息肉状膀胱炎临床病理特征并预后分析

Clinicopathologic features and outcomes of polypoid cystitis

摘要

目的 总结息肉状膀胱炎的临床、影像学及病理特征，探讨其临床病理特征并评估预后。方法 回顾性报告广东医科大学附属医院（1例）确诊息肉状膀胱炎病例的诊治，并结合文献报道的8例患者资料，提取临床、影像学、内镜及病理学信息进行总结，并对其预后进行分析总结。结果 共纳入9例经病理确诊的息肉状膀胱炎患者。临床表现以无痛性肉眼血尿、排尿困难为主，少数伴腰痛。影像学多表现为膀胱壁不规则增厚或膀胱腔内肿块样突起，增强扫描可见不同程度强化，术前多数被误诊为尿路上皮癌。病理学特征为膀胱黏膜显著息肉样增生，间质疏松并高度水肿，伴大量慢性炎症细胞浸润。治疗以经尿道电切除为主。随访显示总体预后良好，整体复发率较低。结论 息肉状膀胱炎为良性反应性增生性病变，临床及影像学表现可类似膀胱癌。确诊依赖病理学检查，经尿道电切除并去除潜在刺激因素是诊治关键。术后应规律随访。

Abstract

Objective To summarize the clinical，radiologic，and pathologic features of polypoid cystitis，and evaluate the prognosis. Methods The clinical data of 9 cases of polypoid cystitis (including 1 case treated in our hospital and 8 collected from literature review) were retrospectively analyzed.The clinical presentations，imaging and cystoscopic findings，and histopathologic features were extracted and analyzed，and follow-up outcomes were summarized. Results A total of 9 cases were included.The predominant manifestations were painless gross hematuria and dysuria/voiding difficulty，with flank pain in a minority.Imaging most commonly demonstrated irregular bladder wall thickening or an intravesical mass-like protrusion with variable contrast enhancement.Most cases were preoperatively misdiagnosed as urothelial carcinoma.Histopathology，the cases showed prominent polypoid mucosal proliferation with loose，markedly edematous stroma and dense chronic inflammatory cell infiltration.Transurethral resection was the primary treatment.Follow-up indicated generally favorable outcomes with a low overall recurrence rate. Conclusion Polypoid cystitis is a benign reactive proliferative lesion that can closely mimic bladder cancer clinically and radiologically.Definitive diagnosis relies on histopathologic evaluation.Transurethral resection with elimination of underlying irritative factors is central to management，and regular postoperative surveillance is recommended.

关键词

关键词：息肉状膀胱炎 / 血尿 / 排尿困难 / 鉴别诊断 / 经尿道膀胱肿瘤电切术

Key words

KEY WORDS：polypoid cystitis / hematuria / dysuria / differential diagnosis / transurethral resection of bladder tumor

参考文献

[1] 王庆丰. 膀胱炎性息肉超声误诊为膀胱肿瘤1例[J]. 实用临床医学， 2018，19（8）： 106-107.

[2] EUN RJ， SANG CB， HEE JM， et al. Polypoid cystitis in an adult without history of catheterization[J]. Iranian Journal of Radiology：A Quarterly Journal Published by the Iranian Radiological Society， 2011，8（3）： 173-175.

[3] ZHAOLI L， IE J. Polypoid/papillary cystitis：a series of 41 cases misdiagnosed as papillary urothelial neoplasia[J]. The American Journal of Surgical Pathology， 2008，32（5）： 758-764.

[4] HEMAMALI S， BRETT D， JOHN Y， et al. Tumour-like lesions of the urinary bladder[J]. Pathology， 2020，53（1）： 44-45.

[5] KUMI O， KIYOHIDE K， TOSHIFUMI G， et al. A case of polypoid and papillary cystitis mimicking an advanced bladder carcinoma with invasion of perivesical fat[J]. Urology Annals， 2014，6（1）： 72-74.

[6] 田锦林， 郭跃辉， 王志鹏， 等. 膀胱炎性息肉误诊为膀胱癌1例[J]. 罕少疾病杂志， 2012，19（4）： 54-55.

[7] MASOOD B， IQBAL W， IQBAL N， et al. Incidental findings of polypoid cystitis in a 6-year old child without any history of lower urinary tract symptoms and previous urinary catheterization[J]. J Ayub Med Coll Abbottabad， 2020，32（3）： 410-412.

[8] KWOK JL， ENG M. Polypoid cystitis and bilateral hydronephrosis mimicking urothelial carcinoma[J]. Journal of Endourology Case Reports， 2019，5（2）： 34-38.

[9] DESSYN J F， DUQUENNE S， HOARAU G. Incidental pseudolymphomatous bladder inflammatory polyp revealing urinary schistosomiasis[J]. International Journal of Infectious Diseases， 2016，53： 39-40.

[10] ADDO EA， EMTAGE J， MASSIS K， et al. A congenital high flow arteriovenous malformation of the bladder presenting with polypoid cystitis and ureteral obstruction[J]. Urology Case Reports， 2015，3（6）： 181-184.

[11] NGUYEN JK， PRZYBYCIN CG， MCKENNEY JK， et al. Immunohistochemical staining patterns of Ki-67 and p53 in florid reactive urothelial atypia and urothelial carcinoma in situ demonstrate significant overlap[J]. Human Pathology， 2020，98： 81-88.

[12] WANG M， LI S. Bladder polypoid cystitis-derived A20 associates with tumorigenesis[J]. Cell Biochemistry and Biophysics， 2014，67（2）： 669-673.

基金资助

广东省基础与应用基础研究基金项目(2024A1515012742)