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三、膀胱癌的组织病理学 目前，膀胱癌的分级广泛采用WH0的国际肿瘤组织学分类(WH01973, 1998,2004)分级标准-，而浸润深度则主要以国际抗癌联盟(Union Internationale Contre le Cancer/Intemational Union Against Cancer,UICC)TNM 期法为标准4。 (一)膀胱癌的组织学类型 被覆尿路的上皮统称为尿路上皮(urothelium)或移行上皮(transitional epithelium),本指南中主要采用尿路上皮的概念。 膀胱癌包括尿路上皮（移行）细胞癌、鳞状细胞癌和腺细胞癌，其次还有较 少见的小细胞癌、混合型癌、癌肉瘤及转移性癌等。其中，膀胱尿路上皮癌最为 常见，占膀胱癌的90%以上6，列；膀胱鳞状细胞癌比较少见，约占膀胱癌的3% 7%。膀胱腺癌更为少见，占膀胱癌的比例<2%610，膀胱腺癌是膀胱外翻最常 见的癌1,2。 (二)膀胱癌的组织学分级 膀胱癌的分级与膀胱癌的复发和侵袭行为密切相关。膀胱肿瘤的恶性程度以 分级(Grade)表示，关于膀胱癌的分级，目前普遍采用WHO分级法WHO1973叫 WH0/MSUP1998I2,WHO20043)。 1.WH01973分级法1973年的膀胱癌组织学分级法根据癌细胞的分化程 度分为高分化、中分化和低分化3级，分别用gade1、2、3或grade I、Ⅱ、 Ⅲ表示（表）。 2.WHO/ISUP分级法：I998年WHO和国际泌尿病理协会(Interational Society of Urological Pathology,.ISUP)提出了非浸润性尿路上皮（移行细胞）癌 新分类法2,2004年WH0正式公布了这一新的分级法)。 此分级法将尿路上皮肿瘤分为低度恶性倾向尿路上皮乳头状肿瘤(papillary urothelial neoplasms of low malignant potential,PUNLMP)、低分级和高分级尿路 上皮癌（表I)(www,pathology.jhu.edu/bladder上可以查到各级膀胱肿瘤的详细描 述)。 低度恶性倾向尿路上皮乳头状肿瘤的定义为尿路上皮乳头状肿瘤，其细胞形 态正常，无恶性肿瘤的细胞学特征。虽然，此种尿路上皮肿瘤进展的风险很小
三、膀胱癌的组织病理学 目前，膀胱癌的分级广泛采用 WHO 的国际肿瘤组织学分类(WHO 1973, 1998, 2004) 分 级 标 准 [1-3] ， 而 浸 润 深 度 则 主 要 以 国 际 抗癌联盟 (Union Internationale Contre le Cancer/International Union Against Cancer, UICC) TNM 分 期法为标准[4,5]。 （一）膀胱癌的组织学类型 被覆尿路 的 上皮统称为尿路上皮 (urothelium) 或移行上皮 (transitional epithelium)，本指南中主要采用尿路上皮的概念。 膀胱癌包括尿路上皮（移行）细胞癌、鳞状细胞癌和腺细胞癌，其次还有较 少见的小细胞癌、混合型癌、癌肉瘤及转移性癌等。其中，膀胱尿路上皮癌最为 常见，占膀胱癌的 90%以上[6,7]；膀胱鳞状细胞癌比较少见，约占膀胱癌的 3%～ 7%。膀胱腺癌更为少见，占膀胱癌的比例＜2% [6-10]，膀胱腺癌是膀胱外翻最常 见的癌[11,12]。 （二）膀胱癌的组织学分级 膀胱癌的分级与膀胱癌的复发和侵袭行为密切相关。膀胱肿瘤的恶性程度以 分级（Grade）表示。关于膀胱癌的分级，目前普遍采用 WHO 分级法(WHO 1973[1] , WHO/ISUP 1998[2], WHO2004[3])。 1. WHO1973 分级法 1973 年的膀胱癌组织学分级法根据癌细胞的分化程 度分为高分化、中分化和低分化 3 级，分别用 grade 1、2、3 或 grade Ⅰ、Ⅱ、 Ⅲ表示 (表 1)。 2. WHO/ISUP 分级法：1998 年 WHO 和国际泌尿病理协会 ( International Society of Urological Pathology, ISUP) 提出了非浸润性尿路上皮（移行细胞）癌 新分类法[2]，2004 年 WHO 正式公布了这一新的分级法[3]。 此分级法将尿路上皮肿瘤分为低度恶性倾向尿路上皮乳头状肿瘤（papillary urothelial neoplasms of low malignant potential, PUNLMP）、低分级和高分级尿路 上皮癌 (表 1) (www.pathology.jhu.edu/bladder 上可以查到各级膀胱肿瘤的详细描 述)。 低度恶性倾向尿路上皮乳头状肿瘤的定义为尿路上皮乳头状肿瘤，其细胞形 态正常，无恶性肿瘤的细胞学特征。虽然，此种尿路上皮肿瘤进展的风险很小