4 200例膀胱肿瘤病理特点分析
Analysis of pathological character of 4 200 bladder tumor cases
目的 探讨膀胱肿瘤的组织学特点和各亚型的生物学特点,为合理选择治疗方法提供理论依据.方法 回顾性分析2001年5月至2014年10月收治的4 200例膀胱肿瘤患者的病理资料,男3 443例,女757例;年龄20 ~ 95岁,平均(62.7±11.4)岁.肿瘤直径0.2~6.5cm,平均(1.8±0.6)cm,单发肿瘤3 214例(76.5%),多发性肿瘤986例(23.5%),分析肿瘤病理类型、分期、分级、脉管瘤栓、原位癌、异常分化、少见亚型等资料.结果 良性肿瘤162例(3.9%),恶性肿瘤4 038例(96.1%),其中尿路上皮癌(urothelial carcinoma,UC)4 008例(95.4%),腺癌(包括脐尿管腺癌)18例,鳞癌12例.高级别UC 2 460例(61.4%),低级别UC 1 548例(38.6%).肿瘤伴脉管瘤栓和淋巴血管侵犯(lymphovascular invasion,LVI) 320例,UC伴鳞状化生391例,鳞状分化230例,腺性分化120例,腺性及鳞状分化110例,其他少见亚型和变异39例.原位癌112例(2.8%),Ta期548例(13.7%),T1期2 599例(65.1%),T2期480(12%)例,T3期92例(2.3%),T4期23例(0.6%),其余135例无法准确分期.多因素Logistic回归分析显示肿瘤LVI与肿瘤分级、分期及异常分化相关(P<0.05),而与肿瘤大小、数目和原位癌等无关(P>0.05).尿路上皮癌伴鳞状分化和腺性分化与肿瘤复发及进展相关(P=0.02).结论 大多数膀胱肿瘤为高级别低分期尿路上皮癌并可出现多种分化形式,其中鳞状分化和腺性分化最常见,应避免误诊为混合癌.肿瘤脉管内瘤栓、异常分化与肿瘤分级、分期密切相关.
更多Objective To investigate the histopathologic characteristics of bladder tumor and provide theoretical basis for the reasonable selection of treatment modality.Methods This retrospective study collected the pathological data of 4 200 bladder tumor from May 2001 to October 2014.There were 3 443 male and 757 female, and the average diameter of these tumors was (1.8 ± 0.6) cm (ranged 0.2 to 6.5 cm).Among all cases, 3 214 (76.5%) cases were solitary tumor while 986 (23.5%) were multiple tumors.The histologic subtype, pathological grade and stage, the existence of vascular and lymphovascular invasion, tumor in situ, abnormal variants and rare subtypes were recorded and analyzed.Results 162 cases (3.9%)were benign tumors and 4 038 cases (96.1%)were malignant tumors including 4 008 cases of urothelial cancer (UC), 18 cases of primary adenocarcinoma and 12 cases of primary bladder squamous carcinoma.Furthermore, 2 460 (61.4%)cases were high grade UC while 1 548(38.6%)cases were low grade.320 cases were found intravascular tumor embolus or lymphovascular tumor thrombus and 391 (9.3%)cases were found metaplasia of squamous epithelium.Moreover, there were 230 cases of squamous differentiation, 120 cases of glandular differentiation, 110 cases of both squamous and glandular differentiation, and 39 cases (0.9%)of other rare subtypes or variations.On pathological stage, 112 (2.8 %) cases were carcinoma in situ, 548 (13.7%)cases were Ta, 2 599(65.1%)cases were T1, 480(12%)cases were T2, 92 cases(2.3%)were T3 and 23 cases(0.6%)were T4 stage, with the rest cases being unable to be accurate staging.Multiple Logistic regression analysis revealed that lymphovascular invasion was related to tumor grade , pathological stage and abnormal differentiation (P < 0.02).Moreover, UC with squamous and glandular differentiation were related with tumor recurrence and progression (P =0.02).Conclusions Most bladder tumors were high grade and low stage urothelial cancer with various forms of differentiation.Squamous and glandular differentiation were most common variation which should be avoided to diagnosed as hybrid carcinoma.Lymphovascular tumor thrombus and abnormal differentiation were correlated with tumor stage and grade.
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