PO.CL12.01 · 临床研究
膀胱前列腺切除术标本中膀胱癌变异型的形态学谱系及偶发性前列腺病理
Morphologic spectrum of bladder cancer variants and incidental prostate pathology in cystoprostatectomy specimens
作者与单位 Authors & Affiliations
摘要 Abstract
中文摘要
高级别膀胱癌表现出显著的形态学异质性，若干变异组织学类型显示出独特的生物学行为和治疗反应性。为界定膀胱前列腺切除术标本中的完整病理谱系，我们分析了2010年至2023年间治疗的44例病例。该队列(平均年龄67.1±12.2岁)主要表现为晚期疾病；pT3a为最常见的分期(25%)，三分之一显示≥pT3的浸润。高级别尿路上皮癌是主要亚型(14例)。真性变异型较为常见，包括鳞状分化(6例)、肉瘤样(2例)、微乳头状(1例)、巢状(1例)、巨细胞/多形性(1例)和小细胞癌(1例)。乳头状癌和CIS被重新归入高级别尿路上皮类别。切缘阳性发生于6例患者(13.6%)，尤其见于侵袭性变异型，如鳞状、肉瘤样和微乳头状癌。3例患者(6.8%)发现淋巴结转移，均为高级别浸润性疾病。偶发性前列腺腺癌较为常见，跨越分级组1-4级，且常为多灶性。这些肿瘤为低体积、器官局限性，且很少显示不良特征，如前列腺外扩展、精囊浸润或切缘阳性。筛状/肾小球样模式不常见。其他发现包括HGPIN、慢性炎症和治疗相关改变。膀胱癌实际浸润至前列腺间质(pT4a)罕见(1例)。值得注意的是，偶发性前列腺癌与膀胱癌的组织学或分期无相关性，反映了两者的生物学独立性。变异组织学具有直接的治疗意义：肉瘤样、微乳头状和小细胞癌与侵袭性行为、更高的切缘阳性率相关，可能需要强化全身治疗或纳入针对特定变异型的临床试验。准确识别可避免高危患者治疗不足。相比之下，偶发性前列腺癌临床隐匿且惰性；认识它们可避免不必要的PSA监测、影像学发现的误读，并防止分期错误，尤其是在区分偶发性癌与实际前列腺间质浸润方面。总体而言，膀胱-前列腺整合病理评估提高了分期准确性，指导风险适应性管理，并支持多学科决策。这些发现强调了膀胱癌变异组织学的生物学和临床意义，同时证实膀胱前列腺切除术标本中的偶发性前列腺癌通常为低风险，且不影响膀胱癌的结局。
查看英文原文 English abstract
High-grade bladder cancer exhibits substantial morphologic heterogeneity, and several variant histologies show distinct biological behavior and therapeutic responsiveness. To define the full pathologic spectrum in cystoprostatectomy specimens, we analyzed 44 cases treated between 2010 and 2023.The cohort (mean age 67.1 ± 12.2 years) predominantly presented with advanced disease; pT3a was the most common stage (25%), and one-third showed invasion of≥pT3. High-grade urothelial carcinoma was the primary subtype (14 cases). True variants were frequent and included squamous differentiation (6), sarcomatoid (2), micropapillary (1), nested (1), giant-cell/pleomorphic (1), and small-cell carcinoma (1). Papillary carcinoma and CIS were reclassified into the high-grade urothelial category. Margin positivity occurred in 6 patients (13.6%), especially among aggressive variants such as squamous, sarcomatoid, and micropapillary carcinoma. Lymph-node metastasis was identified in 3 patients (6.8%), all with high-grade invasive disease.Incidental prostate adenocarcinoma was common, spanning Grade Groups 1-4 and often multifocal. These tumors were low-volume, organ-confined, and rarely showed adverse features such as extraprostatic extension, seminal vesicle invasion, or positive margins. Cribriform/glomeruloid patterns were uncommon. Additional findings included HGPIN, chronic inflammation, and treatment-related changes. Actual bladder cancer invasion into prostatic stroma (pT4a) was rare (one case). Significantly, incidental prostate cancer did not correlate with bladder cancer histology or stage, reflecting their biological independence.Variant histologies have direct therapeutic implications: sarcomatoid, micropapillary, and small-cell carcinoma are associated with aggressive behavior, higher positive-margin rates, and may warrant intensified systemic therapy or enrollment in variant-specific clinical trials. Accurate identification prevents under-treatment of high-risk patients. In contrast, the incidental prostate cancers were clinically silent and indolent; recognizing them avoids unnecessary PSA surveillance, misinterpretation of imaging findings, and prevents staging errors, especially in distinguishing incidental cancer from actual prostatic stromal invasion.Overall, integrated bladder-prostate pathologic assessment improves staging accuracy, guides risk-adapted management, and supports multidisciplinary decision-making. These findings underscore the biological and clinical significance of variant histology in bladder cancer, while confirming that incidental prostate cancer in cystoprostatectomy specimens is typically low-risk and does not influence bladder cancer outcomes.
利益披露 Disclosure
S. Carskadon, None..
A. Joshi, None..
N. S. Gupta, None..
N. Palanisamy, None.