观察p63标记的目的有二个，1）基底细胞是否存在；2）尿路上皮分化？

本病例主要鉴别诊断为：前列腺腺癌浸润 VS 伴有腺泡/小管分化的尿路上皮癌。

参考文献：

Huang Q, Chu PG, Lau SK, Weiss LM. Urothelial carcinoma of the urinary bladder with a component of acinar/tubular type differentiation simulating prostatic adenocarcinoma. Hum Pathol. 2004;35(6):769-73.

We report a case of an 83-year-old man with a high-grade carcinoma of the urinary bladder who underwent cystoprostatectomy. The invasive carcinoma showed mixed, morphologically distinct patterns consisting of conventional high-grade urothelial carcinoma, glandular differentiation resembling enteric type adenocarcinoma, and acinar/tubular type differentiation, morphologically similar to Gleason grade 3 prostatic adenocarcinoma.Immunohistochemical studies revealed the acinar/tubular component of the tumor to be negative for prostate-specific antigen (PSA-) and prostatic acid phosphatase(PAP-), but positive for cytokeratin 7(CK7+), cytokeratin 20(CK20+), high molecular weight cytokeratin (34 beta E12+), and thrombomodulin, consistent with origin from the bladder rather than the prostate. Although bladder carcinomas composed of mixed morphologic patterns are not uncommon, to our knowledge, the presence of acinar/tubular type features simulating prostatic adenocarcinoma in such tumors has not been described elsewhere.

金老师好！我们没有P501s，只有P504s，P63没做，PAP和PSA如下：

是否标记了P63、P501S、PSMA、PAP？

谢谢各位老师，免疫组化如下：

赞成，最后一图乳头状结构，首先考虑尿路上皮癌伴腺样分化，需鉴别前列腺癌、肠癌。

能否告诉病变的具体部位？

 脉管内见癌栓，排除腺性膀胱炎。尿路上皮癌伴腺样分化是首先的一个考虑。

由于肿瘤靠近尿道内口，需要标记鉴别前列腺癌累及膀胱。由于尿道在尿道前列腺部的特殊部位，前列腺癌可在尿道形成息肉状肿块。

 学习：

肿瘤大部分为单层及复层细胞构成的管样、腺样结构，单管样、多导管融合均可见，图七显示不规则巢团样上皮细胞，图八显示梭形细胞、不规则形细胞肉瘤样结构。图12显示间质水肿的乳头状结构。

期待进展