肾嫌色细胞癌19例临床病理分析

Chromophobe cell renal carcinoma: a report of 19 cases and review of literature

目的 探讨肾嫌色细胞癌的临床病理特征、免疫学表型、鉴别诊断及预后。方法对19例肾嫌色细胞癌进行光镜观察、免疫组化研究及随访10～102个月，并复习相关文献。结果 19例中男性9例，女性10例；年龄30—72岁，平均47．9岁。肿块直径3～18cm。镜下肿瘤由嫌色细胞和嗜酸细胞构成，呈片状、梁状和腺状分布。嫌色细胞体积较大、多角形，胞膜清晰，胞质半透明细网状，胞核皱缩，可见核沟及核异型，核仁不明显；而嗜酸细胞胞质嗜酸，可见明显的核周空晕。免疫表型中的表达率分别为：EMA和Ksp-cadherin100％，CD1047％，vimentin 0，CK7 73．7％，P504S21．1％，CD11794．7％。结论 肾嫌色细胞癌是一种少见的肾肿瘤，预后好于透明细胞癌，与乳头状肾细胞癌相当。其特征性的组织形态、免疫表型、电镜及遗传学改变有助于诊断和鉴别诊断。

Objective To study the clinicopathological features, differential diagnosis and prognosis of chromophobe cell renal carcinoma. Methods We examined the microscopic and immunohistochemical features in 19 cases of chromophobe cell renal carcinoma, followed up for 10 - 102 months and reviewed related literatures. Results There were 9 male and 10 female patients, aged from 30 to 72 （mean age 47.9）. The sizes of tufters were from 3 cm to 18 cm. Histologically, the patterns showed sheet, trabecular and alveolar architectures. The tuners composed of chromophobe cells and eosinophilic ceils. Chromophobe cells with distinct membrunes were larger and polygonal with translucent and finely reticulated cytoplasm. Eosinophilic cells had eosinophilic cytoplasm and perinuclear halo. Wrinkled, grooved and bizarre nuclei were found in chromophobe cell renal carcinoma and nucleolns was not obvious, lmmunohistochemically, the tuners expressed EMA （19/19）, CD10 （9/19）, vimentin （0/19）, CK7 （14/19）, P504S （4/19）, CD117 （18/19）, Ksp-cadherin （19/19）, respectively. Conchusions Chromophobe cell renal carcinoma is an uncommon tumor. Its prognosis is better than that of clear cell renal carcinoma but not different from papillary renal carcinoma. Its differential diagnosis must be established on the characteristics of pathology, immunohistochemical findings, ultrastrucural and genetic changes.