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目的探讨膀胱术后梭形细胞结节(PSCN)的病理和临床特征,以防误诊。方法对1例PSCH进行光镜、电镜观察并结合免疫组化、临床表现特点综合分析,同时复习文献。结果患者经尿道前列腺等离子体双极汽化电切(TUPKRP)术后22天出现尿路感染,膀胱镜检示有一个3 cm×2 cm大小的息肉样肿块。光镜下病变表面为炎性渗出及出血、坏死,底部由大量增殖的梭形细胞构成;增生细胞呈束状排列,稀疏或密集,细胞呈梭形,核浅染,异型性不明显,局部呈浸润性生长;核分裂象易见(平均15个/10 HPF),但不见病理性核分裂象;伴水肿、黏液变性及中性粒细胞弥漫浸润,未见肿瘤性坏死。免疫组化示vimentin、α-SMA、MSA、desmin、actin、CK-L均(+)。电镜显示长梭形细胞,核膜光滑,染色质细腻,核无异型性;胞质内粗面内质网丰富,胞膜下有少许短束状肌丝。术后随访36个月,未见复发。结论 PSCN形态学和临床上易误诊为恶性肿瘤,光镜特点一定要结合病史才能做出准确的诊断。
Objective To investigate the pathological and clinical features of spindle cell nodules (PSCN) after bladder surgery to prevent misdiagnosis. Methods A case of PSCH was observed by light microscope and electron microscope combined with immunohistochemistry, comprehensive analysis of clinical manifestations and review of the literature. Results Urinary tract infection occurred on day 22 after TUPKRP. Cystoscopy showed a polypoid tumor of 3 cm × 2 cm in size. Under the light microscope, the surface of the lesion was inflammatory exudation, hemorrhage and necrosis, and the bottom was composed of a large number of spindle-shaped cells proliferating. The hyperplastic cells were arranged in a bundle, sparse or dense, the cells were fusiform, Local invasive growth; mitotic figures easy to see (average 15/10 HPF), but no pathological mitosis; with edema, mucinous degeneration and neutrophil diffuse infiltration, no tumor necrosis. Immunohistochemistry showed vimentin, α-SMA, MSA, desmin, actin, CK-L were (+). Electron microscopy showed spindle cells, nuclear membrane smooth, chromatin delicate, nuclear atypia; rich in endoplasmic reticulum cytoplasm, subcellular membrane a few short fascicular filaments. Follow-up 36 months after operation, no recurrence was found. Conclusion PSCN is often misdiagnosed as malignant tumor in morphology and clinic. The characteristics of light microscope must be combined with medical history to make accurate diagnosis.