膀胱尿路上皮癌恶性程度分级和浸润程度分期的进展.ppt
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1、膀胱癌最新膀胱癌最新膀胱癌最新膀胱癌最新WHOWHOWHOWHO分级法、分级法、分级法、分级法、UICC-TNMUICC-TNMUICC-TNMUICC-TNM分期法介绍分期法介绍分期法介绍分期法介绍济宁市第一人民医院泌尿外科济宁市第一人民医院泌尿外科济宁市第一人民医院泌尿外科济宁市第一人民医院泌尿外科马鸣马鸣马鸣马鸣介绍介绍介绍介绍l近年来,近年来,WHOWHO和国际抗癌协会(和国际抗癌协会(UICCUICC)分别对膀胱癌的组织)分别对膀胱癌的组织学分级、学分级、TNMTNM分期法进行了一些重要的改动和修订分期法进行了一些重要的改动和修订l欧洲泌尿外科医师协会也适时推出了膀胱癌的新版指南欧洲
2、泌尿外科医师协会也适时推出了膀胱癌的新版指南2006-Guidelines on TaT1(Non-muscle invasive 2006-Guidelines on TaT1(Non-muscle invasive)bladder cancer)bladder cancer。l在我国,中华医学会泌尿外科学分会肿瘤学组正在着手制定在我国,中华医学会泌尿外科学分会肿瘤学组正在着手制定膀胱癌诊断治疗指南。膀胱癌诊断治疗指南。主要分期(主要分期(主要分期(主要分期(Stage)Stage)Stage)Stage)和分级(和分级(和分级(和分级(Grade)Grade)Grade)Grade)标准标
3、准标准标准Grade Grade lBergkvistBergkvist分级法分级法19651965改良改良BergkvistBergkvist法法77(19871987)l世界卫生组织世界卫生组织(WHO)(WHO)WHO 1973WHO 1973WHO/ISUP 1998 WHO/ISUP 1998 ConsensusConsensus WHO 1999 WHO 1999WHO 2004WHO 2004StageStagel国际癌控制中心国际癌控制中心UICC(UICC(Union International Union International Contre le CancerCont
4、re le Cancer,19981998,2002)2002)的的TNMTNM分期法为分期法为标准标准 33,44l美国美国Jewett-Strong-Jewett-Strong-MarshallMarshall分期法分期法 (AJCCAJCC)膀胱尿路上皮癌的组织学分级膀胱尿路上皮癌的组织学分级膀胱尿路上皮癌的组织学分级膀胱尿路上皮癌的组织学分级l被覆尿路的上皮统称为尿路上皮被覆尿路的上皮统称为尿路上皮(urothelium)(urothelium)。l传统上将尿路上皮称为移行上皮传统上将尿路上皮称为移行上皮1414,目前在文献上和习目前在文献上和习惯上这两个名词常常交替使用。惯上这两个名
5、词常常交替使用。膀胱癌的组织学分级膀胱癌的组织学分级膀胱癌的组织学分级膀胱癌的组织学分级l 膀胱肿瘤的恶性程度以级(膀胱肿瘤的恶性程度以级(gradegrade)来表示。)来表示。l关于膀胱癌的分级,国际上有不少版本,综合于(表关于膀胱癌的分级,国际上有不少版本,综合于(表1 1)。)。Grading systemGrading systemGrading systemGrading systemWHO 1973,1999 WHO 1973,1999 WHO/ISUP 1998 Consensus,WHO WHO/ISUP 1998 Consensus,WHO 2004 2004 Papill
6、oma Papilloma Papilloma Papilloma TCC grade 1 TCC grade 1 Papillary urothelial neoplasm of low malignant Papillary urothelial neoplasm of low malignant potential(PUNLMP potential(PUNLMP)Urothelial carcinoma low grade Urothelial carcinoma low grade TCC grade 2 TCC grade 2 Urothelial carcinoma high gr
7、ade Urothelial carcinoma high grade TCC grade 3 TCC grade 3历史发展和演变历史发展和演变历史发展和演变历史发展和演变lWHO 1973 Classification WHO 1973 Classification 19731973年年WHOWHO提出,方法简单,便于分类,主要是根据肿瘤提出,方法简单,便于分类,主要是根据肿瘤细胞核间变的程度,将膀胱尿路上皮癌分为细胞核间变的程度,将膀胱尿路上皮癌分为3 3级,分化良级,分化良好、中度分化和分化不良,用好、中度分化和分化不良,用grade 1grade 1、2 2、3 3或或grade g
8、rade、分别表示。目前仍然广泛使用(分别表示。目前仍然广泛使用(WHO1999WHO1999相同)相同)。历史发展和演变历史发展和演变历史发展和演变历史发展和演变l19981998年,世界卫生组织(年,世界卫生组织(WHOWHO)和国际泌尿病理协会)和国际泌尿病理协会(ISUPISUP)提出了非浸润性膀胱癌的新分类。以后,)提出了非浸润性膀胱癌的新分类。以后,20042004年年WHOWHO正式出版了这一新的分类方法(表正式出版了这一新的分类方法(表1 1)。)。l本新分类法应用特殊的细胞学和结构学标准,对膀胱癌本新分类法应用特殊的细胞学和结构学标准,对膀胱癌的各个级别有详尽的描述。可以在网
9、页的各个级别有详尽的描述。可以在网页www.pathology.jhu.edu/bladderwww.pathology.jhu.edu/bladder查到各级膀胱的说明例查到各级膀胱的说明例证。这个分级法把尿路上皮肿瘤分为低度恶性潜能证。这个分级法把尿路上皮肿瘤分为低度恶性潜能(PUNLMPPUNLMP)、低级和高级尿路上皮癌。)、低级和高级尿路上皮癌。Urothelial Papilloma Urothelial Papilloma Urothelial papilloma is defined as discrete Urothelial papilloma is defined as
10、discrete papillary growth with a central fibrovascular papillary growth with a central fibrovascular cores lined by urothelium of normal thickness cores lined by urothelium of normal thickness and cytology.There is no need for counting and cytology.There is no need for counting the number of cell la
11、yers.the number of cell layers.散在的乳头状肿瘤,其中央有中心纤维血管核心,散在的乳头状肿瘤,其中央有中心纤维血管核心,排列着正常厚度,正常细胞的尿路上皮。不需计数细排列着正常厚度,正常细胞的尿路上皮。不需计数细胞的层次。胞的层次。Papillary Urothelial Neoplasm of Low Malignant Papillary Urothelial Neoplasm of Low Malignant Potential Potential Papillary urothelial neoplasm of low malignant Papillar
12、y urothelial neoplasm of low malignant potential is a papillary urothelial lesion with an potential is a papillary urothelial lesion with an orderly arrangement of cells within papillae with orderly arrangement of cells within papillae with minimal architectural abnormalities and minimal minimal arc
13、hitectural abnormalities and minimal nuclear atypia irrespective of the number of cell nuclear atypia irrespective of the number of cell layers.The urothelium in papillary urothelial layers.The urothelium in papillary urothelial neoplasms of low malignant potential is much neoplasms of low malignant
