肾脏转移性腺样囊性癌1例临床病理分析

Renal metastatic adenoid cystic carcinoma:a clinicopathologic analysis of 1 Case

目的:阐明肾脏转移性腺样囊性癌临床病理特点。方法:回顾性分析1例肾脏转移性腺样囊性癌的临床表现、组织学和免疫组织化学及超微结构特点。结果:右侧腮腺腺样囊性癌根治术后13年发生肾脏转移,肿瘤位于左侧肾脏上极,切面灰白、细腻、质中,与周围组织分界清楚。组织学显示瘤细胞由腺上皮细胞和肌上皮细胞两种细胞构成,肿瘤组织呈条索状、腺囊状或筛网状排列,囊腔内充以嗜碱性黏液样物质,局部可见瘤栓及神经束侵犯。免疫组化结果显示两种肿瘤细胞vimentin阳性;腺上皮细胞CD117阳性;肌上皮细胞actin、p63、34βE12阳性。电镜显示瘤细胞间具有腺腔,瘤细胞巢周围有完整或不完整的基板。结论:腺样囊性癌是一种生长缓慢的恶性上皮性肿瘤,易复发和远处转移,甚至可以转移至肾脏,对此类肿瘤患者应进行长年随访观察。

Objective：To investigate the clinicopathological characteristics of the renal metastatic adenoid cystic carcinoma（ACC）. Methods：Clinical manifestations, histological, immunohistochemical and ultrastructural features of the renal metastatic ACC patient were analyzed retrospectively. Results ：The right parotid ACC which was radical resected thirteen years ago metastasized to left kidney. The tumor located at the upper pole of left kidney was gray in cross-section, fine and moderately in texture. It was well -circumscribed mass. Histological features showed the tumor was consisted of glandular epithelial cells and myoepithelial cells. These cells were arranged in cord - like, glandular cystic or sieve - like pattern. The cysts were filled with basophilia mucus - like substance. Tumor tissue infiltration was observed in local blood vessels and nerve bundles. Immunohistochemistry showed two type ceils were positive for Vimentin. CD117 was positive expression in glandular epithelial cell mainly, p63, actin and 34βE12 were positively expressed in myoepithelial cell mainly. Ultrastructural examination revealed that there were glandular cavities between neoplastic cells, and complete or incomplete basal lamina around nests of neoplastic cells. Conclusion： ACC is a slow -growing malignant epithelial tumor. It often recurs and distant metastasizes,even metastasized to kidney. The cautious and careful long - term follow - up should be recommended.