尿路上皮癌伴透明细胞变异的临床病理分析

Clinical and pathological analysis of urothelial carcinoma with clear cell variant

目的 探讨尿路上皮癌伴透明细胞变异的临床及病理特点.方法 回顾性分析我院2005年3月至2014年5月收治的7例尿路上皮癌伴透明细胞变异患者的临床及病理资料.男6例,女1例.年龄46～75岁,平均61岁.临床表现为肉眼血尿5例,腰疼伴血尿2例.肿瘤直径2.0～6.0 cm,平均3.5 cm.7例中多发肿瘤1例,单发6例.原发于输尿管2例,均行肾输尿管全切;原发于膀胱5例,行经尿道膀胱肿瘤切除术＋表柔比星膀胱灌注1例、根治性膀胱切除4例.结果 术后病理诊断：7例均为高级别尿路上皮癌伴透明细胞变异,其中透明细胞癌为主1例,局部透明细胞癌6例.合并腺性分化2例、鳞状分化1例、微乳头变异1例,4例脉管系统内可见瘤栓.病理分期pT2a期1例,pT2b期3例,pT3a期3例.免疫组化染色：细胞角蛋白7、细胞角蛋白20、上皮膜抗原均为（＋）,前列腺特异性抗原（-）.7例中6例获随访,1例保留膀胱者随访8个月未见复发;4例膀胱全切者中1例于术后25个月死于转移,2例术后分别随访10和12个月未见肿瘤复发及转移,失访1例;肾输尿管全切1例术后18个月死于转移,另1例术后随访6个月未见复发及转移.结论 尿路上皮癌伴透明细胞变异临床罕见,多为高级别、高分期肿瘤,预后差,根治性全切是主要的治疗方法.

Objective To investigate the clinical and pathological features of urothelial carcinoma with clear cell variant.Methods The pathological and clinical data of 7 cases pathological diagnosed urothelial carcinoma with clear cell variant between March 2005 and May 2014 were retrospectively reviewed.There were 6 males and 1 female,aged 46-75 years （mean,61 years）.Clinical manifestations included gross hematuria in 5 cases,hematuria and backache in another 2 cases.The mean tumor size was 3.5 cm （ranged 2.0-6.0 cm）.One case was multiple tumor and 6 cases were single tumor.Five cases were positive in urine cytology.All the 7 cases accepted surgical treatment,including radical nephroureterectomy in 2 cases,transurethral resection of bladder tumor plus pharmorubicin regular intravesicalinstillationin 1 case,and radical cystectomy in 4 patients.Results Pathological findings revealed that all the tumors were high-grade urothelial carcinoma with clear cell variant in different proportion.Among them,clear cell tumor was predominant in 1 case and focal in other 6 cases.Meanwhile,tumorsaccompanied by glandular differentiation were found in 2 cases,squamous differentiation was found in 1 case,and micropapillary variant was found in 1 case.Vascular tumor embolus was found in 4 cases.Pathological stage was pT2a （n =1）,pT2b （n =3）,and pT3a （n =3）.Immunohistochemicalstaining revealed cytokeratin 7 （＋）,cytokeratin 20 （＋）,epithelial membrane antigen （＋）and prostate specific antigen （-）.Six cases were followed up.The bladder preservation case was followed up for 8 months without recurrence.In 3 radical cystectomy cases,1 died of cancer 25 months after surgery and another 2 case were followed up for 10 and 12 months after surgery without recurrence and metastasis.In 2 nephroureterectomy cases,1 died of tumor metastasis 18 months after surgery and the other case was followed up for 6 months without recurrence or metastasis.Conclusions Urothelialcarcinoma with clear cell variant is a malignancy often with advanced stage and poor prognosis.Radical surgery is recommended for the treatment.