尿路上皮反应性不典型增生
Reaction Urothelial Atypia Hyperplasia
发病部位: 膀胱、输尿管、肾盂、尿道
诊断要点:
- 常有膀胱感染或介入检查、灌注治疗史;
- 尿路上皮增厚,极向一般保存,细胞核一致性增大,核轮廓规则,染色质一致性细颗粒状,可见多个清楚的核仁;
- 核分裂可活跃,可见于上皮浅层,但无病理性核分裂像;
- 常见混合性急、慢性炎细胞浸润(可浸润上皮内);
- 当存在反应性的背景但尿路上皮的细胞学改变超过反应性不典型增生所见时,不能除外异型增生,此时可描述性的诊断为意义不明的尿路上皮不典型增生。
免疫组织化学染色:
弥漫表达 CK5/6,表达 CD44,CK20 通常仅局限于伞细胞层,Ki67 表达常增高,AMACR/P504s,P16 和 P53 通常阴性
鉴别诊断:
尿路上皮异型增生 :核大小和轮廓轻度不规则,染色体分布不均匀,通常无反应性背景,CK20 表达不仅仅局限于伞细胞层。
预后:
非肿瘤性病变
参考文献:
Appl Immunohistochem Mol Morphol. 2012 May;20(3):264-71. doi: 10.1097/PAI.0b013e3182351ed3. Utility of cytokeratin 5/6, cytokeratin 20, and p16 in the diagnosis of reactive urothelial atypia and noninvasive component of urothelial neoplasia.
Edgecombe A1, Nguyen BN, Djordjevic B, Belanger EC, Mai KT.
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Hodges KB, Lopez-Beltran A, Davidson DD, Montironi R, Cheng L.
Hum Pathol. 2010 Feb;41(2):155-62. doi: 10.1016/j.humpath.2009.07.002. Epub 2009 Sep 16. Review.
Utility of a triple antibody cocktail intraurothelial neoplasm-3 (IUN-3-CK20/CD44s/p53) and α-methylacyl-CoA racemase (AMACR) in the distinction of urothelial carcinoma in situ (CIS) and reactive urothelial atypia.
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Am J Surg Pathol. 2013 Dec;37(12):1815-23. doi: 10.1097/PAS.0000000000000114.