膀胱尿路上皮肿瘤的诊断和鉴别诊断PPT参考幻灯片.pptx

膀胱尿路上皮肿瘤的诊断和鉴别诊断 曹登峰 Email: caodengfeng2009@126.com电话：180-0125-2716 膀胱尿路上皮肿瘤非浸润性尿路上皮肿瘤 non-invasive 浸润性尿路上皮癌 invasive 非浸润性尿路上皮病变形成乳头结构不形成乳头结构（扁平）1. 乳头状瘤 papilloma 2. 恶性潜能低的乳头状尿路上皮肿瘤 papillary urothelial neoplasm of low malignant potential (PUNLMP)3. 非浸润性低级别乳头状尿路上皮癌 non-invasive low grade papillary urothelial carcinoma (LGTCC) 4. 非浸润性高级别乳头状尿路上皮癌 non-invasive high grade papillary urothelial carcinoma (HGTCC) 异型增生（dysplasia)原位癌 carcinoma in situ (CIS)原位腺癌 in situ adenocarcinoma （+/- 非浸润性尿路上皮癌，+/- 乳头）膀胱乳头状肿瘤诊断术语的变迁WHO1973和WHO/ISUP对比WHO 1973WHO/ISUPPapilloma Papilloma Grade 1 TCCPUNLMP Grade 2 TCC LGTCC Grade 3 TCC HGTCC 乳头状肿瘤的病理形态学 From Epstein et al. Biopsy Interpretation of the Bladder 4th edition乳头状瘤 papilloma外生性乳头状瘤（exophytic papilloma)，简称乳头状瘤 内翻性乳头状瘤 (inverted papilloma)混合性乳头状瘤：内生和外生均有 乳头状瘤Papilloma Defined as papillary fronds lined by normal appearing urothelium 乳头结构，衬以正常的尿路上皮Most as single lesions 多数单发Most having non-branching or minimally branching arrangement, slender fibrovascular stalks 多数乳头为非分叉型或者轻度分叉，乳头轴性纤细Some have more complex anastomosing papillae 有些有复杂的串联性乳头No mitosis 无分裂相Papilloma 乳头状瘤 papilloma外生性乳头状瘤（exophytic papilloma)，简称乳头状瘤 内翻性乳头状瘤 (inverted papilloma)混合性乳头状瘤：内生和外生均有 内翻性乳头状瘤 (inverted papilloma)Cords and trabeculae of cells arising from a smooth surface and invaginating into the lamina propria 小梁状和条索状，发自表面上皮，向下生长Periphery cells: darker and palisaded 周围细胞Central cells: more mature, often streaming, luminal spaces 中间细胞Cells: minimal to absent cytologic atypia but may have focal degenerative atypia Inverted papillomaInverted papilloma尿路上皮上皮内瘤变形成乳头结构不形成乳头结构（扁平）1. 乳头状瘤 papilloma 2. 恶性潜能低的乳头状尿路上皮肿瘤 papillary urothelial neoplasm of low malignant potential (PUNLMP)3. 非浸润性低级别乳头状尿路上皮癌 non-invasive low grade papillary urothelial carcinoma (LGTCC) 4. 非浸润性高级别乳头状尿路上皮癌 non-invasive high grade papillary urothelial carcinoma (HGTCC) 异型增生（dysplasia)原位癌 carcinoma in situ (CIS)原位腺癌 in situ adenocarcinoma （+/- 非浸润性尿路上皮癌，+/- 乳头）恶性潜能低的乳头状肿瘤 (PUNLMP)“Lesions that do