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1、肾脏上皮样血管平滑肌脂肪瘤3例临床病理特点分析(江苏大学附属武进医院病理科江苏常州213000)目的：探讨肾脏上皮样血管平滑肌脂肪瘤(epithelioidagiomyolipoma,EAML)的临床病理特点、鉴别诊断及生物学行为。方法:观察3例肾脏EAML临床病理特点、免疫表型，并进行术后随访。结果：3例年龄分别为47、50和63岁，均无结节硬化症。光镜下肿瘤主要有异型上皮样细胞组成，弥漫或巢片状排列，部分区域有血管周上皮样排列，其中2例可见出血和坏死，肿瘤细胞体积大，呈圆形或多边形，胞质丰富，嗜酸性颗粒状，细胞核大，核仁明显，可见核分裂象，多核巨细胞散在其中，3例
2、均可见经典AML成分。免疫组化染色显示瘤细胞HMB-45阳性，SMA、Vimentin散在阳性；上皮细胞膜抗原(EMA)、CK、S-100、CD10均阴性。2例患者术后12个月状态良好，未见肿瘤局部复发和转移，1例患者手术后33个月颈部发现肿瘤转移结节。结论：EMAL的病理学及免疫组化特点对诊断及鉴别诊断至关重要，而肿瘤细胞的不典型性、出血、坏死、核分裂象活跃提示肿瘤A有恶性潜能或预后不良，须密切随访。远处转移为该肿瘤恶性的确切证据。【关键词】肾肿瘤；上皮样血管平滑肌脂肪瘤；免疫组织化学；恶性R730.2A2095-1752(2016)35-0018-03【Abstr
3、act】ObjectiveToinvestigatetherenalepithelioidangiomyolipomas(epithelioidagiomyolipoma,EAML)theclinicalpathologicalfeatures,differentialdiagnosisandbiologicalbehavior.MethodsToobservetheclinicalpathologicalcharacteristics,3casesofrenalEAMLimmunephenotype,andpostoperativefollow-up.Results
4、3casesofage47,50and63yearsold,respectively,notuberoussclerosis.Angiohyalinosistumorsaredifferentofepithelioidcells,diffuseorflake,nestareaofvascularweeksepithelioidarrangement,which2casesofhemorrhageandnecrosis,tumorcellvolumeisbig,assumesthecircularorpolygonal,abundantcytoplasm,eosinop
5、hilicgranular,thenucleus,nucleolus,visiblefission,multinucleatedgiantcellsarescatteredamongthem,3casesofclassicAMLcomponentarevisible.ImmunohistochemicalstainingshowedHMB-45positivetumorcells,theSMA,Vimentinpositive;Epithelialmembraneantigen(EMA),CK,S-100,CD10arenegative.Ingoodcondition
6、after12months,2caseswithnotumorlocalrecurrenceandmetastasis,1caseof33monthsafteroperationinpatientswithnecktumormetastasesnodules.ConclusionEMALpathologyandimmunohistochemicalcharacteristicsisveryimportanttothediagnosisanddifferentialdiagnosis,andtypicality,hemorrhage,necrosisoftumorcel
7、lsandnuclearfissionasactiveprompttumorswithamalignantpotentialandprognosis,mustbecloselyfollowedup.Theexactevidenceofdistantmetastasisofthetumor.【Keywords】Renaltumor;Epithelioidangiomyolipomas.lmmunohistochemistry;Malignant肾脏上皮样血管平滑肌脂肪瘤是血管平滑肌脂肪瘤(angiomyolipoma,AML)的一种罕见亚型，属于具奋恶
