膀胱前间隙炎性假瘤临床病理观察及文献复习

Inflammatory pseudotumor in retropubic space:3 cases report and review of literatures

目的 探讨膀胱前间隙炎性假瘤的临床病理特征及发病因素 ,以提高对本病的认识。方法 复习 3例膀胱前间隙炎性假瘤的临床特征、组织病理学、免疫表型及相关文献。结果 3例患者均为女性 ,均为输卵管结扎术后 1～ 2年发现膀胱前间隙炎性假瘤 ,CT及B超提示膀胱前壁肿块 ,但膀胱黏膜光滑。术中发现肿块位于膀胱前间隙并累及膀胱前壁。病理检查 :眼观为灰白色质韧的结节状肿块 ,镜下见炎性假瘤的病理特征及不同程度炎症背景 ,有组织疏松区、黏液样区、部分区域梭形细胞和纤维母细胞排列杂乱 ,细胞较大 ,光镜检查时易误诊为肉瘤 ,但缺乏核异型。 3例均成功行肿块连同部分膀胱壁切除术 ,随访 3～ 5年无复发。结论 膀胱前间隙炎性假瘤形态上需与软组织肉瘤、结节性筋膜炎、术后梭形细胞结节、间质性膀胱炎等疾病相鉴别 。

Purpose To explore the clinical and pathological characteristics and mechanism of inflammatory pseudotumor in retropubic space (IPRS), and to deepen our understanding of this disease. Methods The clinical characteristics, histopathology and immunophenotype were reviewed in 3 cases. Results All of 3 patients were female, IPRS were found after ligation of Fallopian tube for 1～2 years. CT examination and B type ultrasonography indicated that the mass was at the anterior wall of bladder, but the mucosa of bladder was smooth. During operation, it was found that the mass located at the retropubic space and involved the anterior wall of the bladder, and grayish white in color, toughness and nodular in shape. It was found microscopically there were the characteristics of inflammatory pseudotumor, different degrees of inflammatory background, zone of tissue rarefaction, and mucoid zone. Fusiform cell and fibroblast were found disorder in arrangement in partial region. These cells were larger and could be misdiagnosed as sarcoma, but they could be lack of nucleic atypia. Mass combined with partial cystectomy was successfully resected in all three cases. There was no recurrence after 3～5 years’ follow-up.Conclusions In morphology, the pseudotumor in the retropubic space should be differentiated from sarcoma of the soft tissue, nodular fascitis, postoperative spindle cellular nodule and interstitial cystitis. Prior ligation of the Fallopian tube and the infection may be the important pathogenic factors.