透明细胞乳头状肾细胞癌的临床病理特征及鉴别诊断(附6例报告)

doi:10.19558/j.cnki.10-1020/r.2018.01.012

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摘要 目的:探讨透明细胞乳头状肾细胞癌(CCPRCC)的临床病理特征及鉴别诊断,提高对该肿瘤的认识。方法:复习6例CCPRCC患者的临床资料,进行组织病理学形态和免疫组织化学观察并随访。结果:6例CCPRCC患者中男4例,女2例,中位年龄56.5岁(41~82岁)。肿瘤平均最大径3 cm(1.2~6.5 cm)。镜下肿瘤细胞呈乳头状、腺泡状、管状或实性巢状排列,胞质透明,细胞核远离基膜朝向管腔、腺泡或乳头表面,呈整齐的单层线状排列。免疫组化:6例中CK7、CA-Ⅸ和Vimentin均弥漫阳性,5例CD10和AMACR阴性。术后中位随访时间18.5个月(6~42个月),均未见肿瘤复发及转移。结论:CCPRCC是近年来才认识的肾细胞癌的新亚型,术后病理检查是确诊的主要手段,免疫组化CK7和CA-Ⅸ阳性,CD10和AMACR阴性对诊断有帮助,CCPRCC需与多种其他类型的肾细胞癌鉴别,治疗以手术切除为主,总体预后良好。

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关键词 ：肾细胞癌, 临床病理, 免疫组化, 鉴别诊断

Abstract：Objective: To investigate the clinicopathological features and differential diagnosis of clear cell papillary renal cell carcinoma (CCPRCC) so as to improve the understanding of the tumor. Methods: The clinical data of six patients with CCPRCC were studied and their histopathological and immunohistochemical features were investigated. Results: Patients included 4 males and 2 females with a median age of 56.5 years (range from 41 to 82 years), the mean tumor diameteris 3.0 cm (rangefrom 1.2 to 6.5 cm). Microscopically, all tumor cells were papillary, alveolar, tubular or solid nested arrangement, the cytoplasm is transparent, the nucleus away from the basement membrane and toward the surface of lumen, acini and papillae, which were arranged in a single line of arrangement. Immunohistochemical study showed all tumor cells diffuse positive for CK7, CAIX and Vimentin, five of six negative for CD10 and AMACR. Post operative median follow-up time was19 months (range from 6 to 42 months), No recurrence or metastasis was found. Conclusions: CCPRCC is a new subtype of renal cell carcinoma which has been recognized in recent years. Pathological examination is the main method of diagnosis. Positive for CK7 and CA-Ⅸ, negative for CD10 and AMACR are helpful for diagnosis. CCPRCC needs to be distinguished from a variety of other types of renal cell carcinoma and surgical resection is the main treatment, the prognosis is relatively good.

Key words： renal cell carcinoma Clinicopathology Immunohistochemistry Differential diagnosis

收稿日期: 2017-02-13

ZTFLH:

R737.11

基金资助:国家自然基金资助项目(81572512)

通讯作者: 甘卫东,gwd@nju.edu.cn

引用本文:

赛孜木·阿合孜木汗, 甘卫东, 庄文渊, 刘宁, 王振, 郭宏骞. 透明细胞乳头状肾细胞癌的临床病理特征及鉴别诊断(附6例报告)[J]. 微创泌尿外科杂志, 2018, 7(1): 50-54.
Sezim Agizamhan, Gan Weidong, Zhuang Wenyuan, Liu Ning, Wang Zhen, Guo Hongqian. Clinicopathological features and differential diagnosis of clear cell papillary renal cell carcinoma:A report of six cases. JOURNAL OF MINIMALLY INVASIVE UROLOGY, 2018, 7(1): 50-54.

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http://journal20.magtechjournal.com/Jwk_zgmnwk/CN/abstract/abstract1341.shtml 或 http://journal20.magtechjournal.com/Jwk_zgmnwk/CN/Y2018/V7/I1/50

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