Baumeister Philipp, Zamboni Stefania, Mattei Agostino, Antonelli Alessandro, Simeone Claudio, Mordasini Livio, DiBona Carlo, Moschini Marco
Klinik für Urologie, Luzerner Kantonsspital, Lucerne 6004, Switzerland.
Department of Urology, Spedali Civili di Brescia, Brescia 25123, Italy.
Transl Androl Urol. 2019 Feb;8(1):34-38. doi: 10.21037/tau.2019.01.09.
Several studies evaluated the role of histological variants on oncological outcomes after radical cystectomy (RC) and they were found significantly associated with worse recurrence and survival. Sparse data exists regarding the role variant histology in non-muscle invasive diseases: assessing their relationship with recurrence and progression is important to understand the most effective treatment and follow-up schedule. For these reasons, the aim of the present non-systematic review was to assess the literature on variant histology in non-muscle invasive bladder cancer (BCa). The diagnosis of presence variant histology at transurethral resection (TUR) specimens challenging for pathologists and several studies published in literature evaluated concordance between TUR and RC specimen with discordant results. These differences are probably related to diversity in collection of samples and pathological evaluation and underline the necessity to have good tissue-sample and a pathologic evaluation performed by expert and dedicated uropathologists. Treatment of BCa with variant histology shall include immediate RC in case of plasmacitoid, pure squamous, micropapillary and sarcomatoid variants. The neuroendocrine differentiation, therefore, showed chemosensitiveness, and RC preceded by neoadjuvant chemotherapy should be proposed. Intravesical instillations with Bacillus Calmette Guerin (BCG) can be suggested in very selected cases of nested and glandular variants.
多项研究评估了组织学变体在根治性膀胱切除术（RC）后肿瘤学结局中的作用，发现它们与更差的复发率和生存率显著相关。关于变体组织学在非肌层浸润性疾病中的作用，现有数据稀少：评估它们与复发和进展的关系对于了解最有效的治疗方法和随访计划很重要。出于这些原因，本非系统性综述的目的是评估非肌层浸润性膀胱癌（BCa）中变体组织学的相关文献。经尿道切除术（TUR）标本中变体组织学的诊断对病理学家来说具有挑战性，文献中发表的几项研究评估了TUR和RC标本之间的一致性，但结果不一致。这些差异可能与样本采集和病理评估的多样性有关，并强调了获得良好组织样本以及由专业且专注的泌尿病理学家进行病理评估的必要性。对于具有变体组织学的BCa，治疗方法如下：对于浆细胞样、纯鳞状、微乳头和肉瘤样变体，应立即进行RC。因此，神经内分泌分化显示出化疗敏感性，应建议在新辅助化疗后进行RC。在非常特定的巢状和腺性变体病例中，可以建议使用卡介苗（BCG）膀胱灌注。
