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目的探讨膀胱巢状变异型尿路上皮癌(NVUC)的临床病理特征、诊断与鉴别诊断及预后。方法应用常规HE和免疫组化染色及光镜观察4例膀胱NVUC,通过临床随访及结合文献复习进行讨论。结果本组患者男性3例,女性1例,年龄52~62岁,平均57岁;首发症状大多表现为肉眼血尿。组织学上,NVUC癌巢的形态多样,主要呈不规则小巢团状或大巢团状,也可呈条索状、小管状结构。癌细胞相对温和,核异型性很小或无异型性,核/浆比例较典型尿路上皮癌者小;多数染色质纤细,颗粒状,核仁不明显。其中1例肿瘤侵及固有层,2例肿瘤侵及深肌层,1例肿瘤侵及外膜。免疫组化示4例AE1/AE3、CK7、34βE12、p63均弥漫强(+),2例CK20(+),Ki-67阳性细胞指数20%~40%(平均30%),p53均(+);P504S和uroplakin-Ⅲ均(-)。4例随访时间8~18个月,2例术后复发,均无转移,4例均健在。结论 NVUC是膀胱尿路上皮癌的一种罕见变异型,生物学行为常呈侵袭性。确诊主要依赖正确的形态学观察,免疫组化检查在鉴别诊断中有一定的辅助作用。
Objective To investigate the clinicopathological features, diagnosis, differential diagnosis and prognosis of bladder neoplasia variant neoplasia (NVUC). Methods Four cases of bladder NVUC were observed by routine HE and immunohistochemical staining and light microscopy. The clinical follow-up and literature review were discussed. Results This group of patients, 3 males and 1 females, aged 52 to 62 years, mean 57 years; the first symptom of most manifestations of gross hematuria. Histologically, NVUC cancer nests of various shapes, mainly irregular small nest clusters or large clumps, but also was a cord-like, small tubular structure. Relatively mild cancer cells, nuclear atypia with little or no atypia, nuclear / plasma ratio of urinary tract cancer than typical small; most of the chromatin fine, granular, nucleoli are not obvious. One case of tumor invasion and lamina propria, 2 cases of tumor invasion and deep muscle, 1 case of tumor invasion and adventitia. Immunohistochemistry showed that the expression of AE1 / AE3, CK7, 34βE12 and p63 in 4 cases were diffusely strong (+), 2 cases of CK20 (+) and Ki-67 positive cells were 20% -40% ); Both P504S and uroplakin-III (-). Four patients were followed up for 8-18 months. Two patients relapsed after operation without metastasis. All four patients were alive. Conclusion NVUC is a rare variant of urothelial carcinoma of the urinary bladder and its biological behavior is often invasive. Confirmed mainly rely on the correct morphological observation, immunohistochemistry in the differential diagnosis of a certain role in supporting.