肾未分化癌2例报道及文献复习

Undifferentiated renal larcinoma(2 cases reported and literature review)

目的：探讨肾未分化癌的临床病理特点。方法：对手术切除的2例肾未分化癌进行巨检、镜检和免疫组化染色，结合文献报道2例分析其特点。结果：结合国内报道2例，共4例，男3例，女1例，男：女性别比例为3：1；发病年龄59—74岁，平均年龄68．2岁。临床症状有血尿、腰痛、发热，伴发肾结石。肿瘤均为单发，直径4—8厘米。大体，灰黄、灰红色。伴坏死、出血。镜下：瘤细胞分化低，片状，细胞圆形、梭性，胞质嗜酸或略淡染，可见多核瘤巨细胞。免疫组化表达CD10，CK，VIM，P53强阳性表达。两例随访死亡。结论：肾未分化癌是一种少见肿瘤，发病年龄较大，预后差。诊断需结合免疫组化检查，P53基因突变可能与肾未分化癌发生发展相关。

Objective： Purpose To study the clinicopatholngical features of undifferentiated renal cell carcinoma. Methods： clinical data of 2 cases with undifferentiated renal cell careinoma treated from 1964 to 2006 were were observed with gross, microscopic and immtmohistochemical stains, and discussed with literature reviewed. Results： the total 4 case,3 were male, 1 was female, age from 59 to 74. clinical symptom include gross hematuria, low back pain and discomfort, pyrexia and kidney stone calculus. All the renal mass were solitary, with diameter ranged 4 - 8cm. gross： cut surface is light brown, contain areas of haemorrhage and necrosis; Microscopically the tumors cell were poorly differentiated , areas consisting of sheetes and alveolar of cells, the tumour cell are round or oval with eosinophilie or pale cytoplastom, some were multinucleated giant tumour cells; assay was positive for CK, VIM, CD10, P53.2 case follow- up was available and patient were died Conclusion： undifferentiated renal cell carcinoma is rare neoplasm, it occurs in older patients, its prognosis is poor. The development of undifferentiated renal cell carcinoma may be associated with mutation of P53 gene.