Annan Anand C, Stevens Keith A, Osunkoya Adeboye O
Department of Pathology, Emory University School of Medicine, Atlanta, GA 30322.
Department of Pathology, Emory University School of Medicine, Atlanta, GA 30322; Department of Urology, Emory University School of Medicine, Atlanta, GA 30322; Department of Pathology, Veterans Affairs Medical Center, Decatur, GA 30033; Winship Cancer Institute, Emory University, Atlanta, GA 30322.
Hum Pathol. 2017 Jul;65:101-106. doi: 10.1016/j.humpath.2017.04.018. Epub 2017 Apr 29.
Although tumors involving the bladder and ureter have been well described, there are only few studies in the pathology literature specifically analyzing tumors involving the ureteral orifice (UO). A search was performed for biopsy and resection specimens (transurethral resection, radical cystectomy/cystoprostatectomy, nephroureterectomy and bladder cuff resection) of urothelial carcinoma (UCa) involving the UO. Ninety-three cases were identified. Sixty-two (67%) patients were male. Mean patient age was 71 years (range, 43-91 years). Forty-two of 93 (45%) cases were invasive UCa (41 high-grade UCa; 1 low-grade UCa); 17/42 (40%) were invasive into muscularis propria. Tumor laterality was as follows: right side, 43 (46% of cases); left side, 41 (44%); bilateral, 4 (4.5%); and in 5 cases (5.5%), the laterality was not specified by the urologist. Seven cases of UCa with variant histology were also identified. Five patients had lymph node (LN) metastasis at the time of resection, and another 3 presented with LN or distant metastasis after resection (range, 4-38 months). Although this study focused primarily on the index tumor involving the UO (Group 1 cases are those with only UO involvement), in 70/93 (75%) cases (Group 2 cases), at least one other tumor was located at another site within the bladder. The fact that the majority of cases (75%) had tumors located at other sites of the bladder, emphasizes that careful examination of the UO needs to be performed by both urologists and pathologists when examining cases of UCa of the bladder.
尽管涉及膀胱和输尿管的肿瘤已有详尽描述，但病理学文献中专门分析累及输尿管口（UO）肿瘤的研究却寥寥无几。我们对累及UO的尿路上皮癌（UCa）的活检和切除标本（经尿道切除术、根治性膀胱切除术/膀胱前列腺切除术、肾输尿管切除术和膀胱袖口切除术）进行了检索。共识别出93例病例。62例（67%）患者为男性。患者平均年龄为71岁（范围43 - 91岁）。93例中有42例（45%）为浸润性UCa（41例高级别UCa；1例低级别UCa）；其中17/42（40%）浸润至固有肌层。肿瘤侧别如下：右侧43例（占病例的46%）；左侧41例（44%）；双侧4例（4.5%）；5例（5.5%）病例的侧别未被泌尿外科医生明确标注。还识别出7例具有组织学变异的UCa病例。5例患者在切除时已有淋巴结（LN）转移，另外3例在切除后出现LN或远处转移（范围4 - 38个月）。尽管本研究主要关注累及UO的索引肿瘤（第1组病例为仅累及UO的病例），但在70/93（75%）例病例（第2组病例）中，膀胱内其他部位至少还有一个肿瘤。大多数病例（75%）在膀胱其他部位有肿瘤这一事实强调，泌尿外科医生和病理科医生在检查膀胱UCa病例时都需要仔细检查UO。
