Feldman Alexander, Borak Samuel, Rais-Bahrami Soroush, Gordetsky Jennifer
1 University of Alabama at Birmingham, AL, USA.
2 Community Pathology Practice Program, Montgomery, AL, USA.
Int J Surg Pathol. 2018 Apr;26(2):120-125. doi: 10.1177/1066896917741550. Epub 2017 Nov 23.
Although rare, secondary tumors of the bladder can present a diagnostic dilemma to pathologists considering a differential diagnosis of primary bladder cancer. We investigated the clinicopathologic and imaging characteristics of metastatic tumors to the bladder. We retrospectively reviewed the surgical pathology databases from 2 sites from 2013 to 2016, identifying 66 cases of secondary bladder tumors. Clinical, pathologic, and imaging findings were reviewed. Mean age at diagnosis was 63 years (range = 25-87). Females had a significantly higher proportion (44/66, 66.7%) of secondary bladder tumors compared with males (22/66, 33.3%; P = .007). In total, 56/66 (84.8%) patients had a clinical history of an in situ or invasive malignancy in another organ, and 54/66 (81.8%) patients had imaging supporting a metastatic tumor. Only 2/66 (3.0%) patients had a prior history of urothelial carcinoma. In total, 4/66 (6.1%) cases (all females) were originally misdiagnosed as primary bladder malignancies and were corrected after clinicoradiologic correlation. Overall, colorectal origin was most common (15/66, 22.7%), followed by cervical and ovarian primaries (10/66, 15.2% each). Cervical and ovarian origins predominated in the female cohort (10/44, 22.7% each), followed by endometrial (8/44, 18.2%). Colorectal and prostate primaries were the most common among males (10/22, 45.5%, and 7/22, 31.8%, respectively). Secondary bladder tumors can mimic urothelial carcinomas. In our cohort, gynecological, colorectal, and prostatic origins were most common. Clinical history, imaging, and immunohistochemical studies can be useful in avoiding this diagnostic pitfall.
尽管罕见，但膀胱继发性肿瘤可能给考虑原发性膀胱癌鉴别诊断的病理学家带来诊断难题。我们研究了膀胱转移性肿瘤的临床病理和影像学特征。我们回顾性分析了2013年至2016年来自2个地点的手术病理数据库，确定了66例继发性膀胱肿瘤病例。对临床、病理和影像学检查结果进行了回顾。诊断时的平均年龄为63岁（范围 = 25 - 87岁）。与男性（22/66，33.3%）相比，女性继发性膀胱肿瘤的比例显著更高（44/66，66.7%；P = 0.007）。总共有56/66（84.8%）的患者有其他器官原位或浸润性恶性肿瘤的临床病史，54/66（81.8%）的患者有支持转移性肿瘤的影像学表现。只有2/66（3.0%）的患者有尿路上皮癌病史。总共有4/66（6.1%）的病例（均为女性）最初被误诊为原发性膀胱恶性肿瘤，经临床与放射学对照后得以纠正。总体而言，结直肠来源最为常见（15/66，22.7%），其次是宫颈和卵巢原发性肿瘤（各10/66，15.2%）。宫颈和卵巢来源在女性队列中占主导（各10/44，22.7%），其次是子宫内膜（8/44，18.2%）。结直肠和前列腺原发性肿瘤在男性中最为常见（分别为10/22，45.5%和7/22，31.8%）。膀胱继发性肿瘤可能类似尿路上皮癌。在我们的队列中，妇科、结直肠和前列腺来源最为常见。临床病史、影像学检查和免疫组化研究有助于避免这一诊断陷阱。
