Eble J N, Young R H
Department of Pathology, Indiana University School of Medicine, Indianapolis, USA.
Semin Diagn Pathol. 1997 May;14(2):98-108.
The microscopic appearances of carcinomas of the urinary bladder are reviewed, with emphasis on patterns that have been highlighted only recently or account for major problems in differential diagnosis. Approximately 80% of bladder cancers are of urothelial (transitional cell) type. The major new information pertaining to that category is the appreciation of the extent to which they may have unusual patterns that, on occasion, lead to their misinterpretation as benign. The homology between some of these variants and benign epithelial abnormalities is emphasized and helps in understanding them: nested carcinomas and von Brunn's nests, small tubules and nephrogenic adenoma, carcinomatous glands and cystitis glandularis, cystic carcinomas and cystitis cystica. Other peculiar patterns seen in urothelial carcinoma include silt-like spaces, clefts, and angulated nests with spikes. Differences in opinion have been apparent in recent contributions concerning carcinomas of the bladder with a prominent component of spindle cells (sarcomatoid carcinomas) and whether they represent a category distinct from carcinosarcoma. Irrespective of this academic distinction, the potential for some epithelial-derived tumors of the bladder to be dominated by or even have an exclusive component of spindle cells is important. Three other major categories of primary bladder cancer are squamous cell carcinoma, adenocarcinoma, and undifferentiated carcinoma. The differences in the frequency of subtypes of adenocarcinoma originating in the bladder mucosa and urachus has recently been emphasized, as has the spectrum of undifferentiated carcinomas. In some bladder cancers, the stroma has unusual features. These are carcinomas with pseudosarcomatous stroma, osseous or cartilaginous metaplasia, or osteoclast-type giant cells. The diversity of appearances of bladder cancer has important implications in differential diagnosis.
本文对膀胱癌的微观表现进行了综述，重点关注那些最近才受到关注或在鉴别诊断中存在重大问题的模式。大约80%的膀胱癌为尿路上皮（移行细胞）型。与该类型相关的主要新信息是认识到它们可能具有不寻常的模式，有时会导致被误诊为良性。强调了其中一些变体与良性上皮异常之间的同源性，这有助于理解它们：巢状癌与von Brunn巢、小管与肾源性腺瘤、癌性腺管与腺性膀胱炎、囊性癌与囊性膀胱炎。尿路上皮癌中还可见其他特殊模式，如泥沙样间隙、裂隙和带棘的角状巢。关于具有显著梭形细胞成分的膀胱癌（肉瘤样癌）以及它们是否代表与癌肉瘤不同的类别，最近的文献中存在明显的意见分歧。无论这种学术区分如何，膀胱一些上皮来源的肿瘤有可能以梭形细胞为主导甚至完全由梭形细胞组成，这一点很重要。原发性膀胱癌的其他三个主要类别是鳞状细胞癌、腺癌和未分化癌。最近强调了起源于膀胱黏膜和脐尿管的腺癌亚型频率的差异，以及未分化癌的谱系。在一些膀胱癌中，间质具有不寻常的特征。这些是具有假肉瘤样间质、骨或软骨化生或破骨细胞型巨细胞的癌。膀胱癌外观的多样性在鉴别诊断中具有重要意义。
