膀胱输尿管口前列腺异位临床病理分析及文献复习

Ectopic prostate tissue at the ureteral orifice of the bladder:a clinicopathological analysis and review of literature

目的探讨膀胱输尿管口前列腺异位(EPT)的临床病理学特征,避免漏诊、误诊。方法回顾性分析2例膀胱输尿管口EPT患者的临床病理资料,结合相关文献复习,总结其病理形态学特征和鉴别诊断要点。结果2例患者均为男性,年龄分别为43岁和60岁,前者因血精就诊,后者体检发现膀胱肿物。分别行输尿管镜及膀胱镜检查提示病变均位于输尿管开口,分别为滤泡状及息肉状隆起病变,予以活检。巨检均为灰白色小组织,直径0.1~0.2 cm。低倍镜下示病变组织呈息肉样,表面被覆正常的尿路上皮,黏膜固有层内散在大不一的腺腔;中-高倍镜下示腺腔为温和的双层细胞结构,由内层的立方/柱状分泌细胞和外层的基底样细胞构成,部分区域呈簇状/乳头状增生,细胞无明显异型性和核分裂象,部分腺腔内可见淀粉样小体。免疫组化染色示腔面细胞呈PSA、PSAP阳性表达而P504S、PAX-8、CK7和CK20均阴性,基底样细胞呈CK5/6、P63及GATA-3阳性表达,Ki-67增殖指数约1%。结论膀胱输尿管口EPT临床非常少见,属于良性病变,易误诊为膀胱恶性肿瘤,完整切除后预后良好。

Objective To investigate the clinicopathological features of ectopic prostate tissue(EPT)at the ureteral orifice of the bladder and avoid misdiagnosis.Methods The clinicopathologic data of 2 patients with EPT at the ureteral orifice of the bladder were retrospectively analyzed,and the pathologic features and differential diagnosis points were summarized combined with the relevant literature review.Results Both of 2 patients were male,aged 43 and 60 years old respectively.The former sought medical attention because of bloody sperm,and the latter was found to have a bladder mass during a physical examination.Ureteroscopy and cystoscopy showed that the lesions were located at the ureteral orifice of the bladder,which were follicular and polypoid-protuberance lesions respectively.Subsequently biopsy was performed.Macroscopic examination showed grey-white small tissues with a diameter of 0.1-0.2 cm.Under low power microscope,the polypoid-shaped lesion was covered with normal urothelium,and very different glandular cavities were scattered randomly in the mucosa lamina propria.Under medium and high power microscope,the gland cavity showed a mild double-layer cell structure,consisting of cubic/columnar secretory cells in the inner layer and basal-like cells in the outer layer,accompanied by clusters/papillary hyperplasia in some areas.All of the cells had no obvious atypia and mitotic figures.Amyloid bodies could be seen in some gland cavities.Immunohistochemical analysis revealed that the glands stained diffusely and strongly positive for PSA and PSAP within the luminal epithelial cells,while negative for P504S,PAX-8,CK7 and CK20.Basal-like cells showed positive expression of CK5/6,P63 and GATA-3,highlighting an outer basal layer associated with all of the glands.The Ki-67 index was approximately 1%.Conclusion The EPT at the ureteral orifice of the bladder is very rare clinically,which belongs to a benign disease with good prognosis after complete excision.However,it is easily misdiagnosed as bladder malignant tumor before operation.