肾脏黏液样小管状和梭形细胞癌2例报道及文献复习

Mucinous Tubular and Spindle Cell Renal Cell Carcinoma:Two Cases Report and Review of Literature

目的探讨黏液样小管状和梭形细胞癌(MTSC)的临床病理特征、组织发生、鉴别诊断及预后。方法通过HE、免疫组织化学染色及免疫组织化学观察2例MTSC,随访39及83月,并复习相关文献。结果2例MTSC均为女性,发病年龄分别为60及73岁,肿瘤界限清楚,组织学示紧密排列的、小而狭长的小管,其间为淡染黏液样间质。瘤细胞呈立方形至梭形,嗜酸性胞浆,核级别低,核分裂相很少见。2例CK34βE12、E-cadherin、CK7、CK19、vi mentin均为阳性,1例部分表达NSE及Syn,Ki-67增殖指数<5%,随访期内患者病情稳定。结论MTSC是一种罕见的低级别肾上皮性肿瘤,免疫组织化学支持MTSC起源于远端小管的假设,与乳头状肾细胞癌相似,可有神经内分泌分化。单独全肾切除术预后较好,但需密切随访。

Objective To investigate the clinicopathologic characteristics, histogenesis, differential diagnosis and prognosis of Mucinous Tubular and Spindle Cell Renal Cell Carcinoma （MTSC）. Methods Two cases NITS（; were examined by HE, histochemical and immunohistochemical stains, followed up for 39 and 83 months, and the related literatures were reviewed. Results The patients were both females, at ages of 60 and 73. The tumors were well circumscribed. Tumors consisted of tightly packed, small, elongated tubules separated by pale mucinous stroma. The tumor cells were cuboidal to spindled with eosinophilic cytoplasm and low nuclear grade. Mitoses were few or nonexistent. Both were immunoreactive for CK34βE12, E-cadherin, CK7, CK19, vimentin and one case was partly positive for NSE and synaptophysin. The proliferative rate （Ki-67） is 〈5%. Prognosis was favorable in our two cases. Conclusion MTSCs are rare and low-grade renal epithelial neoplasms, immunohistochemistry favored the hypothesis of a distal tubule origin partly with neuroendocrine differentiation, relatively similar to papillary renal cell carcinoma. Radical nephrectomy alone was needed, without adjuvant therapy, but Follow-up in the future is necessarily.