CAJ | 학술논문

目的探讨发生于泌尿道绒毛状腺瘤患者的临床病理学特征、免疫表型、鉴别诊断及预后.方法收集3例发生于泌尿道的绒毛状腺瘤患者的临床和病理资料,对其大体改变、组织形态和免疫表型(EnVision法)进行回顾性分析,并复习文献和总结.结果 3例均为中老年男性,均因血尿及黏液尿就诊.内镜显示例1为膀胱顶壁广基息肉样物,例2为输尿管下段实性占位,例3为肾盂菜花状肿物.镜下观察,例l显示纤细的乳头状结构和假复层柱状上皮,伴有丰富的分泌黏液的杯状细胞,部分瘤细胞具有中度异型性；例2与例3为绒毛状腺瘤与低分化腺癌并存,肿瘤部分区域为绒毛状腺瘤,局灶绒毛相互搭连成筛状结构,细胞异型性明显,核分裂象增多,并与浸润性低分化腺癌相移行.免疫组织化学检测,3例中肿瘤细胞均表达CK20、癌胚抗原、上皮细胞膜抗原及MUC-1,均不表达CDX-2及前列腺特异性抗原,例2与例3中乳头状腺瘤与低分化腺癌成分的免疫表型一致,所不同的是在腺癌中p53和Ki-67的阳性细胞数明显增多.结论泌尿道绒毛状腺瘤较为少见,可发生于膀胱、脐尿管、肾盂、输尿管及尿道等处,常伴发恶性肿瘤,因此临床工作中一定要完整切除并充分取材,以防漏诊.
목적 탐토발생우비뇨도융모상선류환자적림상병이학특정、면역표형、감별진단급예후.방법 수집3례발생우비뇨도적융모상선류환자적림상화병리자료,대기대체개변、조직형태화면역표형(EnVision법)진행회고성분석,병복습문헌화총결.결과 3례균위중노년남성,균인혈뇨급점액뇨취진.내경현시례1위방광정벽엄기식육양물,례2위수뇨관하단실성점위,례3위신우채화상종물.경하관찰,례l현시섬세적유두상결구화가복층주상상피,반유봉부적분비점액적배상세포,부분류세포구유중도이형성；례2여례3위융모상선류여저분화선암병존,종류부분구역위융모상선류,국조융모상호탑련성사상결구,세포이형성명현,핵분렬상증다,병여침윤성저분화선암상이행.면역조직화학검측,3례중종류세포균표체CK20、암배항원、상피세포막항원급MUC-1,균불표체CDX-2급전렬선특이성항원,례2여례3중유두상선류여저분화선암성분적면역표형일치,소불동적시재선암중p53화Ki-67적양성세포수명현증다.결론 비뇨도융모상선류교위소견,가발생우방광、제뇨관、신우、수뇨관급뇨도등처,상반발악성종류,인차림상공작중일정요완정절제병충분취재,이방루진.
Objective To explore the clinicopathological features,immunophenotype,differential diagnosis,pathogenesis and prognosis of villous adenoma with poorly differentiated adenocarcinoma of the urinary tract.Methods Clinical and pathologic findings of 3 cases of villous adenoma with poorly differentiated adenocarcinoma of the urinary tract were analyzed by gross examination,microscopic investigation and immunohistochemical staining.The related literatures were reviewed.Results All of the three cases were middle-aged or elderly patients.Three cases all presented with hematuria and mucusuria.Endoscopic examination identified that case 1 had a polyp with broad attachment in the dome of bladder,case 2 had a solid mass in the ureter,and case 3 had a exophytic fungating tumor in the renal pelvis.Microscopically,case 1 revealed a papillary lesion with finger-like processes lined by pseudostratified columnar epithelium with abundant goblet cells.The cells demonstrated moderate degree dysplasia.In case 2 and case 3,both villous adenomas and poorly differentiated adenocarcinoma were observed,the adenoma cells arranged in a cribriform pattern,and the tumor cells showed severe atypia,mitotic activity,and transition with invasive poorly differentiated adenocarcinoma.Immunohistochemically,the tumor cells in three cases were positive for CK20,CEA,EMA and MUC-1 ; none of them expressed cdx-2 and PSA; In case 2 and 3,the same immunophenotype of villous adenomas and their associated adenocarcinomas was observed,but the number of the positive cells of p53 and Ki-67 staining were significantly increased in the area of adenocarcinomas than in that of the villous adenomas.Conclusions Villous adenoma of the urinary tract is rare.It can occur in the urinary bladder,urachus,renal pelvis,ureter and urethra.These lesions may have malignant potential and frequently coexist with other malignant tumors.So,villous adenoma of the urinary tract should be removed completely and sampled thoroughly to avoid missing a more aggressive component.