膀胱浸润性高级别尿路上皮癌合并原发性膀胱腺癌3例临床病理分析

Bladder invasive high-grade urothelial carcinoma complicated with primary bladder adenocarcinoma:a clinicopathological analysis of three cases

目的探讨膀胱浸润性高级别尿路上皮癌合并原发性膀胱腺癌的临床病理特征。方法对3例膀胱浸润性高级别尿路上皮癌合并原发性膀胱腺癌的临床及病理特点、免疫表型、鉴别诊断等进行分析,并回顾相关文献进行探讨总结。结果患者男性2例,女性1例,平均年龄67岁(58~78岁)。3例患者膀胱肿物均为多发,临床表现为血尿伴膀胱刺激症,2例排尿困难,1例腰背部及下腹痛。2例患者行根治性膀胱切除术及盆腔淋巴结清扫联合新辅助化疗,1例患者行经尿道膀胱肿瘤电切术(TURBT)及部分膀胱壁切除术联合灌注化疗。术后病理形态学:浸润性高级别尿路上皮癌组织呈实性巢状或乳头状生长,部分乳头融合,上皮层次紊乱、细胞异形,可见病理性核分裂;腺癌组织呈不规则腺样或筛孔状排列,腺腔内可见凋亡坏死,细胞异型性明显。免疫表型:浸润性高级别尿路上皮癌均GATA3、UroplakinⅢ、CK7、P63阳性,CK202例部分阳性,1例阴性,β-catenin、CDX2、Villin阴性;原发性膀胱腺癌均β-catenin膜阳性,CDX2、Villin及CK20不同程度阳性,GATA3、UroplakinⅢ、CK7及P63阴性。3例患者中1例失访,2例随访时间2~36个月,1例死亡,1例间断化疗中。结论膀胱浸润性高级别尿路上皮癌合并原发性膀胱腺癌极为罕见,恶性程度高且预后差,临床表现无特异性,诊断主要依靠临床及病理检查,并辅以免疫组化检测。

Objective To investigate the clinicopathological features of bladder invasive high-grade urothelial carcinoma complicated with primary bladder adenocarcinoma.Methods The clinical and pathological features,immunophenotype and differential diagnosis of 3 cases of invasive high-grade urothelial carcinoma of the bladder complicated with primary bladder adenocarcinoma were analyzed,and the related literature was reviewed.Results There were 2 males and 1 female with a mean age of 67 years(ranged 58-78 years).All the 3 patients had multiple bladder masses,and the clinical manifestations were hematuria and bladder irritation,2 cases of dysuria,and 1 case of low back and lower abdominal pain.Two patients underwent radical cystectomy and pelvic lymph node dissection combined with neoadjuvant chemotherapy,and 1 patient underwent transurethral resection of bladder tumor(TURBT)and partial bladder wall resection combined with intravesical chemotherapy.Postoperative pathology showed that the invasive high-grade urothelial carcinoma tissue presented solid nests or papillary growth,some papillary fusion,epithelial layer disorder,cell atypia,and pathological mitotic figures.The adenocarcinoma tissue showed irregular glandular or cribriform arrangement,apoptosis and necrosis could be seen in the glandular cavity,and cell atypia was obvious.Immunohistochemically,invasive high-grade urothelial carcinoma was positive for GATA3,Uroplakin Ⅲ,CK7 and P63,2 case were porrtially positive and 1 case was negative for CK20,and negative for β-catenin,CDX2 and Villin.Primary bladder adenocarcinoma was positive for β-catenin membrane,different degree of positivity for CDX2,Villin and CK20,but negative for GATA3,Uroplakin Ⅲ,CK7 and P63.Among the 3 patients,1 patient was lost to follow-up,2 patients were followed up for 2-36 months,1 patient died,and 1 patient was undergoing intermittent chemotherapy.Conclusion The invasive high-grade urothelial carcinoma combined with primary bladder adenocarcinoma is extremely rare,with high malignancy and poor prognosis.The clinical manifestations are not specific.The diagnosis mainly depends on clinical and pathological examination,supplemented by immunohistochemical detection.