本帖最后由 pathology 于 2015-7-16 12:08 编辑
本周病例(2015.5.25—2015.5.31)
1、你考虑什么诊断?
原位尿路上皮癌累及Brunn巢(Urothelial carcinoma in situ involving von Brunn nests)
Urothelial carcinoma in situ, also known as high grade intraurothelial neoplasia (HG IUN), is a flat lesion composed of cells in the mid to upper epithelium with high cytologic grade. By definition, no invasion into the lamina propria is present. Symptoms are similar to cystitis, and hematuria is common.
No mass is present. The lesion is flat, with erythematous, granular or cobblestone mucosa, and may involve large areas of the bladder mucosa, ureters and urethra. Common patterns are large cells with pleomorphism, large cells without pleomorphism, small cell, clinging (single layer of atypical cells on denuded urothelium) or pagetoid / cancerization of urothelium. Histologically, except for the small cell pattern, the cells are large with irregular, hyperchromatic nuclei, prominent nuclear pleomorphism and a high N/C ratio. Mitotic figures are found in the mid to upper epithelium. The nuclear size is typically 5x that of lymphocytes, compared to normal urothelium with a nuclear size of 2x lymphocytes.
Carcinoma in situ can involve von Brunn nests, resulting in nests of neoplastic cells within the lamina propria, and suggestive of invasion. However, von Brunn nests typically have a rounded contour, and lack the stromal changes associated with invasion.
2、需要做什么鉴别诊断?
腺性膀胱炎、浸润性尿路上皮癌、伴腺样分化的非浸润性尿路上皮癌等
3、本病预后如何?
如果不经治疗,约20%的膀胱原位癌会进展为浸润性癌。非外科手术治疗包括经尿道膀胱肿瘤电切术(TURBT),术后膀胱内灌注化疗(如:BCG、丝裂霉素C)。
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