膀胱浆细胞样移行细胞癌临床病理观察

Plasmacytoid transitional cell carcinoma of bladder: a clinicopathological study and review of literature

目的总结并探讨膀胱浆细胞样移行细胞癌的病理特征、诊断和鉴别诊断及临床特点。方法采用常规HE和免疫组化方法(SP法),光镜观察2例膀胱浆细胞样移行细胞癌,通过临床随访和文献复习进行讨论。结果膀胱浆细胞样移行细胞癌极其罕见,其特点除黏膜有原位癌外,肿瘤多侵犯固有膜和/或肌层。细胞形态与浆细胞或淋巴细胞相似,组织形态接近于淋巴造血系统肿瘤。肿瘤细胞除高表达AE1/AE3外,CEA和CK18也呈强(+)。临床预后较差。结论膀胱浆细胞样移行细胞癌非常少见,有其特有的组织病理学和生物学特点,诊断膀胱肿瘤时应考虑到该肿瘤的可能性。

Objective To study the cytology, histopathology and immunohistochemistry of plasmacytoid transitional cell carcinoma of the bladder, and to analyze the diagnostic features, criteria for differential diagnosis and the clinical significance of the tumor. Methods Two cases of bladder plasmacytoid transitional cell carcinoma were studied. Rothine paraffin sections with HE staining and immunohistochemistry by S-P method were observed under light microscope. Pathological and clinical data were analyzed by comparison with early reported cases in the literature. Results A feature of this tumor was of deep invasion into the lamina propria and/or muscularis propria, in addition to the component of carcinoma in situ in the mucosa, when tumors were diagnosed. The histological pattern and cytological features showed some similarity to a plasmacytoid or lymphoid tumor. The tumor cells were positive for AE1/AE3, CEA and CK18 but negative for markers of plasma cells and lymphocytes. The prognosis appeared to be worse than ordinary transitional cell carcinoma. Conclusions The plasmacytoid transitional cell carcinoma of the bladder is rare but has typical pathological, immunohistological and clinical features. Pathologists should be aware of this primary tumor of the bladder. Primary or secondary haematopoietic tumors are the major differential diagnosis and possible mistakes.