肾孤立性纤维瘤临床病理观察

Clinicopathologic analysis of solitary fibrous tumor of kidney

目的探讨肾孤立性纤维瘤的临床病理特征、诊断和鉴别诊断,提高对该肿瘤的诊断水平。方法对1例肾孤立性纤维瘤进行光镜、免疫组化观察,并结合文献讨论。结果患者女性,47岁。临床、放射学诊断为肾盂癌。肿瘤边界清楚,切面灰白色。镜下梭形细胞呈束状、旋涡状或不规则状排列,部分与胶原纤维混杂,部分呈血管外皮瘤样结构。细胞无明显异型,核分裂象偶见。免疫组化示肿瘤细胞vimentin、CD34和CD99(+),bcl-2部分(+),desmin、SMA、MAS、HMB45、carponin、S-100蛋白、CD1l7、CD31、FVIII、CK(AE1/AE3)、EMA、Ki-67和p53均(-)。结论肾孤立性纤维瘤是一种非常罕见的肿瘤,诊断主要依靠病理形态学及免疫组化,并应与肾的其他梭形细胞肿瘤鉴别。

Objective To explore the clinical pathological features,diagnosis and differential diagnoses of solitary fibrous tumor （SFT） of the kidney. Methods A case of SFT of the kidney was examined with light microscopy and immunohistochemistry, and related literature was reviewed. Results The patient was 47 year old woman. Clinical and radiological examination revealed a tumor in the renal pelvis suspected carcinoma of renal pelvis. Grossly the tumor was well-circumscribed with grey white color on cut surface. Microscopically, the tumor was composed of bland spindle-shaped cells and dense collagenous bands, with fascicular, storform, or haphazard arrangements. Focal areas showed a haemangiopericytoma-like structure. The cells had no obviously atypical. Mitoses were seen occasionally. Immunohistochemically, the tumor cells were positive for vimentin, CD34, CD99, partially positive for Bel-2, and negative for desmin, SMA, MSA, carponin, HMB45, CD117, S-100 protein,CD31,FVⅢ,CK （AE1/AE3）, and EMA. Conclusions SFr of the kidney is a very rare spindle-cen neoplasm. Diagnonsis is based on its morphology and immunohistochemistry.Differential diagnosis includes other spindle-shaped cell tumors of the kidney. Immunohistochemistry