具有乳头状结构的透明细胞肾细胞癌临床病理分析

Clear cell renal cell carcinoma with papillary architecture: a clinicopathologic study of 12 cases

目的探讨具有乳头状结构的透明细胞肾细胞癌的临床病理学特征及诊断与鉴别诊断。方法对12例具有乳头状结构的透明细胞肾癌进行光镜及免疫组织化学观察。结果12例中男性11例,女性1例,平均53岁。10例发生于右侧肾脏,2例发生于左侧肾脏,主要症状为血尿、腰腹痛或无明显症状仅体检发现。12例肿瘤组织形态学上都具有乳头状结构区域,占整体肿瘤的10%～30%,其他区域为经典型透明细胞癌排列区,乳头结构为原发性簇状微乳头、小管乳头或纤维血管轴心乳头及继发性囊性变形成、坏死形成或人工因素形成的乳头;免疫组化:CK(12/12)、CD10(9/12)、vimentin(11/12)、CK7(5/12)、AMACR(3/12)阳性,CD117和TFE3阴性。9例患者随访2至66个月,5例无瘤生存,3例复发,其中2例死亡。结论具有乳头状结构的透明细胞肾细胞癌属于透明细胞肾细胞癌范畴,以形态学上具有乳头状结构为特点,免疫表型与经典型透明细胞肾癌基本一致并具有一定的差异,这些特点对临床病理诊断具有很高的价值。

Purpose To investigate the pathological features of clear cell renal cell carcinoma with papillary architecture,and its diagnosis and differential diagnosis.Methods 12 cases of clear cell renal cell carcinoma with papillary architecture were studied by routine stain and immunohistochemisitry.Results 11 males and one female were retrieved with an average age of 53 years.The tumor involved both sides of kidney,10 right and 2 left,respectively.Hematuria,abdominal and back pain were predominant clinical manifestation,and 3 cases were found by medical examination.Follw-up was conducted in 9 cases from 2 to 66 months,and results showed that 6 cases had no evidence of disease,recurrence appeared in 3 cases and 2 of them died of the disease.Histologically,all of 12 cases of clear cell renal cell carcinoma with papillary architecture had papillary architecture in common,there were primary papillary architectures that were micropapillary composed of turmor cells,tubulopapillary,papillary with fibrovascular cores,and secondary papillary architectures that were the outcome of necrosis,cystic change,and artifact.Immunohistochemical staining for CK,CD10,AMACR,CK7,vimentin,CD117,and TFE3 was valuable for diagnosis.Conclusions Clear cell renal cell carcinoma with papillary architecture has its own morphological and immunohistochemical features,which are with great value in clinicopathological diagnosis.