原发性膀胱恶性类癌的临床及病理观察(附4例报告)

Primary malignant carcinoid tumor of urinary bladder: a report of four cases

目的 观察总结原发性膀胱恶性类癌的临床、病理形态学特点、诊断及其预后。方法 对4例原发性膀胱恶性类癌进行光镜观察和免疫组织化学检测嗜铬素A(Chromogranin A,Chr)、突触素(Syanptophysin,Syn)、神经特异性烯醇化酶(neuron specific enolase,NSE)等,其中3例电镜观察。结果 4例原发性膀胱恶性类癌临床表现均为肉眼血尿,无类癌综合征。瘤细胞大小较一致,胞核圆形、椭圆形或梭形,较深染,可见核分裂象及坏死。胞浆较宽广,嗜酸性。瘤细胞呈腺泡状、梁状、实性片状排列。免疫组织化学 Chr、Syn、NSE二种或二种以上阳性。电镜下瘤细胞胞浆内可见内分泌颗粒。结论 原发性膀胱恶性类癌是一种少见的神经内分泌肿瘤,其诊断依靠组织学、免疫组织化学和电镜观察。临床分期是决定预后的主要因素。

Objective To observe and summarize the clinical characteristics, pathomorphological features, diagnosis, and prognosis of primary malignant carcinoid tumor of the urinary bladder. Methods Light microscopic observation, Immunohistochemical (IHC) staining for chromogranin A (Chr), synaptophysin (Syn), and neuron specific enolase (NSE) cytokeratin (CK), epithelial membrane antigen (EMA) , and electronic microscopy (EM) for three cases were performed and the literature was reviewed. Results Primary malignant carcinoid tumor of the urinary bladder of 4 cases presented with macroscopic hematuria without carcinoid syndrome. The tumor cells were relatively uniform with nucleus hyperchromatic, round, oval or spindle - like and cytoplasm eosinphilic. Mitotic figures and necrosis may be seen. The arrangement of the tumor cells was in aciniform, trabecula, sheet - like. The tumor cells were immunoreactive to at least two of Chr, Syn, NSE. Endocrine granules could be seen in the cytoplasm of tumor cells under EM. Con- elusions Primary malignant carcinoid tumor of the urinary bladder is a rare endocrine tumor. The pathological diagnosis depends on histology, IHC and EM observation. Clinical stage is the predominant determining factor in prognosis.