肾血管平滑肌脂肪瘤120例临床病理分析

Clinico-pathological analysis of 120 cases of renal angiomyolipoma with emphasis on follow-up

目的探讨肾血管平滑肌脂肪瘤(AML)病理形态学特点与恶性生物学行为的相关性。方法回顾性分析120例AML的相关病理形态学因素,将所有病例分为经典型、上皮样型伴或不伴有异形性三组,分别随诊。χ2检验比较三组间形态学的差异。结果 120例中,经典型为94例(78.3%);上皮样型为26例(21.7%),其中,伴异形性10例(8.4%)。上皮样型AML的核仁、核分裂相、多核巨细胞和出血特征显著多于经典型(P<0.01)。伴异形性的上皮样AML的细胞核异型性即核仁和病理性核分裂相显著高于无异形性的上皮样AML(P<0.01)。120例病例中随诊104例,仅1例根治性肾切除术后1年出现肝脏转移;其余病例均未发现复发或转移。结论肾脏AML以经典型良性为主,近1/3为上皮样型。上皮样AML中仅少数具有明显细胞核异型性的病例可能具有恶性生物学行为。

Objective To highlight clinical pathological features of renal angiomyolipoma（AML）and their prognostic significance by follow-up.Methods 120 AMLs between 1981-2010 were retrospectively analyzed and classified into three subtypes：classical,epithelioid with atypia,and epithelioid without atypia.χ^2 test was performed to clarify significance of the specially pathological findings among the classical and epithelioid subtypes with or without atypia.Results All 120 AMLs were classified into classical and epithelioid with or without atypia.The classical AMLs were 78.3%（94/120）,epithelioid AMLs（EAMLs）were 21.7%（26/120）,of which 10 were with atypia（8.4%,10/120）.EAMLs had more obvious mitosis,hemorrhage,and multinucleated giant cells than classical ones（P0.05）.EAMLs with atypia had more nucleoli and mitosis than EAML without atypia（P0.05）.Follow-up results of 86.7%（104/120）cases were obtained,and only one（0.8%,1/120）presented liver metastasis one year after nephrectomy.Conclusion Few AMLs and EAMLs are malignant.EAMLs with atypical nuclear features including nucleoli and atypical mitosis may possess malignant behavior.