14、 potential is much thicker than in papillomas and/or the nuclei are thicker than in papillomas and/or the nuclei are significantly enlarged and somewhat significantly enlarged and somewhat hyperchromatic.Mitotic figures are infrequent in hyperchromatic.Mitotic figures are infrequent in papillary uro
15、thelial neoplasms of low malignant papillary urothelial neoplasms of low malignant potential,and usually confined to the basal potential,and usually confined to the basal layer.layer.l低度恶性潜能的尿路上皮癌指乳头状尿路上皮损害,乳头状低度恶性潜能的尿路上皮癌指乳头状尿路上皮损害,乳头状肿瘤细胞排列有序,结构轻度异常,细胞核轻度间变,可不肿瘤细胞排列有序,结构轻度异常,细胞核轻度间变,可不考虑细胞层次的数目。低度
16、恶性潜能的尿路上皮癌比乳头状考虑细胞层次的数目。低度恶性潜能的尿路上皮癌比乳头状瘤细胞层次明显多,和瘤细胞层次明显多,和/或细胞核轻微增大,染色质增多,或细胞核轻微增大,染色质增多,有丝分裂相偶见,通常限于基底层。有丝分裂相偶见,通常限于基底层。Low-grade Papillary Urothelial Carcinoma Low-grade Papillary Urothelial Carcinoma lLow-grade papillary urothelial carcinomas are Low-grade papillary urothelial carcinomas are ch
17、aracterized by an overall orderly appearance but characterized by an overall orderly appearance but with easily recognizable variation of architectural with easily recognizable variation of architectural and or cytologic features even at scanning and or cytologic features even at scanning magnificat
18、ion.Variation of polarity and nuclear magnification.Variation of polarity and nuclear size,shape,and chromatin texture comprise the size,shape,and chromatin texture comprise the minimal but definitive cytologic atypia.Mitotic minimal but definitive cytologic atypia.Mitotic figures are infrequent and
19、 usually seen in the lower figures are infrequent and usually seen in the lower half,but may be seen at any level of the urothelium.half,but may be seen at any level of the urothelium.It is important to recognize that there may be a It is important to recognize that there may be a spectrum of cytolo
20、gic and architectural spectrum of cytologic and architectural abnormalities within a single lesion,such that the abnormalities within a single lesion,such that the entire lesion should be examined,with the highest entire lesion should be examined,with the highest grade of abnormality noted.grade of
21、abnormality noted.l低级乳头状尿路上皮癌低级乳头状尿路上皮癌 整体排列整齐。高倍视野下细胞整体排列整齐。高倍视野下细胞特征和结构有明显的变异,极向和细胞核大小、形状、染色特征和结构有明显的变异,极向和细胞核大小、形状、染色质的变化虽然不是很明显,但又肯定的细胞的病变。有丝分质的变化虽然不是很明显,但又肯定的细胞的病变。有丝分裂相少见。裂相少见。High-grade Papillary Urothelial Carcinoma High-grade Papillary Urothelial Carcinoma lHigh-grade papillary urothelial c
22、arcinomas are High-grade papillary urothelial carcinomas are characterized by a predominantly or totally characterized by a predominantly or totally disorderly appearance at low magnification.The disorderly appearance at low magnification.The disorder results from both architectural and disorder res
23、ults from both architectural and cytologic abnormalities.Architecturally,cells cytologic abnormalities.Architecturally,cells appear irregularly clustered and the epithelium is appear irregularly clustered and the epithelium is disorganized.Cytologically,there is a spectrum of disorganized.Cytologica
24、lly,there is a spectrum of pleomorphism ranging from moderate to marked.The pleomorphism ranging from moderate to marked.The nuclear chromatin tends to be clumped and nucleoli nuclear chromatin tends to be clumped and nucleoli may be prominent.Mitotic figures,including may be prominent.Mitotic figur
25、es,including atypical forms,are frequently seen at all levels of atypical forms,are frequently seen at all levels of the urothelium.There is an option in the diagnosis the urothelium.There is an option in the diagnosis of high-grade papillary urothelial carcinoma to of high-grade papillary urothelia
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- 膀胱 路上 恶性 程度 分级 浸润 分期 进展
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