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目的:探讨膀胱透明细胞腺癌(clear cell adenocarcinoma,CCA)的形态学和免疫组织化学特征。方法:对1例膀胱透明细胞腺癌进行临床病理和免疫组织化学分析,并结合文献讨论其诊断与鉴别诊断。结果:患者临床表现为尿路刺激症、血尿及排尿困难。内镜发现膀胱三角区肿块。组织学显示癌组织呈分化良好的腺管状或管囊状结构,局部区域呈乳头状排列,癌细胞异型性小,呈立方形或椭圆形,部分呈鞋钉样,胞质丰富、嗜酸性,部分透亮,核分裂象多见。肿瘤周围背景有腺性膀胱炎病变。免疫组织化学显示癌细胞的P504s,Pax-2,CKpan和波形蛋白(vimentin)表达呈阳性;而CK7,34βE12,p63,CD34,CD31,CR,绒毛蛋白(villin)和D2-40均为阴性。结论:膀胱CCA是膀胱腺癌中的一种罕见类型,肿瘤细胞表达P504s及Pax-2。瘤组织具有透明细胞或/和鞋钉样细胞的腺管状结构,其形态温和,而细胞核显示明显的异型性。病理学上要注意与膀胱肾源性腺瘤和转移性的CCA鉴别。
Objective: To investigate the morphological and immunohistochemical features of clear cell adenocarcinoma (CCA). Methods: One case of clear cell adenocarcinoma of bladder was analyzed by clinicopathological and immunohistochemical methods, and its diagnosis and differential diagnosis were discussed in combination with the literature. Results: The clinical manifestations of patients with urinary tract irritation, hematuria and dysuria. Endoscopic Bladder trigone mass found. Histology showed well differentiated adenoid or tubular vesicular structures in cancerous tissues. The localized regions were papillaryly arranged with small atypia of cancer cells. The cancer cells were cuboidal or oval in shape with some spikes, abundant cytoplasm, eosinophilicity, Partly translucent, more common mitosis. Tumors surrounding the cystitis gland disease. Immunohistochemistry showed that the expression of P504s, Pax-2, CKpan and vimentin in cancer cells was positive, while CK7, 34βE12, p63, CD34, CD31, CR, villin and D2-40 were all negative. Conclusions: Bladder CCA is a rare type of adenocarcinoma of the bladder and tumor cells express P504s and Pax-2. Tumor tissue has a glandular tubular structure of clear cells and / or chisel-like cells that are mildly shaped while the nucleus shows marked atypia. Pathology should pay attention to with bladder neoplasms and metastatic CCA identification.