【原】2024-5-13病理

仙舞晨曦 2024-05-13 发布于山东

展开全文

724-80岁男性，放疗后有转移性尿路上皮癌病史。经EGD检查，经活检后表现为十二指肠球部溃疡。

EGD：溃疡性的∼，3cm的肿块，并伴有渗出物

鉴别诊断：

-肉芽组织/溃疡

-放射改变转移性尿路上皮癌

·肉瘤样尿路上皮癌（Sarcomatoid urothelial carcinoma）

·伴破骨细胞样细胞癌（Carcinomas with osteoclast-like cells）

十二指肠肿块，活检：不典型的细胞增生，可疑为转移性肉瘤样尿路上皮癌；见评论。活检将被测序，以与之前的UCSF500结果进行比较。

肉瘤样尿路上皮癌

巨细胞尿路上皮癌

富含破骨细胞的泌尿路未分化癌

Take home points

✓肉瘤样尿路上皮癌是罕见的。

✓变量的形态学。

✓预后较差（CaSS，T期）

✓无常规UC或UCIS的转移性诊断困难。

✓IHC结果不一致。

✓的分子病理学可能会很有帮助。

References

· McCash SI, Unger P, Dillon R, Xiao GQ. Undifferentiated carcinoma of the renal pelvis with osteoclast-like giant cells: a report of two cases. APMIS.

2010;118(5):407-412.

· Rosenkrantz AB, Melamed J, Stifelman M. Osteoclast-like giant cell tumor of the renal pelvis associated with urothelial carcinoma: computed

tomography, gross, and histologic appearance. Urology. 2011;78(6):1310-1312.

· Wright JL, Black PC, Brown GA, Porter MP, Kamat AM, Dinney CP, Lin DW. Differences in survival among patients with sarcomatoid carcinoma,

carcinosarcoma and urothelial carcinoma of the bladder. J Urol. 2007 Dec;178(6):2302-6; discussion 2307. doi: 10.1016/j.juro.2007.08.038. Epub 2007

Oct 15. PMID: 17936803.

· Baydar, D., Amin, M. & Epstein, J. Osteoclast-rich undifferentiated carcinomas of the urinary tract. Mod Pathol 19, 161171 (2006).

· Sjdahl G et al. A systematic study of gene mutations in urothelial carcinoma; inactivating mutations in TSC2 and PIK3R1. PLoS One. 2011;6(4):e18583.

PMID: 21533174.

· Buyucek S et al. Receptor Tyrosine Kinase Pathway and Infiltrating Urothelial Carcinoma. J Environ Pathol Toxicol Oncol. 2023;42(1):65-77. PMID:

36734953.

· Wang J, Wang FW, Lagrange CA, Hemstreet Iii GP, Kessinger A. Clinical features of sarcomatoid carcinoma (carcinosarcoma) of the urinary bladder:

analysis of 221 cases. Sarcoma. 2010;2010:454792. PMID: 20706685.

· Wright JL, Black PC, Brown GA, Porter MP, Kamat AM, Dinney CP, Lin DW. Differences in survival among patients with sarcomatoid carcinoma,

carcinosarcoma and urothelial carcinoma of the bladder. J Urol. 2007 Dec;178(6):2302-6; discussion 2307. PMID: 17936803.

· Lopez-Beltran A, Blanca A, Montironi R, Cheng L, Regueiro JC. Pleomorphic giant cell carcinoma of the urinary bladder. Hum Pathol. 2009

Oct;40(10):1461-6. doi: 10.1016/j.humpath.2009.02.016. Epub 2009 May 20. PMID: 19467692.

泌尿道富含破骨细胞的未分化癌

725-唾液腺母细胞瘤（Sialoblastoma）。

原始基底样上皮细胞的实性器官样细胞巢，由致密的纤维基质隔开。

具有高 N：C 比值、细胞边界模糊、圆形/椭圆形泡状核的肿瘤细胞。

+/- 外周栅栏、筛状形成、导管形成。