膀胱尿路上皮癌伴偶发前列腺癌7例临床病理分析

Urothelial carcinoma of bladder with incidental prostate cancer:a clinicopathological analysis of seven cases

目的分析膀胱前列腺根治性切除标本中偶发前列腺癌(incidental prostate cancer,IPCa)的临床病理学特征,探讨影响IPCa检出率的原因。方法回顾性分析7例行根治性膀胱前列腺切除术(radical cystoprostatectomy,RCP)男性膀胱癌患者的临床资料、病理学特征及免疫表型,并进行随访。结果7例患者年龄67~83岁,平均76岁,其中6例以膀胱肿瘤首诊,伴间歇性无痛性肉眼血尿;1例体检发现PSA升高首诊(PSA 4.296 ng/mL),伴尿频、夜尿增多。3例术前PSA升高;4例有长期吸烟史。膀胱癌特征:1例(14.2%)为低级别非浸润性尿路上皮癌;1例(14.2%)为低级别浸润性尿路上皮癌;5例(71.4%)为高级别浸润性尿路上皮癌。其中5例侵及肌层,2例脉管内见癌栓,2例见淋巴结转移。2例(28.6%)pT1期,2例(28.6%)pT2期,3例(42.9%)pT3期。IPCa特点:7例均为腺癌,Gleason评分1组3例(42.9%),2组3例(42.9%),3组1例(14.2%);1例侵及被膜,周围切缘灶性区域见癌组织浸润;肿瘤分期:pT1期6例(85.8%),pT3期1例(14.2%)。免疫表型:PSA、PSAP、P504s均(+),p63、CK(34βE12)均(-),其中1例PSA(■),7例AR(+),Ki-67增殖指数3%~25%。随访时间6~72个月,1例失访,4例死亡,2例存活。结论IPCa术前诊断较困难,且术后检出率较低,易漏诊,标本规范化取材及病理技术对该病的检出率极为重要。

Purpose To analyze the clinicopathological features of incidental prostate cancer(IPCa)in radical prostatectomy specimens of the bladder,and to explore the reasons influencing the detection rate of IPCa by reviewing relevant literature.Methods The clinical data,pathological characteristics and immunophenotype of 7 male patients with bladder cancer who underwent radical cystoprostatectomy(RCP)were retrospectively analyzed and followed up.Results The patients ranged in age from 67 to 83 years,with an average of 76 years.Six of them were first diagnosed with bladder tumor,accompanied by intermittent painless gross hematuria.One case was first diagnosed with elevated PSA(PSA 4.296 ng/mL),accompanied by frequent urination and increased nocturia.PSA was elevated in 3 cases.Four patients had a long history of smoking.Characteristics of bladder cancer included:one case(14.2%)was low-grade non-invasive urothelial carcinoma,one case(14.2%)was low-grade invasive urothelial carcinoma,5 cases(71.4%)had high grade invasive urothelial carcinoma.Among them,5 cases invaded muscular layer,2 cases showed tumor thrombus in vessels,and 2 cases showed lymph node metastasis.2 patients(28.6%)had PT1 stage,2 patients(28.6%)had PT2 stage,and 3 patients(42.9%)had PT3 stage.IPCA features included:all the 7 specimens were adenocarcinoma.Gleason score was as follows:3 cases in Group 1(42.9%),3 cases in Group 2(42.9%),and 1 case in Group 3(14.2%).In 1 case,the capsule was invaded,and cancer tissue was found in the focal area around the incisor margin.Tumor staging showed Pt1 in 6 cases(85.8%)and Pt3 in 1 case(14.2%).Immunophenotyping showed that the cancer cells were positive for PSA,PSAP and P504s,but negative for p63 and CK(34βE12)in 7 cases of incidental prostate cancer,among which 1 case was positive for PSA.One case was positive for AR,and the Ki-67 proliferation index was 3%-25%.Follow-up period ranged from 6 to 72 months,1 case was lost to follow-up,4 cases died,and 2 cases survived.Conclusion Preoperative diagnosis of IPCA is difficult,and the detection rate is low after surgery,easy to misdiagnosis,and therefore standardized sample sampling and pathological techniques are very important for the detection rate of this disease.