肾脏混合性上皮间质肿瘤的诊断和治疗(附3例报告)

Diagnosis and Treatment of Mixed Epithelial and Stromal Tumor of the Kidney

目的:提高对肾脏混合性上皮间质肿瘤(MESTK)的认识。方法:回顾性分析3例MESTK患者的临床诊治情况:3例MESTK患者平均发病年龄45.7(40～51)岁;临床表现为腰腹部疼痛或伴血尿;B超及CT检查显示肾脏囊实性或实性肿物,边界清,大小为7.0 cm×6.0 cm×5.0 cm、7.6 cm×7.5 cm×7.0 cm、4.3 cm×4.0 cm×4.0 cm,增强后可见中等或明显强化。2例行根治性肾切除术,1例行单纯肾切除术。结果:光镜下以不等量增生、腺管样或囊性扩张的腺上皮与以不同排列方式的梭形细胞间质混合组成为特征,两种细胞均分化良好,无明显异型性及病理性核分裂相。免疫组织化学显示上皮细胞CK(AE1/AE3)(3/3)、vimentin(3/3)、CK7(3/3)、EMA(2/3)+,梭形细胞vimentin(3/3)、SMA(3/3)、actin(3/3)、Desmin(2/3)+,肿瘤细胞ER、PR、CD117、S-100、HMB45、CK20、P63、CD34阴性。3例分别随访38、52、159个月,肿瘤无局部复发和远处转移。结论:MESTK是一种少见的肾脏混合性肿瘤,确诊需依赖组织病理学及免疫组织化学检查;治疗以单纯肾切除手术为主,患者大多预后良好。

Objective：To discuss the diagnosis and therapeutic methods of mixed epithelial and stromal tumor of the kidney （MESTK）. Methods： Three cases of MESTK were studied by analysing the results of operation, light microscopy, immunohistochemistry with review of literature. Three patient with the mean age of 46. 7 years old（range 40 to 51）. The clinical symptoms were flank or abdo-minal pain, or follow with hematuia. B-ultrasound and computed tomography（CT） of the kidney showed cystic/solid（1/3） or solid（2/3） masses measuring 7.0 cm× 6.0 cm × 5.0 cm, 7.6 cm × 7.5 cm × 7.0 cm. 4.3 cm × 4.0 cm × 4.0 cm, respectively. Enhanced CT revealed a well circumscribed mass showing mild or markedly enhancement. Two were performed radical nephrectomy, one was performed simple nephrectomy. Results： Microscopically, the tumors consisted of proliferating and glandulous or cystically dilated glands admixed with solid stromal areas of spindle cells with variable cellularity and growth patterns, both of them were well differentiated with no atypia and mitosis of the nuclei. Histochemical staining showed positive for CKAE1/AE3（3/3）, vimentin（3/3）, CK7（3/3）, EMA（2/3） in the epithelial cells and vimentin（3/3） ,SMA（3/3）, actin（3/3） and Desmin（2/3） in the spindle cells, and negative for ER, PR, CD117,S-100, HMB45, CK20,P63,CD34 in the tumor cells, No tumor recurrence and metastasis was found in all the three patients that followed up 38, 52, 159months, respectively. Conclusions：MESTK is rare mixed renal neoplasm. Di- agnosis of MESTK depends on pathologic and immunohisto-chemical examination. Surgery（nephrectomy） is the main therapy for MESTK and mostpatients are favorable prognosis.