膀胱镜活检10例病理误诊分析

Pathologic analysis of the misdiagnosis in urinary bladder:A report of 10 cases

目的 对在膀胱活检小标本中出现低诊断和过诊断问题进行病理形态学分析。方法 复习我院存档的膀胱活检病例共 382例。结果 有 10例 (3 1% )为误诊病例 ,其中 2例旺炽型腺性膀胱炎过诊断为移行细胞癌 ;8例移行细胞癌低诊断为良性病变 ,其中诊断腺性膀胱炎 4例 (1例为原位癌 ,3例为早期浸润癌 ) ,乳头状瘤 2例 (均为乳头状移行细胞癌Ⅰ级 ) ,内翻性乳头状瘤 1例 (为伴有内翻性生长的乳头状移行细胞癌 1级 ) ,上皮增生 1例 (原位癌 )。结论 ①腺性膀胱炎与癌最易混淆 ;②泌尿道上皮良恶性病变的形态学鉴别诊断主要依靠细胞的异型性和有 /无上皮内中层以上的核分裂象 ;

Objective To analyze patho morphologically the problem on the smaller bladder biopsies that may be underdiagnosed and overdiagnosed Methods The 382 cases of bladder biopsies hading be reviewed, that were queried on diagnosis, were followed up and consulted with some specialists Also, all the samples were immunohistochemically stained for PCNA,Ki-67, CEA, p53 and bcl-2 Results 10/382 cases(3 1%) were identified with misdiagnosis before, including that 2 cases with florid cystitis glandularis were overdiagnosed as transitional cell carcinoma and that 8 cases with transitional cell carcinoma were underdiagnosed as benign lesions , of which, 4 cases as cystitis glandularis(one carcinoma in situ, others with early invasive carcinoma),2 cases with as papilloma ( papillary transitional cell carcinomas), one as inverting papilloma (papillary transitional cell carcinoma with inverting pattern) and one as urothelial hyperplaisa ( carcinoma in situ) Conclusions Among these lesions, cystitis glandularis may most easily be confused with carcinoma,The differential diagnosis between benign and malignant is based on the cytologic atypia and mitotic activity in the mid to upper urothelium In addition, using the markers of cytologic proliferative activity is helpful for differential diagnosis