-type IC and non-IC cases (P = 0.035). Accordingly, several fibrosis-promoting genes were highly expressed in bladder tissues of non-Hunner-type IC, as compared with Hunner-type IC. Patients with severe fibrosis showed significantly higher urinary frequency and smaller bladder capacity than those with moderate and mild fibrosis (all P < 0.05).
Non-Hunner-type IC is characterized by severe fibrosis and increased mast cell infiltration, whereas Hunner-type IC is characterized by severe inflammation and urothelial denudation in the entire bladder. Fibrosis in the bladder of IC/BPS patients was correlated with increased urinary frequency and decreased bladder capacity.
评估非 Hunner 型和 Hunner 型间质性膀胱炎（IC）/膀胱疼痛综合征（BPS）的不同组织病理学特征及其临床意义。
我们前瞻性地根据膀胱镜检查结果将 IC/BPS 患者分为非 Hunner 型 IC 和 Hunner 型 IC。在水压扩张时从非 Hunner 型 IC 患者的后侧壁或在经尿道切除时从 Hunner/非 Hunner 病变中获得标本，对标本进行评估。选择有显微镜下血尿的压力性尿失禁患者作为对照。从 15 例非 Hunner 型 IC、15 例 Hunner 型 IC 和 5 例非 IC 患者中获得活检标本。与 Hunner 型 IC 和非 IC 病例相比，非 Hunner 型 IC 中更常观察到严重和中度纤维化。然而，与非 Hunner 型 IC 病例相比，Hunner 型 IC 中更常观察到严重和中度炎症。与非 Hunner 型 IC 和非 IC 病例相比，Hunner 型 IC 病例中的残余尿路上皮明显减少（P<0.05），并且非 Hunner 型 IC 病例中的肥大细胞数量高于 Hunner 型 IC 和非 IC 病例（P=0.035）。因此，与 Hunner 型 IC 相比，非 Hunner 型 IC 的膀胱组织中表达了几种促进纤维化的基因。纤维化严重的患者的尿频率明显高于纤维化中度和轻度的患者（均 P<0.05）。
非 Hunner 型 IC 的特征是严重纤维化和肥大细胞浸润增加，而 Hunner 型 IC 的特征是整个膀胱的严重炎症和尿路上皮脱落。IC/BPS 患者的膀胱纤维化与增加的尿频率和减少的膀胱容量相关。
