膀胱肾源性腺瘤3例报道及文献复习

Nephrogenic adenoma of the urinary bladder: report of 3 cases and review of literature

目的探讨膀胱肾源性腺瘤(NA)的临床病理学及免疫组化特征,诊断与鉴别诊断。方法回顾性分析3例膀胱NA,总结其临床、病理学和免疫组化特征,并复习相关文献。结果男性2例,女性1例,年龄20~76岁。1例有急性膀胱炎病史,1例2年前有经尿道前列腺电切病史。膀胱镜下3例病变均表现为黏膜的局部隆起。组织学上,病变主要由乳头状、小管状和小囊状结构组成,管腔中可见嗜酸性分泌物,上皮为立方状或矮柱状,部分呈“靴钉样”改变;间质水肿及慢性炎改变。免疫组化:上皮细胞PAX2、PAX8(+),CK7、P504S部分(+),而PSA和p63(-),Ki-67增殖指数<2%。结论膀胱NA是一种少见的良性增生性改变,患者常有泌尿道损伤病史。膀胱NA常需与尿路上皮癌、前列腺癌以及膀胱透明细胞腺癌等相鉴别。掌握其临床病理学和免疫组化特征,有助于提高诊断率。

Objective To investigate the clinicopathological and immunohistochemical features of nephrogenic adenoma ( NA) and its diagnosis and differential diagnosis. Methods Clinical,pathomorphologic and immunophenotypic features of 3 cases were retrospectively analyzed,and relevant literatures were also reviewed. Results Two males and one female were included in this study,aged from twenty to seventy-six. One case had a history of acute cystitis,and another had transurethral resection of prostate history 2 years ago. All cases showed papillary lesions in the cystoscopy. Histologically, these lesions were mainly composed of papillary,tubular and cystic structure,and eosinophilic secretions could be observed in the lumen. The lining epithelium was cuboidal or low columnar,some of which were hobnail cells. Stroma usually showed edema and chronic inflammation. Immunohistochemiscally,the epithelial cells were positive for PAX2,PAX8,CK7,and P504S,but they did not express PSA and p63,while Ki-67 was usually less than 2%. Conclusion NA of urinary bladder is a rare benign proliferative lesion that can occur throughout the whole urinary system. Patients often have a history of urinary tract injury. NA of urinary baldder should be distinguished from urothelial carcinoma,prostatic adenocarcinoma and baldder clear cell adenocarcinoma. Understanding its clinicopathological and immunohistochemical features will facilitate the diagnostic accuracy of NA.