肾嗜酸细胞腺瘤的诊断(附九例报告)

Renal oncocytoma (report of 9 cases)

目的提高肾嗜酸细胞腺瘤的临床诊断及鉴别诊断水平。方法回顾９例肾嗜酸细胞腺瘤患者的临床及ＣＴ检查资料，对肿瘤标本行光镜和电镜观察，应用免疫组化ＬＳＡＢ法检测Ｃｙｔｏｋｅｒａｔｉｎ８（相对低分子质量角蛋白）和Ｖｉｍｅｎｔｉｎ（波型蛋白），并与肾细胞癌相鉴别。结果ＣＴ增强扫描后肿瘤密度均匀一致，瘤体中央可见星状低密度区是该瘤的主要特征。病理组织学：肉眼观察肿瘤质均、无坏死、呈红棕色，部分肿瘤有中心瘢痕；光镜下胞浆强嗜酸性，粗颗粒，巢状或实片状排列，无坏死，无核分裂像或核分裂像罕见；Ｃｙｔｏｋｅｒａｔｉｎ８阳性，Ｖｉｍｅｎｔｉｎ阴性；电镜下有多量粗大线粒体。结论肾嗜酸细胞腺瘤是一种肾脏良性肿瘤，其ＣＴ影像特征有助于术前诊断。根据其组织学改变、免疫组化及电镜特点，可与胞浆嗜酸性肾癌鉴别。

Objective To present 9 cases of renal oncocytoma and its characteristic features. Methods The clinical data of the 9 cases including CT scan,light and electromicroscopic features and immunohistochemical studies for cytokeratin 8 and vimentin were reviewed. Results Homogeneous attenuation with a central,marginated stellate area of low attenuation after intravenous contrat medium has been the charateristic feature of renal oncocytoma on CT scan.The tumor has been grossly homogenous and red brown in color with no necrosis.Central scarring might be present in some cases.On light microscopy,there was strong eosinophilic cytoplasm with coarse granules,the tumor cells being nested or compact in patern with no necrosis and very rare or no mitosis.The cytokeratin 8 has been positive,whereas vimentin was negative.Enormous mitochondria was noted on electromicroscopy. Conclusions Renal oncocytoma is benign,its differentiation from renal carcinoma being clinically important.A preoperative diagnosis could be made with the aid of CT scan.The diagnosis could be further established on microscopic and immunohistochemical studies.