肾盂移行细胞癌伴破骨细胞样巨细胞肿瘤1例及文献复习

Transitional cell carcinoma of the renal pelvis associated with osteoclast-like giant cell tumor:a case report and review of the literature

目的探讨伴破骨细胞样巨细胞肿瘤的肾盂移行细胞癌的临床病理学特征。方法对1例伴破骨细胞样巨细胞的肾盂移行细胞癌进行临床病理学分析及免疫组化研究,并复习相关文献。结果患者男性,51岁。肿物位于右侧肾盂内,约3.0cm×2.5cm×1.5cm,灰白色,蕈伞状。镜下:肿瘤组织由典型的Ⅱ级移行细胞癌及破骨细胞样肿瘤两种成分组成,混杂存在,未见移行。免疫组织化学:癌成分表达CK7、CK(AE1/AE3)及EMA阳性,灶性表达p53;破骨细胞样巨细胞及单核肿瘤细胞成分表达波形蛋白,CD68,少数异型单核肿瘤细胞呈CK(AE1/AE3)及EMA阳性,而CK7及p53均阴性。结论伴破骨细胞样巨细胞肿瘤的肾盂移行细胞癌应视为移行细胞癌的一个特殊组织学类型,破骨细胞样巨细胞肿瘤成分的出现可能提示肿瘤更具侵袭性,预后不良。

Objective To explore the clinicopathologic features of transitional cell carcinomas of renal pelvis associated with osteoclast-like giant cell tumor. Methods The clinieopathologic data of a case of transitional cell carcinoma with osteoclast-like giant cell tumor of the renal pelvis was reviewed and immunohistochemical staining was performed using antibodies against CK7, EMA, Vimentin, CD68, p53 on the dewaxed sections and review of related literature. Results The patient was 51-year-old male,his tumor was located in the right renal pelvis, and the size of the tumor was 3.0cm×2.5cm×1.5cm, The tumor was grossly gray-white in color and cauliflower-shaped in appearance. Histologically, the tumor was composed of transitional cell carcinoma and osteoclast-like giant cell tumor, lmmunohistochemical study demonstrated carcinomatous component was positive staining with antibodies against CK7, CK, EMA and negative for CD68; focal positivity for p53 was found in the carcinomatous components, whereas the osteoclast-like giant cells and mononuclcar cells were immmunoreactive for CD68 and Vimentin,some atypical mononuclear cells were immunoractive for CK （AE1/AE3）and EMA,but negative for CK7, p53. Conclusions Transitional cell carcinoma of the renal pelvis associated with osteoclast-like giant cell tumor should be considered as a rare variant of urothelial carcinoma, and the existence of osteoclast-like giant cell tumor may indicate high malignancy and poor prognosis. However, more cases are required to clarify the clinical signifigance and tissue origination of the osteoclast-like giant cell tumor.