膀胱浆细胞样尿路上皮癌的临床与病理学特点分析  

Analysis of clinicopathological features of plasmacytoid urothelial carcinoma of the bladder

作　　者：王一[1] 梁博[2] 刘晓强[1] 郭战军[1] 刘雨[1] 胡海龙[1] 吴长利[1] 孙光[1] 

机构地区：[1]天津医科大学第二医院泌尿外科天津市泌尿外科研究所天津市泌尿外科基础医学重点实验室,300211 [2]四川省遂宁市中心医院泌尿外科

出　　处：《中华泌尿外科杂志》2014年第2期107-110,共4页Chinese Journal of Urology

摘　　要：目的 分析膀胱浆细胞样尿路上皮癌的临床与病理学特点.方法 报告我院收治的1例膀胱浆细胞样尿路上皮癌患者的临床资料.患者男,54岁.临床表现为间歇性全程无痛肉眼血尿.尿脱落细胞检查为阴性.术前行B超检查提示膀胱左侧壁有一约2.5 cm×3.5 cm中低回声团块,CT检查示膀胱左侧壁一隆起性中等密度肿物,未见盆腔淋巴结肿大影.膀胱镜检查发现一广基、单发隆起性肿物,大小约2.5 cm×3.5 cm,表面可见出血坏死灶,双侧输尿管口未累及.术前病理活检诊断为膀胱尿路上皮癌,侵及肌层,临床分期为T2bN0M0.应用免疫组化方法对肿瘤标本进行分析并对相关文献进行复习.结果 本例术前诊断为膀胱尿路上皮癌,行膀胱全切除术加双侧淋巴结清扫.术后病理诊断为膀胱浆细胞样尿路上皮癌.肿瘤细胞浸润膀胱黏膜及黏膜下层,并侵及肌层.特殊染色AB/PAS阳性.免疫组化染色提示EMA、CK（AE1/AE3）、CK7、CK18、CK20、CEA、CD138、β-hCG均为阳性,E-cadherin、CD45、CD38、S-100、HMB45、vimentin、desmin、SMA、myogenin、MyoD1、Syn及CgA均为阴性.术后给予规律全身吉西他滨＋顺铂（GC）方案化疗,4个疗程后由于化疗不良反应而终止.随访18个月,患者死于肿瘤进展.结论 膀胱浆细胞样尿路上皮癌临床罕见,具有特殊的组织病理学特点,治疗方面尚没有明确的指导治疗方案.Objective To study the clinicopathological features,diagnosis and differential diagnosis,treatment and prognostic features of plasmacytoid urothelial carcinoma of the bladder.Methods One patient＇s clinical data with bladder plasmacytoid urothelial carcinoma in our department was reported.Routine paraffin sections with HE staining and immunohistochemistry were performed.Pathological and clinical data were analyzed and literatures were reviewed.Results The case was diagnosed as bladder carcinoma before operation,and partial cystectomy was performed with the diagnosis of plasmacytoid urothelial carcinoma of the bladder by pathological examination after operation.The tumor cells exhibited typical plasmacytoid profiles,which are round or oval with abundant eosinophilic cytoplasm and eccentric,hyperchromatic nuclei,and mitoses were frequently found.Monomorphous tumor cells invaded the mucoma,submocum and musculair of the bladder.Some tumor cells were positive by AB/PAS staining.Immunohistochemically,there were positive for EMA,CK （AE1/AE3）,CK7,CK18,CK20,CEA,CD138 andβ-hCG,and negative for E-cadherin,CD45,CD38,S-100,HMB45,vimentin,desmin,SMA,myogenin,MyoD1,Syn and CgA.This patient was treated by adjuvant chemotherapy of GC for 4 courses after operation,and he died of tumor progression after 18 months of follow-up.Conclusions Plasmacytoid urothelial carcinoma of the bladder is a rare tumor.The treatment strategy has not been established and it is always in dispute.

关 键 词：膀胱 尿路上皮癌 浆细胞样 诊断 

分 类 号：R737.14[医药卫生—肿瘤]