膀胱器官相关性假肉瘤性肌纤维母细胞性增生3例临床病理观察  

Organassociated pseudosarcomatous myofibroblastic proliferation of urinary blader: a clinicopathological study of three cases

作　　者：李亮[1] 徐青霞[1] 韩翠红[1] 周凤娟[1] 崔文[2] LI Liang XU Qing-xia HAN Cui-hong ZHOU Feng-juan CUI Wen(Department of Pathology, Jining No. 1 People＇s Hospital, Jining 272011, China Department of Pathology, Jining Medical College, Jining 272013, China)

机构地区：[1]济宁市第一人民医院病理科,山东济宁272011 [2]济宁医学院病理学教研室,山东济宁272013

出　　处：《诊断病理学杂志》2017年第3期178-181,共4页Chinese Journal of Diagnostic Pathology

摘　　要：目的探讨膀胱器官相关性假肉瘤性肌纤维母细胞性增生(PMP)临床病理特征、诊断与鉴别诊断、治疗及预后。方法对3例膀胱PMP的临床表现、组织形态学及免疫组化进行观察并结合文献分析。结果该病临床主要表现为无痛性肉眼血尿,有尿频、尿急、尿痛或排尿困难。组织形态上,病变多位于黏膜下,梭形细胞显著增生,排列紊乱,穿插于正常的膀胱肌层内,间质内常伴有较多的炎细胞浸润,嗜酸性粒细胞易见;梭形细胞胞质丰富,核呈圆形、卵圆形或胖梭形,可见显著核仁,核分裂象罕见,间质可见黏液样变性。免疫组化:梭形细胞a-SMA(3/3)、calponin(3/3)、desmin(1/3)和h-caldesmon(1/3)(+),其中1例少数梭形细胞ALK和CK-pan(+);3例CD34、Dog-1、S-100、β-catenin、myogenin和MyoD1均(-)。结论膀胱器官相关性假肉瘤性肌纤维母细胞性增生是一种发生于膀胱的假肉瘤样良性病变,因其呈假性浸润生长模式,细胞有一定异型,有时易误诊为恶性软组织肉瘤,需要结合免疫组化鉴别。Objective To explore the clinicopathologic features, diagnosis, differential diagnosis, treatment and prognosis of organ-associated pseudosarcomatous myofibroblastic proliferation of urinary blader（ PMP）. Methods Three cases of PMP were studied on the clinical characteristics,HE morphology and immunohistochemical characteristics. Related articles were reviewed. Results The major clinical characteristics included painless gross hematuria,urinary urgency and frequency,urine pain or dysuria. Histologicall,lesions most commonly located in the submucosal,the proliferation of spindle cells significantly with disordered arrangement,interspersed within normal muscle layer,often accompanied by more inflammatory cells infiltration,eosinophils were easily noted. The spindle cells had mild atypia,rare mitosis,interstitial myxoid degeneration. Immunohistochemical staining showed that spindle cells were positive for SMA（ 3 /3）,calponin（ 3 /3）,desmin（ 2 /3）,h-caldesmon（ 1 /3） and a series of myogenic markers,and a few spindle cells of two cases were positive for ALK and CK-pan,However,spindle cells of three cases were not expressed in CD34,Dog-1,S-100,β-catenin,Myogenin and MyoD1. Conclusion Organ-associated pseudosarcomatous myofibroblastic proliferation of urinary blader is a kind of benign lesions with false sarcomatoid,and sometimes we misdiagnosed as malignant soft tissue sarcoma because of pseudoinfiltrating growth pattern and heterotypic spindle cells. We can make the correct diagnosis according to its clinicopathologic features and immunohistochemical results to avoid excessive clinical treatment.

关 键 词：膀胱 假肉瘤性肌纤维母细胞性增生 临床病理 

分 类 号：R730.14[医药卫生—肿瘤]