Samarska Iryna V, Dani Hasan, Bivalacqua Trinity J, Burnett Arthur L, Matoso Andres
Department of Pathology, Maastricht University Medical Center, Maastricht, The Netherlands.
Department of Pathology, The Johns Hopkins Medical Institutions, Baltimore, MD, USA.
Transl Androl Urol. 2021 Oct;10(10):3714-3722. doi: 10.21037/tau-21-477.
Urethral stricture is a relatively frequent problem often requiring multiple surgical interventions. The objective of this study was to compare the clinicopathologic features of urethral resections from patients who underwent open end-to-end anastomotic urethroplasty and later recurred compared to those who did not.
A retrospective review of the pathology files identified 36 consecutive patients who underwent urethroplasty. The histopathological analysis included evaluation of the inflammatory infiltrate based on the predominant (>50%) cell type: lymphocyte-rich, neutrophil-rich, plasma cell-rich, and mixed; length and thickness of the fibrous plaque; and the cellularity of the fibrous plaque: cellular (>40 stroma nuclei/HPF) or paucicellular (<40 stroma nuclei/high power field).
Ten (28%) patients recurred, and 26 (72%) did not. There was no significant difference between recurrent and non-recurrent cases in age, race, comorbidities, location of the stricture, and etiology. All patients with recurrent strictures showed dense paucicellular fibrotic plaques (10/10; 100%), while this was seen in 14/26 (53.8%) non-recurrent cases (P=0.01). Only one patient with cellular fibrosis showed recurrence during follow-up. The log-rank test shows that time to recurrence is significantly shorter in patients with paucicellular fibrosis compared to those with cellular fibrosis (P=0.036). The inflammation consisted of a mixed population of CD3(+) T-lymphocytes, CD20(+) B-lymphocytes, and CD68(+) histiocytes, and there was no difference in the composition of the inflammation between groups. All cases with plasma cell-rich infiltrate showed normal IgG4:IgG.
Our study supports reporting cellularity of the fibrous plaque as a potential predictor of outcome in patients undergoing reconstructive urethroplasty. Patients with paucicellular fibrosis are at increased risk of recurrence.
尿道狭窄是一个相对常见的问题，常常需要多次手术干预。本研究的目的是比较接受开放性端端吻合尿道成形术且随后复发的患者与未复发患者的尿道切除术的临床病理特征。
对病理档案进行回顾性分析，确定了36例连续接受尿道成形术的患者。组织病理学分析包括基于主要（>50%）细胞类型评估炎症浸润情况：富含淋巴细胞、富含中性粒细胞、富含浆细胞以及混合性；纤维斑块的长度和厚度；以及纤维斑块的细胞密度：细胞性（>40个基质细胞核/高倍视野）或少细胞性（<40个基质细胞核/高倍视野）。
10例（28%）患者复发，26例（72%）未复发。复发和未复发病例在年龄、种族、合并症、狭窄部位和病因方面无显著差异。所有复发狭窄的患者均表现为致密的少细胞性纤维化斑块（10/10；100%），而在未复发病例中有14/26（53.8%）出现这种情况（P = 0.01）。仅有1例细胞性纤维化患者在随访期间出现复发。对数秩检验显示，与细胞性纤维化患者相比，少细胞性纤维化患者的复发时间显著更短（P = 0.036）。炎症由CD3(+) T淋巴细胞、CD20(+) B淋巴细胞和CD68(+)组织细胞混合组成，两组之间炎症成分无差异。所有富含浆细胞浸润的病例均显示IgG4:IgG正常。
我们的研究支持将纤维斑块的细胞密度报告为接受重建性尿道成形术患者预后的潜在预测指标。少细胞性纤维化患者复发风险增加。
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