膀胱癌伴前列腺癌16例临床病理分析

Concomitant bladder cancer and prostate cancer:Sixteen case report and a clinicopathologic analysis

目的探讨膀胱癌伴前列腺癌(CBP)的临床病理特征、检出率及治疗情况。方法回顾性分析16例CBP的临床资料、病理学特征及免疫表型,并进行随访。结果CBP的发生率为13.9%(16/115),中位年龄73岁(60~87岁),其中临床期前列腺癌7例(6.1%),偶发性前列腺癌(IPCa)9例(7.8%)。11例临床表现为无痛性肉眼血尿,5例有不同程度的排尿困难、尿频、尿急、尿痛。膀胱癌病理特征:12例(75.0%)为高级别浸润性尿路上皮癌,4例(25.0%)为低级别浸润性尿路上皮癌,其中2例高级别尿路上皮癌伴鳞状上皮分化,1例高级别尿路上皮癌伴腺样分化;3例(18.8%)pT1期,9例(56.2%)pT2期,4例(25.0%)pT3期。前列腺癌病理特征:16例前列腺癌均为经典型腺泡癌;Gleason评分显示6分11例(68.8%),7分4例(25.0%),9分1例(6.2%)。免疫表型:16例膀胱癌中p63、CK7、CK5/6呈弥漫阳性,PSA及p504s呈阴性;16例前列腺癌中PSA及p504s均呈弥漫阳性,基底细胞标记物如p63、K903及CK5/6均阴性。随访3~45个月,4例失访,余均无前列腺癌死亡病例。结论CBP在膀胱前列腺切除术后常规病理检查中偶有发现,总体发病率较低,易漏诊,临床医师应提高对该病的认识。

Objective To investigate the clinicopathological features,detection rate and treatment of concomitant bladder cancer and prostate cancer(CBP).Methods Clinical features,histological morphology and immunophenotypes of 16 patients with CBP were analyzed retrospectively and followed up.Results The incidence of CBP was 13.9%(16/115),with a median age of 73 years(range from 60-87 years).There were 7 cases(6.1%)of clinical stage prostate cancer and 9 cases(7.8%)of incidental prostate cancer(IPCa).The clinical manifestations of 11 cases had painless gross hematuria.5 cases had different degrees of dysuria,frequency,urgency and pain.Pathological analysis of bladder cancer:12 cases(75.0%)were high-grade invasive urothelial carcinoma,4 cases(25.0%)were low-grade invasive urothelial carcinoma,including 2 cases of high-grade urothelial carcinoma with squamous cell differentiation,1 case of high-grade urothelial carcinoma with adenoid differentiation.There were 3 cases(18.8%)were pT1,9 cases(56.2%)with pT2,and 4 cases(25.0%)with pT3.Pathological features of prostate cancer confirmed that 16 cases of prostae cancer were classic acinar carcinoma.Gleason score were 6 in 11 cases(68.8%),7 in 4 cases(25%)and 9 in 1 case(6.2%).Immunophenotype showed that p63,CK7 and CK5/6 were diffusely positive in 16 cases of bladder cancer,while PSA and p504s were negative.PSA and p504s were diffuse positive in 16 cases of prostate cancer,while basal cell markers such as p63,K903 and CK5/6 were negative.During the follow-up period of 3-45 months,4 cases were lost to follow-up,and no death of prostate cancer occurred in the rest cases.Conclusion CBP was occasionally found in routine pathological examination after radical cystoprostatectomy.The overall incidence rate was low and it was easy to miss.Clinical doctors should improve the understanding of the disease.