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目的:探讨膀胱尿路上皮癌透明细胞变异亚型的临床病理特点及预后。方法:回顾性分析2005年1月~2014年12月收治的5例膀胱尿路上皮癌透明细胞变异亚型患者的临床病理资料,均为男。年龄46~78岁,中位年龄60岁。临床表现为单纯无痛性肉眼血尿3例,血尿伴腰痛1例,体检发现膀胱占位1例。肿瘤直径2.0~6.1cm,平均3.4cm。其中行TURBT术1例,根治性膀胱切除术4例,均未行盆腔淋巴结清扫术。结果:5例术后病理均诊断为膀胱尿路上皮癌透明细胞变异亚型。病理分级Ⅱ~Ⅲ级2例,Ⅲ级3例;病理分期pT2a1例,pT2b3例,pT3a1例;4例脉管内可见瘤栓;1例合并腺癌样分化;1例合并鳞状分化。免疫组化染色:CK7+,CK20+,EMA+,CEA+,Vimentin-,PSA-。5例均获得随访,1例TURBT术后随访10个月未见肿瘤复发及转移,4例行根治性膀胱切除术中,1例于术后26个月死于转移,3例分别随访5、12、14个月未见肿瘤复发及转移。结论:膀胱尿路上皮癌透明细胞变异亚型发病率极低,恶性度较高,肿瘤分期晚,预后差,根治性膀胱切除术是主要的治疗方法。
Objective: To investigate the clinicopathological features and prognosis of clear cell variant of bladder urothelial carcinoma. Methods: The clinical and pathological data of 5 patients with clear cell variant of bladder urothelial carcinoma who were treated from January 2005 to December 2014 were retrospectively analyzed. All patients were male. Age 46 to 78 years old, the median age of 60 years. Clinical manifestations of simple painless gross hematuria in 3 cases, 1 case of hematuria with low back pain, physical examination found a case of bladder space. Tumor diameter 2.0 ~ 6.1cm, an average of 3.4cm. One line TURBT surgery in 1 case, radical cystectomy in 4 cases, no pelvic lymph node dissection. Results: All the 5 cases were diagnosed as clear cell variant of bladder urothelial carcinoma. Pathological grade Ⅱ ~ Ⅲ grade in 2 cases, Ⅲ grade in 3 cases; pathological stage pT2a1 cases, pT2b3 cases, pT3a1 cases; 4 cases of vascular tumor embolus visible; 1 case with adenocarcinoma-like differentiation; 1 case with squamous differentiation. Immunohistochemical staining: CK7 +, CK20 +, EMA +, CEA +, Vimentin-, PSA-. 5 cases were followed up, 1 case of TURBT followed up for 10 months, no tumor recurrence and metastasis, 4 cases of radical cystectomy, 1 case died of metastasis 26 months after surgery, 3 cases were followed up 5, There was no tumor recurrence and metastasis at 12 and 14 months. Conclusions: The incidence of clear cell variant subtypes in bladder urothelial carcinoma is extremely low, the malignancy is high, the tumor stage is late, and the prognosis is poor. Radical cystectomy is the main treatment.