摘要
目的：探讨膀胱活检中小细胞性浸润性尿路上皮癌的病理形态学特征以及与其它小细胞性病变的鉴别诊断。方法：对北京中医药大学东直门医院1例膀胱黏膜活检的病理及临床资料进行回顾性分析，并对相关国内外文献进行复习。结果：患者，男性，82岁，膀胱镜下见：在膀胱颈部10~12点可见黏膜突起如蕈状，蒂不明显。活检组织光镜下见：1）尿路上皮下小细胞肿瘤细胞呈弥漫性及巢状分布，间质增生；2）瘤细胞体积小，呈短梭形或淋巴细胞样，胞浆极少，局部瘤细胞胞浆宽广透明；3）核为圆形、椭圆形或梭形，核深染且结构不清，部分核不规则，可见双核、核重叠及多核瘤巨细胞，核仁不明显；4）未见核分裂象；5）局部组织可见挤压现象及局灶凝固性坏死；6）可见脉管浸润；7）局部异型增生的尿路上皮基底层处与固有膜内的小细胞性肿瘤成分有移行。免疫组织化学结果显示免疫表型CK少数细胞弱（＋），其余标记均（-），病理诊断为：小细胞低分化癌。临床行经尿道膀胱肿瘤电切术，未送病理，数月后发现肠系膜多个转移瘤结节，瘤细胞形态与活检相似，局部瘤细胞核偏位，可见核仁及病理性核分裂象，免疫组化显示上皮性标记、p63及CD44V6均（＋），神经内分泌标记（-），综合考虑最后病理诊断为：膀胱小细胞性浸润性尿路上皮癌伴肠壁转移。结论：膀胱小细胞性浸润性尿路上皮癌在膀胱镜活检标本中诊断难度较大，应重视其病理特点，鉴别诊断需结合临床和免疫组化特征综合评价，当二者不能提供有价值的帮助时，确诊还需以HE切片形态学特征为主，同时在报告中加以注明。膀胱镜活检标本病理诊断尿路上皮癌核分裂象应是有或无。
Objective：To study the clinicopathological features of small cell invasive urothelial carcinoma and the differential diagnosis of the other small cell lesions of bladder biopsy.Methods： Pathological and clinical data of 1 case of small cell invasive urothelial carcinoma were retrospectively analyzed and relevant literatures from China and abroad were reviewed.Results： Male, 82 years old, cystoscope： in the neck of the bladder 10~12 mucosal protrusions such as mushroom, pedicle was not obvious. Morphological features of bladder biopsy tissue under light microscope were： 1） diffuse and nested distribution of subcutaneous small cell tumor cells in the urinary tract, interstitial proliferation; 2） the cells were small, with short fusiform or lymphoid, very little cytoplasm, the local tumor cell cytoplasm was broad and transparent; 3） the nuclei were round, oval or fusiform, nuclear hyperchromatism and structure were not clear, dual core, nuclear overlap and multinucleated giant tumor cell, prominent nucleoli were not seen; 4） no mitotic figures; 5） local tissue extrusion phenomenon and focal coagulation necrosis; 6） vascular invasion; 7） local dysplasia in urinary tract epithelial basal layer and components of small cell tumor in intrinsic membrane were transitional. Immunohistochemistry, a few cells CK weak （＋）, the remaining markers were （-）; pathological diagnosis： small cell undifferentiated carcinoma. Transurethral resection of bladder tumor, no pathology, mesenteric multiple metastatic tumor nodules were found several months later, the morphology of the tumor cells was similar to that of bladder biopsy, the local tumor cell nuclei deviation, visible nucleoli and pathological mitotic figures. Immunohistochemistry, epithelial markers, p63 and CD44V6 were positive, neuroendocrine markers still were negative. Comprehensive consideration of final pathological diagnosis was bladder small cell invasive urothelial carcinoma with intestinal wall metastasis.Conclusion：hTe diagnosis o
出处
《临床与病理杂志》
2016年第7期1034-1042,共9页
Journal of Clinical and Pathological Research
