膀胱透明细胞腺癌的临床病理分析

Clinicopathological analysis for clear cell adenocarcinoma of urinary bladder

目的:探讨膀胱透明细胞腺癌(clear cell adenocarcinoma,CCA)的形态学和免疫组织化学特征。方法:对1例膀胱透明细胞腺癌进行临床病理和免疫组织化学分析,并结合文献讨论其诊断与鉴别诊断。结果:患者临床表现为尿路刺激症、血尿及排尿困难。内镜发现膀胱三角区肿块。组织学显示癌组织呈分化良好的腺管状或管囊状结构,局部区域呈乳头状排列,癌细胞异型性小,呈立方形或椭圆形,部分呈鞋钉样,胞质丰富、嗜酸性,部分透亮,核分裂象多见。肿瘤周围背景有腺性膀胱炎病变。免疫组织化学显示癌细胞的P504s,Pax-2,CKpan和波形蛋白(vimentin)表达呈阳性;而CK7,34βE12,p63,CD34,CD31,CR,绒毛蛋白(villin)和D2-40均为阴性。结论:膀胱CCA是膀胱腺癌中的一种罕见类型,肿瘤细胞表达P504s及Pax-2。瘤组织具有透明细胞或/和鞋钉样细胞的腺管状结构,其形态温和,而细胞核显示明显的异型性。病理学上要注意与膀胱肾源性腺瘤和转移性的CCA鉴别。

Objective To study the characteristics of morphology and immunohistochemistry of clear cell adenocarcinoma（CCA） of urinary bladder.Methods Clinicopathological and immunohistochemical features were analyzed in a case of CCA of urinary bladder.Related literatures were reviewed and discussed.Results A 74-year-old woman presented with gross hematuria,dysuria and irritative symptoms.Cystoscopy depicted as a sessile polypoid mass near the bladder trigone.Histologically,the tumor was arranged diffusely in well-differentiated glandular or tubulocystic patterns with focal papillary structures.However,it showed obvious nuclear atypia and mitotic activity.Some tumor cells assumed as hobnail-like morphology with abundant clear cytoplasm and some were scatteredly infiltrated in the muscle of the bladder wall.Immunohistochemically,the tumor cells were positive for P504s,Pax-2,CKpan,and Vimentin while negative for CK7,34βE12,p63,CD34,CD31,CR,villin,and D2-40.Conclusion CCA of the urinary bladder is a rare type of bladder adenocarcinoma accompanied by clear cells or/and hobnail cells but with severe cytological atypia.Nephrogenic adenoma is the first consideration in differential diagnosis followed by metastatic CCA of the urinary bladder.