肾脏黏液样小管状和梭形细胞癌临床病理分析

Mucinous tubular and spindle cell carcinoma of kidney:A clinicopathologic study of four cases and review of literature

目的探讨肾脏黏液样小管状和梭形细胞癌（mucinous tubular and spindle cell carcinoma, MTSCCa）的临床病理特征和鉴别诊断要点及生物学行为。方法对4例MTSCCa标本进行组织病理学和免疫组化染色观察，并复习临床资料及相关文献。结果该肿瘤好发于女性，发病年龄17～82岁（平均53岁），临床症状不明显。组织学：肿瘤与周围肾组织分界清楚，切面实性、灰白色，肿瘤细胞形态呈双相（小管状和梭形细胞）或三相（小管状、梭形和脊索瘤样或黏液样）。其他组织学表现：泡沫样巨噬细胞聚集、典型的透明细胞和乳头状或乳头结构。免疫组化显示复合性免疫表型。结论MTSCCa是一种罕见的低级别多形性肿瘤，组织学谱系在不断扩大，免疫组化表型及组织学形态与乳头状肾细胞癌（PRCCa）有重叠。

Purpose To explore the clinicopathologic features, differential diagnosis and biological behavior of mucinous tubular and spindle cell carcinoma （MTSCCa） of the kidney. Methods Four cases of MTSCCa were studied by routine histologic and immunohistochemical staining, together with review of the literature. Results It was more likely to occur in women and usually discovered incidentally. The age ranged from 17 to 82 years （ average 53） at the time of tumor resection. Histopathologically, tumors showed circumscribed growth with gray to tan, solid cut surfaces, and biphasic （tubular and spindle cell） or triphasic （tubular, spindle cell and chordoid/myxoid）. Other histologic findings were aggregates of foamy macrophages, clear cells, papillary structure/well-formed papilstaining showed a complex immunophenotype. Conclusions MTSCCa is a rare low-grade polymorphic neoplasm with expanding histologic spectrum, and significant morphologic and immunophenotypic overlap warrants diagnostic caution.