Kumari Nitu, Jha Anupama, Vasudeva Pawan, Agrawal Usha
National Institute of Pathology, Indian Council of Medical Research, New Delhi, India.
Department of Urology, VMMC and Safdarjung Hospital, New Delhi, India.
Iran J Med Sci. 2017 May;42(3):318-321.
Micropapillary variant of urothelial carcinoma (UC) of the bladder is an aggressive tumour, comprising 0.6-6% of all UC. It generally presents with high-grade and stage, and has been reported as having a worse prognosis when compared to traditional UC. We report the case of a 58-year-old man who presented with macroscopic haematuria. The patient was diagnosed with high-grade urothelial carcinoma and returned with recurrence after 16 months. Histopathology after transurethral biopsy revealed a non-muscle invasive high-grade bladder tumour at first presentation, whereas tumour recurrence was reported after 1.5years. The histopathology at recurrence revealed a high-grade, muscle invasive, micropapillary variant of urothelial carcinoma with focal adenomatous morphology. Immunohistochemical expression of CK7/CK20 in tumour cells and negativity for PSA, AMACR, and CDX2 in paraffin section helped in identifying the tumour as primary in the urinary bladder. Radical cystectomy was performed and the patient has no distant metastases on follow-up. The specific morphology even within the high-grade urothelial cancer cases is important to discern for proper treatment.
膀胱尿路上皮癌（UC）的微乳头变型是一种侵袭性肿瘤，占所有UC的0.6 - 6%。它通常表现为高级别和高分期，据报道与传统UC相比预后更差。我们报告一例58岁男性患者，表现为肉眼血尿。该患者被诊断为高级别尿路上皮癌，16个月后复发。经尿道活检后的组织病理学显示初次就诊时为非肌层浸润性高级别膀胱肿瘤，而1.5年后报告肿瘤复发。复发时的组织病理学显示为高级别、肌层浸润性、尿路上皮癌的微乳头变型，伴有局灶性腺瘤样形态。肿瘤细胞中CK7/CK20的免疫组化表达以及石蜡切片中PSA、AMACR和CDX2阴性有助于将肿瘤确定为膀胱原发性肿瘤。患者接受了根治性膀胱切除术，随访时无远处转移。即使在高级别尿路上皮癌病例中，特定的形态对于正确治疗的辨别也很重要。
