Burger Maximilian, Kamat Ashish M, McConkey David
Department of Urology, University of Regensburg, Regensburg, Germany.
University of Texas-MD Anderson Cancer Center, Houston, TX, USA.
Eur Urol Oncol. 2021 Jun;4(3):510-514. doi: 10.1016/j.euo.2019.06.012. Epub 2019 Aug 6.
A 52-yr-old man, 35 pack-year smoker, is diagnosed with two non-muscle-invasive urothelial tumors, pTa and pT1, the former upstaged to pT1 by a reference pathologist. Two possible treatment strategies include intravesical bacillus Calmette-Guérin (BCG) and/or primary or rescue cystectomy. The importance or even accurate existence of "variant histology" is put into perspective, and whether the reference pathologist's diagnosis of a micropapillary variant requires a real change in treatment strategy is considered. PATIENT SUMMARY: The reference urologist diagnosed two small bladder tumors as two different depths of infiltration: one as pTa and the other (slightly more severe) as pT1. Suspecting a variant, the reference urologist referred to a second pathologist, who upstaged the less severe tumor to T1, with both defined as micropapillary cancer. This presentation discusses removal of the bladder versus a trial of treatment with bladder preservation.
一名52岁男性，有35年的吸烟史，被诊断患有两个非肌层浸润性尿路上皮肿瘤，分别为pTa和pT1，其中前者经会诊病理学家重新分期为pT1。两种可能的治疗策略包括膀胱内灌注卡介苗（BCG）和/或初次或挽救性膀胱切除术。“变异组织学”的重要性甚至其确切存在都得到了审视，并探讨了会诊病理学家对微乳头变异型的诊断是否需要真正改变治疗策略。患者总结：会诊泌尿外科医生将两个小膀胱肿瘤诊断为不同的浸润深度：一个为pTa，另一个（稍严重）为pT1。由于怀疑存在变异型，会诊泌尿外科医生转诊给另一位病理学家，后者将病情较轻的肿瘤重新分期为T1，两者均被定义为微乳头癌。本病例讨论了膀胱切除与保留膀胱治疗试验的选择。
