膀胱肾源性腺瘤恶变:1例罕见病例报道并文献复习  

Malignant transformation of bladder nephrogenic adenoma:report of a rare case and literature review

作　　者：刘阳阳 张玥 王梁[1] 戴志红[1] 郝建戈 张力仁 王莹[1] 刘志宇[1] LIU Yangyang;ZHANG Yue;WANG Liang;DAI Zhihong;HAO Jiange;ZHANG Liren;WANG Ying;LIU Zhiyu(Department of Urology,The Second Affiliated Hospital of Dalian Medical University,Dalian 116000,China)

机构地区：[1]大连医科大学附属第二医院泌尿外科,辽宁大连116000

出　　处：《现代泌尿外科杂志》2022年第7期585-588,共4页Journal of Modern Urology

摘　　要：目的通过对1例肾源性腺瘤恶变为中肾管腺癌的临床病例分析,提高对该病诊治的认识。方法回顾该病例的临床资料并进行文献复习。结果1名66岁的成年男性因发现膀胱肿物入院,膀胱镜检病理考虑肾源性腺瘤,免疫组化结果:PAX-8(+),PAX-2(-),CK7(+),EMA(+),P63(少部分+),Ki-67(1%+)。行机器人辅助腹腔镜膀胱部分切除术后,病理诊断为膀胱中肾管腺癌,考虑肾源性腺瘤恶变。免疫组化结果:AE1/AE3(+),CK7(+),CK20(-,PAX-8(+),P63(部分+),GATA-3(弱+),P53(少许+),Ki-67(+,热点区30%)。结论膀胱肾源性腺瘤恶变为中肾管腺癌十分罕见,确诊依赖于病理免疫组化染色结果。Ki-67增值指数的增加、CEA(+)、P53(+)以及MIB-1的高增值活性是判断肾源性腺瘤恶变的重要分子学标志。Objective To report a rare clinical case of nephrogenic adenoma which progressed to mesonephric adenocarcinoma of the urinary bladder.Methods Clinical data of the patient were analyzed and relevant literature was reviewed.Results A 66-year-old male was admitted due to a mass in the bladder.Cystoscopy suspected nephrogenic adenoma.Immunohistochemical results showed PAX-8(+),PAX-2(+),CK7(+),EMA(+),P63(a small part+),and Ki-67(1%+).After robot-assisted laparoscopic partial cystectomy,the pathological diagnosis was mesonephric adenocarcinoma of the bladder arising from nephrogenic adenoma,and cystoscopy indicated nephrogenic adenoma of the bladder generated from nephrogenic adenoma.Immunohistochemistry results:AE1/AE3(+),CK7(+),CK20(-),PAX-8(+),P63(partial+),GATA-3(weak+),P53(a little+),KI-67(30%,+).Conclusion The malignant transformation of bladder nephrogenic adenoma into mesonephric adenocarcinoma is rare.The diagnosis depends on the results of pathological immunohistochemical staining.The increase in Ki-67,and the high proliferation activity of CEA(+),P53(+)and MIB-1 are important molecular markers for diagnosing the malignant transformation of nephrogenic adenoma.

关 键 词：肾源性腺瘤 中肾管腺癌 透明细胞癌 膀胱 

分 类 号：R737.1[医药卫生—肿瘤]