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1、泌尿系统肿瘤Zhukeqing竺可青PathologyDepartmentZhejiangUniversitySchoolofMedicine2013-4-9TUMORSBENIGNPapillaryAdenomaFibroma/HamartomaAngiomyolipomaOncocytomaMALIGNANTRenalCellCarcinoma(ClearCellCarcinoma,Adenocarcinoma)Urothelial(Transitional)ThreemostcommonformsClearCellCarcinomasPapillaryRenalCellCarcino
2、masChromophobeRenalCarcinomasRENALCELLCARCINOMATOBACCORELATED,STRONGLYSOMEHEREDITARY/FAMILIALMOSTare“CLEARCELL”,afewPAPILLARYYELLOWgrossly,“CLEAR”cellsmicroscopicallySTRONGLYtendtoinvadetherenalVEINearly,inpreferencetolymphatics.Thesetumorsarederivedfromtherenaltubularepithelium,andhencetheyareloc
3、atedpredominantlyinthecortex. Renalcarcinomasrepresent80%to85%ofallprimarymalignanttumorsofthekidney,and2%to3%ofallcancersinadults.Mostrenalcancerissporadic,butunusualformsofautosomal-dominantfamilialcancersoccur,usuallyinyoungerindividuals. Althoughtheyaccountforonly4%ofrenalcancers,familialvar
4、iantshavebeenenormouslyinstructiveinstudyingrenalcarcinogenesis.VonHippel-Lindau(VHL)syndrome:Halftotwo-thirdsofpatientswithVHL,characterizedbyhemangioblastomasofthecerebellumandretina,developrenalcystsandbilateral,oftenmultiple,renalcellcarcinomas(nearlyall,iftheylivelongenough). Currentstudiesi
5、mplicatetheVHLgeneinthedevelopmentofbothfamilialandsporadicclearcelltumors.ThreemostcommonformsClearcellcarcinomasarethemostcommon;associatedwithhomozygouslossoftheVHLtumorsuppressorprotein;tumorsfrequentlyinvadetherenalvein.ThreemostcommonformsPapillaryrenalcellcarcinomasarefrequentlyassociatedwi
6、thincreasedexpressionandactivatingmutationsoftheMEToncogene;tendtobebilateralandmultiple,andshowvaryingpapillaformation.ThreemostcommonformsChromophoberenalcellcarcinomasarelesscommon;tumorcellsarenotasclearasintheotherrenalcellcarcinomas.Clinically,patientsmayshowhematuria,fever,constitutionalsym
7、ptoms,and/oraparaneoplasticsyndrome. Renalcellcarcinomahasatendencytometastasizewidelybeforegivingrisetoanylocalsymptoms.肾细胞癌，肾腺癌本癌不太多见，男性中年较多，临床较隐蔽，难早期发现。肉眼：结节状，可有假包膜，在肾上极较多，色带土黄，易出血坏死镜检：由含类脂及糖原的透明细胞构成，核不大，核浆比例
