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网络 | 2019/01/03 14:40:05  | 182 次浏览

原文: Strict criteria were initially proposed to make the diagnosis of urachal cancer. These include: location in the bladder dome, absence of cystitis glandularis or cystitis cystica, predominant involvement of the muscularis rather than the submucosa, connection of the neoplasm with the urachal remnant, and the presence of the suprapubic mass. More recently, additional criteria required a sharp demarcation between the tumor and surface epithelium, and growth in the bladder wall branching into the space of Retzius. It also has been suggested that another major criterion should require the exclusion of a primary adenocarcinoma located outside the bladder. However, requiring the tumor to fulfill all of these requirements would likely exclude most known cases of urachal cancer that have been published today. Requiring endoscopic procedures of the gastrointestinal tract and mammograms when there is no clinical evidence suggestive of an alternate primary site, seems somewhat heavy-handed. Others have argued that cystitis cystica occasionally may be encountered in bladders with urachal tumors. Additionally, urachal tumors may occur anywhere along the midline of the bladder, and residual urachal remnants may not be easily found. A more practical approach has been adopted at the M.D. Anderson Cancer Center, suggesting that presentation of an adenocarcinoma of the bladder occurring anywhere along the midline in addition to the bladder dome should be considered an urachal tumor unless proven otherwise (Table 1). Evidence of a sharp demarcation between the tumor and normal surface epithelium is also strongly supportive of this diagnosis. The presence of cystitis cystica transitioning to the tumor, urothelial dysplasia, or more traditional urothelial cancer histology should raise a concern that this is a non-urachal bladder cancer. While a thorough patient history and physical should be able to exclude most adenocarcinomas of other organs, additional testing searching for an alternative occult primary site is not indicated. 译文: 最初提出诊断脐尿管标准非常严格,包括: 位于膀胱顶部,无腺性膀胱炎或囊肿性膀胱炎,主要累及肌层而非粘膜下层,肿瘤与脐尿管残留部分相连,出现耻骨上肿块.最近,附加的标准将其限定为:肿瘤和表面上皮的分界清晰,生长于膀胱壁,分支进入膀胱前隙.另一个重要标准也意见加入,即排除初期的膀胱外腺癌.然而,如果要求所有标准都符合,那么,目前已发表的大部分已知脐尿管癌恐怕都要排除了.如没有显示原发病灶的临床症状则要求进行胃肠道内镜检查和乳房X光检查,似乎有些严重了.其他报道证明,脐尿管癌患者的膀胱出现囊肿性膀胱炎.另外,脐尿管癌可能沿膀胱中线发生于任何位置,而且脐尿管残留部分可能不易查找. MD安德森癌症中心采用了一种更实用的方法,即除膀胱顶部之外,沿中线任何位置出现膀胱腺癌,如证实非其他癌症,就认为是脐尿管癌(表1).肿瘤和正常表面上皮之间清晰的分界也有力地支持了该诊断.出现囊肿性膀胱炎转变为肿瘤/尿路上皮发育异常或传统的泌尿道上皮癌组织时,就应考虑为非脐尿管膀胱癌.如病史和体检能排除大部分其他器官的腺癌,则无需附加检查寻找其他隐藏的原发病灶.



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