Tumour-like lesions of the urinary bladder
Tumour-like lesions of the urinary bladder
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DOI：
10.1016/j.pathol.2020.08.005
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发表时间：
2021-01-01
期刊：
影响因子：
4.5
通讯作者：
Egevad, Lars
中科院分区：
文献类型：
--
作者：
Samaratunga, Hemamali;Delahunt, Brett;Egevad, Lars
膀胱中存在许多良性上皮增生，其可能难以与癌区分，包括尿路上皮癌及其变体、鳞状细胞癌和腺癌。如果误诊，有可能过度治疗，伴随并发症的风险，以及与预后评估有关的错误。如果误诊为类似浸润癌的高度增生性病变，可能导致不必要的根治性手术、化疗和放疗。同样，误诊的病变，有低级别癌的外观可能会提示一生的放射学调查和膀胱镜检查。在这篇综述中，我们讨论了各种各样的实体，可能是诊断上的挑战，并强调识别关键的形态学特征，具有诊断效用的重要性。我们还强调了相关临床信息的重要性，以及这些病变可能发生的临床环境。在这篇综述中，我们根据形态学对病变进行了划分，以便于与鉴别诊断相关的讨论。我们讨论的结构模式包括乳头状病变（息肉样/乳头状膀胱炎和乳头状尿路上皮增生），假癌性增生（假癌性尿路上皮增生，血管布伦巢和纤维上皮息肉的华丽增殖），腺体病变（肠上皮化生和苗勒氏管病）和几种不同模式的病变（前列腺型尿道息肉和肾源性腺瘤或化生）。
There are a number of benign epithelial proliferations in the bladder that may be difficult to distinguish from carcinomas, including urothelial carcinoma and its variants, squamous cell carcinoma and adenocarcinoma. If misdiagnosed, there is the potential for over treatment, with its attendant risk of complications, as well as errors relating to prognostic assessment. In the case of the misdiagnosis of high grade proliferative lesions that mimic invasive carcinoma, unnecessary radical surgery, chemotherapy and radiotherapy may result. Similarly, the misdiagnosis of lesions that have the appearance of low grade carcinoma can prompt a lifetime of radiological investigation and cystoscopies. In this review, we discuss a variety of entities that may be diagnostically challenging and emphasise the importance of identifying key morphological features that have diagnostic utility. We also highlight the importance of relevant clinical information and the clinical settings in which these lesions may occur. In this review we have divided the lesions on the basis of morphology in order to facilitate discussion relating to the differential diagnosis. The architectural patterns we discuss include papillary lesions (polypoid/papillary cystitis and papillary urothelial hyperplasia), pseudocarcinomatous proliferations (pseudocarcinomatous urothelial hyperplasia, florid proliferation of von Brunn nests and fibroepithelial polyps), glandular lesions (intestinal metaplasia and mullerianosis) and lesions with several different patterns (prostatic type urethral polyps and nephrogenic adenoma or metaplasia).