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患者女,40岁,膀胱肿块3月余,于1987年10月10日入院。缘于3月前妇科检查时,B超发现膀胱左侧壁有一肿块,经膀胱镜检示:左侧壁见一枣子大新生物,表面光滑,有一短蒂。体检:一般情况好,BP为18/10kPa,血、尿常规均阴性,尿氮、肌酐及尿内3-甲氧04羟基苦杏仁酸(VMA)均正常。膀胱镜检查:肿块较3月前略增大,余膀胱图象正常。术中见肿瘤位于膀胱后壁,双侧输尿管口连线正中偏上的位置,约2.0cm×1.5cm×1.0cm大小,有蒂,表面呈絮状。病理检查:暗红色不整形结状物2个,大小分别为2.0cm×1.0cm×1.0cm和0.6cm×0.5cm×0.5cm,表面粗糙,有包膜,切面棕黄色,实性,质软。镜下见瘤细胞排列呈巢、团块状,间质富于血管及纤维组织,瘤细胞呈圆形、椭圆形,大小基本一致,可见瘤巨细胞,胞浆丰富,红染,核较一致,深染。免疫组化:嗜铬素A(CgA)强阳性(附图),突触素(SY)强阳性,神经纤维丝蛋白(NF)阴性。病理诊断:非功能性膀胱嗜铬细胞瘤。 讨论 自1953年Zimmerman首次报告膀胱嗜铬细胞瘤以来,国内外文献报告大多数为功能性肿瘤,而非功能性肿瘤较少,约占8％10％,多见于肾上腺内嗜铬细胞瘤。在临床上无高血压症状,多在医检中偶尔发现,容易误诊为膀胱癌,本例就是在妇科检查时发现。在鉴别诊断上,嗜铬细胞瘤电镜下有典型的神经分泌颗粒,嗜?
Female patient, 40 years old, bladder mass more than 3 months, was admitted on October 10, 1987. Due to 3 months ago gynecological examination, B-found in the left side of the bladder wall with a mass, the cystoscopy showed: the left wall to see a large new life creatures, smooth surface, a short pedicle. Physical examination: the general situation is good, BP 18 / 10kPa, blood, urine routine were negative, urine nitrogen, creatinine and urine 3-methoxy-04 hydroxy acid (VMA) were normal. Cystoscopy: mass slightly larger than 3 months ago, more than normal bladder image. Surgery, see the tumor is located in the bladder posterior wall, bilateral ureteral orifice midline connection on the position, about 2.0cm × 1.5cm × 1.0cm size, pedunculated, the surface was flocculent. Pathological examination: dark red irregular shaped knot 2, respectively, the size of 2.0cm × 1.0cm × 1.0cm and 0.6cm × 0.5cm × 0.5cm, the surface roughness, with envelopes, brown, yellow, solid, soft . Microscopically see tumor cells arranged in nests, lumps, interstitial vascular and fibrous tissue rich, tumor cells were round, oval, the size of basically the same, visible tumor giant cells, abundant cytoplasm, red dye, the nucleus are more consistent Deeply stained. Immunohistochemistry: Strong positive for CgA (with photo), strong positive for synaptophysin (SY) and negative for neurofilament protein (NF). Pathological diagnosis: non-functional bladder pheochromocytoma. DISCUSSION Since Zimmerman first reported bladder pheochromocytoma in 1953, the majority of reported domestic and foreign literature are functional tumors, while non-functional tumors are less, accounting for about 8% to 10%, more common in adrenal pheochromocytoma. Clinically no symptoms of hypertension, and more often found in the medical examination, easily misdiagnosed as bladder cancer, this case is found in gynecological examination. In the differential diagnosis, pheochromocytoma under electron microscopy typical neuroendocrine particles, addicted?