Persistent Histological Changes in the Exstrophic Bladder After Primary Closure-A Cause for Concern?
Persistent Histological Changes in the Exstrophic Bladder After Primary Closure-A Cause for Concern?
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DOI：
10.1016/j.juro.2012.08.210
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发表时间：
2013-02-01
影响因子：
6.6
通讯作者：
Roesch, Wolfgang H.
中科院分区：
文献类型：
--
作者：
Rubenwolf, Peter C.;Eder, Fabian;Roesch, Wolfgang H.
目的：研究经典型膀胱外翻患者的膀胱活检组织学特点，并探讨其潜在的临床意义。材料和方法：收集2004年至2011年间膀胱外翻患者的膀胱组织。这些标本是在初次膀胱关闭时(组1，29例)、二次重建过程中(组2，27例)或因重建失败而行膀胱切除术(组3，15例)时获得的。对所有组织标本进行炎性、增生性、化生性和异常增生性改变检查。免疫组织化学方法检测尿路上皮细胞分化标志物CK13和CK20的表达。结果：各亚组膀胱组织均有炎性、增生性和化生改变。未发现异型增生和肿瘤。在初次闭合数年后，高达62%的膀胱可观察到严重的上皮性改变，如腺性膀胱炎和肠化生。CK13和CK20在所有亚组的尿路上皮细胞中均有异常表达，提示尿路上皮细胞分化异常。结论：我们的研究结果提供了初步证据，表明未闭合的膀胱模板中观察到的上皮变化在一期闭合后的一组膀胱中持续甚至进展。尽管腺性膀胱炎和肠化生的恶性潜在性存在争议，但从长远来看，一些患者可能会增加异型增生/肿瘤的风险。由于外生性膀胱中这些病变的自然病史尚不清楚，这些患者需要终身监测。
Purpose: We investigated bladder biopsies from patients with classic bladder exstrophy for the histological features and discuss the potential clinical significance of the findings.Materials and Methods: Bladder tissues were collected from patients with bladder exstrophy between 2004 and 2011. These specimens were obtained at primary bladder closure (group 1, 29 patients), during secondary reconstructive procedures (group 2, 27) or during cystectomy for failed reconstruction (group 3, 15). All tissue specimens were investigated for inflammatory, proliferative, metaplastic and dysplastic changes. Expression of urothelial differentiation markers CK13 and CK20 was determined by immunohistochemical analysis.Results: Inflammatory, proliferative and metaplastic changes were found in bladder specimens of all subgroups. Neither dysplasia nor neoplasia was present. Severe epithelial changes such as cystitis glandularis and intestinal metaplasia were observed in up to 62% of bladders several years after primary closure. Aberrant expression patterns of CK13 and CK20 suggesting abnormal urothelial differentiation were shown to be present in the urothelium of all subgroups.Conclusions: Our findings provide prima facie evidence that the epithelial changes observed in the unclosed bladder template persist or even progress in a subset of bladders after primary closure. Although the malignant potential of cystitis glandularis and intestinal metaplasia is controversial, some patients may be at increased risk for dysplasia/neoplasia in the long term. Since the natural history of these lesions in the exstrophic bladder is unknown, these patients require lifelong surveillance.