膀胱尿路上皮乳头状瘤32例临床病理特征分析

Urothelial Papilloma of the Bladder(Clinicopathological Study of 32 Cases)

目的:探讨新发膀胱尿路上皮乳头状瘤的临床病理学特征及其复发、演进的风险。方法:回顾性分析根据1998年WHO/ISUP分类标准诊断出的32例膀胱尿路上皮乳头状瘤患者的临床资料,重新阅读病理组织切片,总结其临床、病理特点及随访情况。结果:所有患者均为乳头状瘤,可见伞细胞的一些组织学改变:空泡形成(4例)、类似于顶浆分泌的改变(1例)、细胞内粘蛋白形成(1例)和嗜酸性胞质小体形成(1例)。32例患者中随访28例,肿瘤无复发/演进的患者平均随访时间为28.9(3～61)个月。2例患者(7.1%)分别在首诊为初发乳头状瘤后5个月和18个月复发,其中1例在18个月时复发且有病灶演进为非侵袭型低级别尿路上皮癌(LGUC)。2例患者(7.1%)演进为更高级别的尿路上皮肿瘤,其中1例演进为非侵袭性LGUC(首诊后11个月),另1例在33个月时演进为低度恶性潜能乳头状尿路上皮肿瘤,41个月时从首诊的乳头状瘤演进为了低级别泌尿上皮癌。无患者演进为黏膜下(T_1)和肌层(T_2)侵袭的尿路上皮癌。其中2例患者死于其他疾病。无患者死于膀胱癌。结论:膀胱尿路上皮乳头状瘤患者有较低的复发率并很少演进为膀胱尿路上皮癌,应避免给这些患者贴上癌症的"标签"。但是对于那些肿瘤没有复发和演进的患者,何时不需要再随访的问题仍需作进一步研究。

Objective：To study the clinicopathologic features of urothelial papillomas of the bladder, and to determine the risk of recurrence and progression. Methods： 32 patients who were diagnosed with urothelial papilloma of the bladder were retrospectively studied using the criteria of the 1998 WHO/ISUP classification system. Pathological tissues were re read, and clinical data, pathological characteristics and follow up of these patients were summarized. Results：Simple papillary fronds were seen in all cases, some of the distinctive histologic features seen were changes in the umbrella cells： vacuolization （n 4） , apocrinelike morphology （n=1）, mucinous metaplasia （n= 1） and eosinophilic syncytial morphology （n=1）. Follow-up was available in 28 cases with a mean follow-up for those without evidence of progression of 28.9 months （range, 3-61 months）. 2 patients （7.1 %） developed recurrent papilloma 5 and 18 months after the initial diagnosis of papilloma; 1 of two patients also showed progression to noninvasive low-grade urothelial carcinoma （LGUC）at the time of recurrence （18 months）. 2 patients （7. 1%） progressed to highe grade disease： 1 to noninvasive LGUC （11 months after the original diagnosis） and 1 to papillary urothelial neoplasm of low malignant potential at 33 months＇and noninvasive low-grade urothelial carcinoma at 41 months from the initial diagnosis of papilloma. None of the patients demonstrated progression to either lamina propria （T1） or muscularis propria （T2） invasion. 2 patients died of unrelated causes. None of the patients died of bladder cancer. Conclusions： Patients with urothelial papillomas have a low incidence of recurrence and rarely progress to develop urothelial carcinoma. It seems reasonable to avoid labeling these patients as having cancer. It remains to be studied whether and when patients with papillomas who have no evidence of recurrence or progression no longer need to be followed.