肾炎性假瘤8例临床病理分析

Renal inflammatory pseudotumor:a clinicopathologic analysis of eight cases

目的探讨肾炎性假瘤的临床及病理组织学特征。方法采用光镜、免疫组化对8例肾炎性假瘤进行观察,并复习文献。结果本组8例中男性2例,女性6例,年龄16～62岁,平均年龄35.4岁。其中5例位于左肾,3例位于右肾;纤维增生型1例,淋巴细胞增生型2例,黄色瘤样型1例,浆细胞肉芽肿型3例,混合细胞型1例。光镜下主要见长梭形细胞散在于丰富的间质中,并可见浸润的淋巴细胞、浆细胞、组织细胞及泡沫细胞等。免疫组化示SMA弥漫(+),desmin局灶(+),S-100弱(+),ALK(-)。结论肾炎性假瘤是一种少见的肾实质非特异性增生性炎性瘤样病变,临床及影像学检查酷似肾肿瘤改变,极易误诊。诊断主要依靠病理学检查,尤其是B超引导下的穿刺活检。目前治疗主要以抗炎治疗为主,预后好。

Objective To study the clinical and pathological features of renal inflammatory pseudotumor （IPT）. Methods Microscopic examination and immunohistochemical findings were studied in eight cases of renal inflananatory pseudotumor with review of related literature. Results There were 2 males and 6 females with average age of 35.4 years. The tumor was located in left kidney in 5 cases and right kidney in 3 cases. Histological examination demonstrated the tumor composed of spindle-shaped fibroblastic cells and infiltrating small lymphocytes, plasma cells, histiocytes, foam cells and others. Histological classification was as follows： fibrohyperplastic type （one ease）, lymphocytic hyperplasia （two eases）, xanthomatous type （one case）, plasma cell grannloma （three cases）and mixed-cell type （one case）. Immunohistochemically, the tumor cells were positive diffusely for SMA and partially positive for desmin. S-100 was weak positive,but ALK was negative. Conclusions Renal IPT is a rare benign disease characterized by proliferative inflammatory cells. It mimics malignant renal tumor by image examination and clinical manifestation. Diagnosis depends mainly on pathologic examination, especially ultrasound-guided needle biopsy. At present, antiimflammation is a main therapy for the disease with favourable prognosis.