Urothelial Proliferation of Unknown Malignant Potential Involving the Bladder: Histopathologic Features and Risk of Progression in De Novo Cases and Cases With Prior Neoplasia.
Urothelial Proliferation of Unknown Malignant Potential Involving the Bladder: Histopathologic Features and Risk of Progression in De Novo Cases and Cases With Prior Neoplasia.
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DOI：
10.5858/arpa.2019-0005-oa
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发表时间：
2020-07-01
影响因子：
4.6
通讯作者：
Hansel DE
中科院分区：
文献类型：
--
作者：
Lowenthal BM;Sahoo D;Amin MB;Hansel DE
未知恶性潜能的尿路上皮增殖(UPUMP)是世界卫生组织2016年的一个分类器，包括先前类别的扁平型和乳头状尿路上皮增生。此外，UPUMP发生在初发和既往膀胱肿瘤的环境中。确定与后续肿瘤发展相关的UPUMP特征。从档案中确定了68名患者，包括26名新生患者和42名既往膀胱肿瘤患者。复习患者幻灯片和临床病程。初发UPUMP患者是通过临床发现的(26/26；100%)，而监视膀胱镜检查主要发现UPUMP(29/42；69%)。评估的组织病理学标准包括尿路上皮增生、尿路上皮细胞学、血管内长、剥脱、炎症、水肿和纤维化。初发肿瘤患者的平均临床随访期为68.9个月，既往肿瘤患者为69.5个月。26例初发UPUMP患者中有4例(15.4%)发生继发性肿瘤，并与膀胱镜下乳头状突起(P=0.02)或显微镜下细小乳头状突起或乳头状突起(P=0.02；中位进展时间4.1个月)相关。在42例既往肿瘤患者中，17例(40.5%)继发肿瘤，与无明显固有层水肿显著相关(P<；.001；进展的中位时间为11.0个月)。与新发疾病患者相比，既往肿瘤患者进展为高级别疾病的比率更高(58.9%比25%)。未知恶性潜能的尿路上皮细胞增殖表明，新发疾病患者发生肿瘤的风险为17%，既往肿瘤患者发生肿瘤的风险为40%。进展的最大风险与早期乳头形成有关。
Urothelial proliferation of unknown malignant potential (UPUMP) is a 2016 World Health Organization classifier that encompasses prior categories of flat and papillary urothelial hyperplasia. In addition, UPUMP occurs in settings of both de novo and prior bladder neoplasia. To identify UPUMP features associated with subsequent neoplastic development. Sixty-eight patients were identified from the archives, including 26 patients with de novo and 42 patients with prior bladder neoplasia. Patient slides and clinical course were reviewed. Patients with de novo UPUMP were detected through clinical findings (26/26; 100%), whereas surveillance cystoscopy primarily detected UPUMP in patients with prior neoplasia (29/42; 69%). Histopathologic criteria evaluated included urothelial hyperplasia, urothelial cytology, vascular ingrowth, denudation, inflammation, edema, and fibrosis. Mean clinical follow-up was 68.9 months in patients with de novo neoplasia and 69.5 months in patients with prior neoplasia. Subsequent neoplasia developed in 4 of 26 (15.4%) of patients with de novo UPUMP and was associated with cystoscopic papillary appearance (P = .02) or microscopic thin papillary ingrowths or papillations (P = .02; median time to progression, 4.1 months). Of 42 patients with prior neoplasia, 17 (40.5%) had subsequent neoplasia, significantly associated with an absence of prominent lamina propria edema (P < .001; median time to progression, 11.0 months). A higher rate of progression to high-grade disease was present in patients with a prior neoplasia versus those with de novo disease (58.9% versus 25%). Urothelial proliferation of unknown malignant potential shows subsequent risk of neoplastic development of 17% in patients with de novo disease and 40% in patients with prior neoplasia. The greatest risk of progression is associated with early papillary formation.