膀胱原发性腺癌的临床病理分析

Clinicopathological analysis of the primary urinary bladder adenocarcinoma

目的探讨膀胱原发性腺癌的临床病理特征、诊断及鉴别诊断要点。方法收集我院1983年至2007年诊治的有完整病历资料的膀胱腺癌患者16例，对其临床、辅助检查、病理组织学、特染及免疫组化特点进行观察、归纳总结分析。结果膀胱原发性腺癌临床特点：主诉多为排尿不畅、血尿、膀胱刺激征；膀胱镜检特点：肿瘤块呈宽基底，蘑菇状，坚硬，表面有坏死或溃烂，或覆有粘液，或黏膜表面广泛糜烂出血，黏膜增厚欠平整；病理组织学管状或管状乳头状腺癌12例，粘液腺癌3例、透明细胞腺癌1例：PAS胞质紫红染阳性6例，免疫组化：CK7阳性11例，CK18阳性、CK19阳性、CK20阳性9例（CK7＋／CK20-者6例、CK7＋／CK20＋者5例），CA19—9阳性者15例，CDX2者11例，P504S及β—Catenin全部阴性。结论临床特点与膀胱结石、膀胱炎相似，膀胱镜检可见肿块及肿块表面糜烂、出血、坏死，组织学特点多与结直肠腺癌极相似，免疫组化对鉴别膀胱原发还是继发腺癌很有帮助意义。

Objective To implore the clinicopathologic characters, the diagnostic and differential diagnostic main points of the bladder adenocarcinoma. Methods The 16 patients with bladder adenocarcinoma which diagnosed and treated from 1983 to 2007 were collected with integrity case history data, and their features of clinic, auxiliary examination, pathohistology, histochemical and immunohistochemical were all summarized and analyzed. Results The clinical complains were characterized by dysuresia, hematuria, urinary frequency and urgency; the tumors eystoseope were characterized by as mushrooms shape with wide basal body, solid, ulceration or necrosis on the surface, covered with mucosal fluid, or erosion and hemorrhage extensively and thickening unsmoothly in the mucosa surface. Twelve patients were tubiform or tubiform - papillary adenocarcinomas, 3 csases were mucinous adenocareinoma and another was clear cell adenocarcinoma; 6 cases were positive to PAS stain as purple in cytoplasm. The immunohistochemical stain positive were 11 cases to CK7, 9 to CK20 （as the CK7 ＋/CK20 - profile 6 patients and CK7 ＋/CK20 ＋ 5 cases）and all to CK18, CK19,15 to CA19 -9, 11 to CDX2,at the same time, all patients were negative to P504S and β - Catenin. Conclusions The clinical findings of bladder adenocarcinoma are similar to the cystolith and cystitis, the tumors and their surface with erosion, hemorrhage and necrosis could be seen through cystoscopy, and the history features are mainly similar to colorectal adenocarcinoma. It is very helpful of differential diagnosis primary bladder adenocarcinoma from secondary by immunohistochemical stain.