膀胱肿物 息肉样膀胱炎 ？讨论病例【病理同学群病例76】

小王

张伟
男，29岁，膀胱肿物，尿频尿急尿痛，是否可以报低级别尿路上皮癌，请赐教！各位老师请发表意见

孔祥田
@保定市二院病理科张伟 polyploid proliferative cystitis with urothelial atypia unknown significance, favor reactive to inflammation

李国霞
息肉样膀胱炎

张伟
孔主任，“异型性未知”和“有利于炎症反应”应该如何解读呢，请您指导一下呗！@孔祥田(Max)*Sacramento*CA] 

王强
@保定市二院病理科张伟  favor倾向于

张伟
噢，明白了！谢谢

孔祥田
Atypia is there, in the background of acute inflammation, favor reactive. If ck20 is done, depends on the staining pattern, we can decide whether it’s low grade dysplasia or inflammatory atypia @保定市二院病理科张伟 

张伟
噢，好的，多谢您的指导

孔祥田
@保定市二院病理科张伟 it’s your case! What’s your opinion?

孙涛
膀胱息肉，部分上皮轻-中度非典，不够癌。期待孔老师的讲解，学习中
张伟
我觉得是否可以报恶性潜能未定的乳头状瘤？科里的同事有的也考虑低级别尿路上皮癌。但我总觉得不够癌。这个病例比较容易产生分歧，期待您的讲解，对于“多倍体增生性膀胱炎”不太了解，也没有见过类似病例。另外，想请教一下孔教授，染ck20的用意是什么呢？@孔祥田(Max)*Sacramento*CA] 

王强
@保定市二院病理科张伟 染ck20的用意是什么呢？
看pattern
全层，则更支持原位癌！

张伟
噢，好的，知道了，多谢指教！

孔祥田









@保定市二院病理科张伟 same patient with different areas showing different morphology. These areas show prominent cytologic atypia. It’s strange about this case: low power view is polyploid proliferative cystitis impression, high power showed prominent cytologic atypia with loss of palority. For proliferative cystitis, the polarity is usually present. This atypia is more than PUNLMP which should have good polarity. If we think this atypia is true, it fits low grade urothelial dysplasia/carcinoma. It’s ok to have different opinions since it’s not a straightforward case. In this setting, ck20 stain is helpful.If you call it polyploid proliferative cystitis, mention about the atypia. The patient should be followed up by cystoscope, same management as PUNLMP or low grade urothelial carcinoma. Speak to the patient and urologist clearly about it.   

xiaofeng

学习了，谢谢分享