Department of Neurology, Sheng Jing Hospital of China Medical University.
Department of Pathology, The First Affiliated Hospital and College of Basic Medical Sciences, China Medical University, Shenyang, Liaoning, China.
Medicine (Baltimore). 2021 Apr 30;100(17):e25693. doi: 10.1097/MD.0000000000025693.
Urinary bladder urothelial carcinoma is the most common malignant tumor in the urinary system, and noninvasive papillary urothelial carcinoma (NIPUC) comprises most bladder malignancies. NIPUC grading is important for therapeutic and clinical protocol selection. Here, we report a case of NIPUC with pathological features in between low (LG-NIPUC) and high (HG-NIPUC) grades NIPUC.
A 72-year-old male, presenting with a 20-year history of hypertension and 5 months of hematuria.
Computed tomography examination revealed a tumor in the urinary bladder neck. Microscopic investigation revealed that most tumor tissue samples had a branching papillary architecture, with well-developed fibrous-vascular cores. Tumor cells were slightly crowded, with somewhat altered cell polarity and cell adhesion. Immunohistochemistry showed positive Ki67 staining, mostly in the basal layer, while p53 staining was rarely positive. These samples were diagnosed as LG-NIPUC. However, a few tumor tissue samples presented mildly fused papillary architectures without cell polarity or adhesion. Most nuclei stained intensely and were pleomorphic. All epithelial tissue layers were ki67 positive, and the p53 positive rate was higher than that in the LG samples. Therefore, these were classified as HG-NIPUC.
The tumor was completely resected during lithotomy postural surgery.
The patient is alive with a good recovery during 3 months after the surgery.
We diagnosed this patient as having LG-NIPUC with local HG-NIPUC components. HG- and LG-HIPUC have different outcomes. This case is a new challenge for the pathological grading of NIPUC. An intermediate HIPUC grade might need to be added to the original NIPUC grading system.
尿路上皮膀胱癌是泌尿系统最常见的恶性肿瘤，非浸润性乳头状尿路上皮癌（NIPUC）构成了大多数膀胱癌。NIPUC 分级对于治疗和临床方案选择很重要。在此，我们报告了一例具有低级别（LG-NIPUC）和高级别（HG-NIPUC）NIPUC 之间病理特征的 NIPUC 病例。
一名 72 岁男性，有 20 年高血压病史和 5 个月血尿史。
计算机断层扫描检查显示膀胱颈部有肿瘤。显微镜检查显示，大多数肿瘤组织样本具有分支状乳头状结构，有发达的纤维血管核心。肿瘤细胞略有拥挤，细胞极性和细胞黏附略有改变。免疫组织化学显示 Ki67 染色阳性，主要位于基底层，而 p53 染色很少阳性。这些样本被诊断为 LG-NIPUC。然而，一些肿瘤组织样本呈现出轻度融合的乳头状结构，没有细胞极性或黏附。大多数细胞核染色深，多形性。所有上皮组织层 Ki67 均阳性，p53 阳性率高于 LG 样本。因此，这些被归类为 HG-NIPUC。
在截石位手术中完全切除肿瘤。
患者在手术后 3 个月时存活，恢复良好。
我们诊断该患者为具有局部 HG-NIPUC 成分的 LG-NIPUC。HG-NIPUC 和 LG-NIPUC 的预后不同。该病例对 NIPUC 的病理分级提出了新的挑战。可能需要在原始 NIPUC 分级系统中添加中间的 NIPUC 分级。
