肾脏黏液性管状及梭形细胞癌的临床病理观察

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1、现学杂志Journalof曼璺曼生箜2鲞箜·193·论著肾脏黏液性管状及梭形细胞癌的临床病理观察高仁里[摘要]目的探讨肾脏黏液性管状及梭形细胞癌(mucinoustubularandspindlecellcarcinoma，MTSCCa)的临床病理特点、免疫表型及鉴别诊断要点，并复习相关文献对其组织起源作一探讨。方法对1例肾脏黏液性小管状和梭形细胞癌进行I临床病理学特征及免疫组化的分析。结果患者女性，56岁，无特异临床症状，体检发现右肾占位。巨检发现肾上极实质内一灰白界清结节，直径7cm，切面均匀。镜下见瘤细

2、胞主要呈两种结构：由单层立方细胞排列成的细管状结构及类似于平滑肌瘤的梭形细胞结构，局部可见透明细胞及乳头样结构，立方状细胞及梭形细胞均形态温和。背景中见大量黏液，并可见淋巴细胞、浆细胞及泡沫细胞浸润。免疫组化：CK7、CK18、Vim阳性表达；SMA、HMB45、SYN均阴性。结论MTSCCa是一种少见的低级别肿瘤，预后较好，可能来源于远端肾单位。[关键词]肾肿瘤；黏液性小管状和梭形细胞癌；免疫组化；组织起源；鉴别诊断[中图分类号]R737．11[文献标识码]A[文章编号]1681—102X(2010)04-

3、0193-03TheclinicopathologicobervationofmucinoustubularandspindlecellcarcinomaofkidneyGAORen—li．DepartmentofPathology，NanhuiCenrtalHospitalofPudongNewDistrict，Shanghai201300，China[Abstract]ObjectiveTo’investigatetheclinic叩athologiccharacteristicsandtheimmuno

4、histochemicalexpres—sionanddifferrentialdiagnosisofmucinoustubularandspindlecellcarcinoma(MTSCC)ofkidney，andreviewtheliteraturetodiscussitghistogenesis．MethodsOnecaseMTSCCofkidneywasanalyzedbyusingmicroscopyandimmunohistochemicalstains．ResultsThepatientwasa

5、56一yeal—oldwomanwithnospecialclinicalsymptom．Shewasfoundanoccupyinglesioninrightkidneywhenhealthexamination．Grossly，a7cmtumorwaslocatedintheupsideofthekidneywithclearcircumscription，grey—whiteoncutsurface．Inmicroscopicalobsevation，therehavetwopredminantlyst

6、mctures：oneiselongated—tubules—likestructurecomposedofcubicalcellsandthean—otherisspindlecellsregionlookslikeleiomyoma．Clearcellandpapillarystructurecanbeseeninsomearea．Allthecellsofthetumorwerenomaligmantcharacteristics．Thebackgroudwasfullofmuchmyxoiddropl

7、et，andalsosomelymphoidcellsandfoamcellsinfiltration．Immunohistochemicalexpression：CK7，CK18andVimentinwerepostiveexpression；WhileSMA，HMB45andSYNwerenegativeexpression．ConclusionMTSCCofkidneyisararelow—gradeepithelialneoplasm，withfavourableprognosisandprobabl

8、ysharingfromdistalnephron．[Keywords]kidneycancer；mucinoustubularandspindlecellcarcinoma；immunohistochimistry；histogenesis；differentialdiagnosis2004年的WHO泌尿和男性生殖系统肿瘤分类鉴别诊断作一探讨。中，肾脏黏液性管状及梭形细胞癌(mucinoustub