CAJ | 학술논문

目的探讨尿路上皮癌伴透明细胞变异的临床及病理特点.方法回顾性分析我院2005年3月至2014年5月收治的7例尿路上皮癌伴透明细胞变异患者的临床及病理资料.男6例,女1例.年龄46～75岁,平均61岁.临床表现为肉眼血尿5例,腰疼伴血尿2例.肿瘤直径2.0～6.0 cm,平均3.5 cm.7例中多发肿瘤1例,单发6例.原发于输尿管2例,均行肾输尿管全切;原发于膀胱5例,行经尿道膀胱肿瘤切除术+表柔比星膀胱灌注1例、根治性膀胱切除4例.结果术后病理诊断:7例均为高级别尿路上皮癌伴透明细胞变异,其中透明细胞癌为主1例,局部透明细胞癌6例.合并腺性分化2例、鳞状分化1例、微乳头变异1例,4例脉管系统内可见瘤栓.病理分期pT2a期1例,pT2b期3例,pT3a期3例.免疫组化染色:细胞角蛋白7、细胞角蛋白20、上皮膜抗原均为(+),前列腺特异性抗原(-).7例中6例获随访,1例保留膀胱者随访8个月未见复发;4例膀胱全切者中1例于术后25个月死于转移,2例术后分别随访10和12个月未见肿瘤复发及转移,失访1例;肾输尿管全切1例术后18个月死于转移,另1例术后随访6个月未见复发及转移.结论尿路上皮癌伴透明细胞变异临床罕见,多为高级别、高分期肿瘤,预后差,根治性全切是主要的治疗方法.
목적 탐토뇨로상피암반투명세포변이적림상급병리특점.방법 회고성분석아원2005년3월지2014년5월수치적7례뇨로상피암반투명세포변이환자적림상급병리자료.남6례,녀1례.년령46～75세,평균61세.림상표현위육안혈뇨5례,요동반혈뇨2례.종류직경2.0～6.0 cm,평균3.5 cm.7례중다발종류1례,단발6례.원발우수뇨관2례,균행신수뇨관전절;원발우방광5례,행경뇨도방광종류절제술+표유비성방광관주1례、근치성방광절제4례.결과 술후병리진단:7례균위고급별뇨로상피암반투명세포변이,기중투명세포암위주1례,국부투명세포암6례.합병선성분화2례、린상분화1례、미유두변이1례,4례맥관계통내가견류전.병리분기pT2a기1례,pT2b기3례,pT3a기3례.면역조화염색:세포각단백7、세포각단백20、상피막항원균위(+),전렬선특이성항원(-).7례중6례획수방,1례보류방광자수방8개월미견복발;4례방광전절자중1례우술후25개월사우전이,2례술후분별수방10화12개월미견종류복발급전이,실방1례;신수뇨관전절1례술후18개월사우전이,령1례술후수방6개월미견복발급전이.결론 뇨로상피암반투명세포변이림상한견,다위고급별、고분기종류,예후차,근치성전절시주요적치료방법.
Objective To investigate the clinical and pathological features of urothelial carcinoma with clear cell variant.Methods The pathological and clinical data of 7 cases pathological diagnosed urothelial carcinoma with clear cell variant between March 2005 and May 2014 were retrospectively reviewed.There were 6 males and 1 female,aged 46-75 years (mean,61 years).Clinical manifestations included gross hematuria in 5 cases,hematuria and backache in another 2 cases.The mean tumor size was 3.5 cm (ranged 2.0-6.0 cm).One case was multiple tumor and 6 cases were single tumor.Five cases were positive in urine cytology.All the 7 cases accepted surgical treatment,including radical nephroureterectomy in 2 cases,transurethral resection of bladder tumor plus pharmorubicin regular intravesicalinstillationin 1 case,and radical cystectomy in 4 patients.Results Pathological findings revealed that all the tumors were high-grade urothelial carcinoma with clear cell variant in different proportion.Among them,clear cell tumor was predominant in 1 case and focal in other 6 cases.Meanwhile,tumorsaccompanied by glandular differentiation were found in 2 cases,squamous differentiation was found in 1 case,and micropapillary variant was found in 1 case.Vascular tumor embolus was found in 4 cases.Pathological stage was pT2a (n =1),pT2b (n =3),and pT3a (n =3).Immunohistochemicalstaining revealed cytokeratin 7 (+),cytokeratin 20 (+),epithelial membrane antigen (+)and prostate specific antigen (-).Six cases were followed up.The bladder preservation case was followed up for 8 months without recurrence.In 3 radical cystectomy cases,1 died of cancer 25 months after surgery and another 2 case were followed up for 10 and 12 months after surgery without recurrence and metastasis.In 2 nephroureterectomy cases,1 died of tumor metastasis 18 months after surgery and the other case was followed up for 6 months without recurrence or metastasis.Conclusions Urothelialcarcinoma with clear cell variant is a malignancy often with advanced stage and poor prognosis.Radical surgery is recommended for the treatment.