婴幼儿肾母细胞瘤23例临床病理学观察

Clinical pathological studies of 23 cases of nephroblastoma

目的 :研究肾母细胞瘤临床病理特征与治疗及预后关系 ,指导临床治疗。方法 :采用免疫组化及组织化学方法检测 2 3例肾母细胞瘤对 Keratin.EMA Vimentin.desmin.NSE的表达及粘液形成 ,并对患者的年龄、肿瘤的大小、间变及临床分期与生存期进行了比较分析。结果 :2 3例肾母细胞瘤中 ,含有上皮成分的 13例均表达 Keratin和 EMA;2 3例的胚基和间质成分均表达 Vimentin;有平滑肌和横纹肌分化的 5例均为 desmin阳性 ;有神经分化的 2例为 NSE表达 ;含有粘液成分的 17例为阿辛蓝染色阳性。 2 3例肿瘤其患者年龄大于 2岁者 ,肿瘤直径大于 10 cm,瘤细胞有间变者 ,临床分期为 期以上者 ,肿瘤组织无肾小管样分化者及有粘液形成者预后生存期短。结论 :肾母细胞瘤的年龄 ,肿瘤大小 ,临床分期 ,肿瘤有无间变 ,肾小管样分化及粘液成分是影响预后的主要指标 ,临床中参考这些指标指导治疗。

Objective:To study the relation of pathologic characters of nephroblastoma between treatment and prognosis to direcr the clinic treatment.Methods:Using methods of immunohistochemistry and histochemistry to detect the expression of keratin, EMA, vimentin, desmin, NSE and mucin in 23 cases of nephroblastoma. And comparatively analyzed the relation between the age of patient, the size of tumor, anaplasia, the clinic stage of tumor and survival duration.Results:In 23 cases nephroblastoma, all 13 cases having the epithelial component expressed keratin and EMA; all 23 cases having the embryonic stroma and mesenchymal expressed vimentin, all 5 cases having smooth and striated muscle compnents were destin postive, 2 cases of neural differentiation expressed NSE, 17 cases having mucin compnent were Alcin blue postive. Those patients under 2 years old, tumor diamter above 10 cm, and tumor cells having anaplasia, the clinic stage above Ⅱ, and no tubular structure differentiation and no mucin formation the survival duration were short.Conclusion:the major prognostic factorts in nephroblastoma were the age of the patient, the stage of the tumor, the size of the tumor, and its microscopic appearance, including anaplasia, tubular structure differentiation and mucin nt.