未分类肾细胞癌10例临床病理分析

Unclassified Renal Cell Carcinoma：An Analysis of I0 Cases

目的 探讨未分类型肾细胞癌（URCC）的临床病理特征,以提高对其认识.方法 收集2001年～2009年苏州大学附属第一医院常规外检肾细胞癌（RCC）422例,对10例未分类型肾细胞癌,作光镜和免疫组化染色观察,结合临床资料进行分析.结果 10例URCC患者年龄55～81岁（平均年龄67岁）,男性5例,女性5例,肿瘤最大径6～12cm（平均直径8cm）,5例伴有肾包膜侵犯,2例伴有肾门淋巴结转移,1例伴有远处肺转移.组织学：各例均未伴有透明细胞癌,乳头状癌,嫌色细胞癌,集合管癌等细胞学特征,10例肿瘤瘤细胞均显示出多形性,部分区域排列成腺管状,滤泡状,条索状,或呈实性片状,可见梭形瘤细胞区域及瘤巨细胞.瘤细胞胞浆丰富,核仁明显.同时伴有不同程度的出血、坏死.免疫组织化学：瘤细胞均Vimentin（＋）,CK、EMA、CD10、CK7部分阳性,CK20、34βE12均阴性,P53阳性率30%～70%.随访8例,均死亡.结论 未分类肾细胞癌为目前现有WHO组织学标准难以分类的一组肾细胞癌,具有形态的多形性及临床高侵袭性特点,预后多不佳.其发病率低,文献资料少,尚有待于更大样本的临床病理及分子遗传学研究总结.

Objective To study the clinicopathological features and diagnosis of the unclassified renal cell carcinoma（URCC）. Methods Ten cases of URCC collected during the period from 2001 to 2009 were enrolled into study.The clinical data were retrospectively analYzed.Histopathological and immunohistochemical changes of the tumors were also observed in the paraffin-embedded tissue samples. Results In 10 cases,5 were male and 5 females.Ages of the patients ranged from 55 to 81 years old（median,67 years）.Tumor size varied from 6 to 12 cm（median,8cm）.Five patients showed evidence of perinephric invasion.Two patients presented with regional lymph node metastases and one patient showed distant metastases the lung.Histologically,tumor cells were not have the features of the clear cell carcinoma,the papillary renal cell carcinoma or collectingductcarcinoma,they showed pleomorphtic feaures,formed glandular, alveolar and cordly, or showed solid pattern.Some tumors appeared spindle and gaint shape with abundant cytoplasm,eccentric nuclei,necrosis and hemorrhage were also found in 10 cases.Immunohistologically,the tumors cells were positive for vimentin（10/10）,CK（3/10）,EMA（6/10）,CD10（4/10 ）,CK7（!/10）,negative for CK20（0/10） and 3413E12（0/10）,and P53 was strongly positive. Conclusions URCC was a rare type of renal cell carcinoma,with advanced stage and poor prognosis,and needed lager samples and further clinicopathological study in the future.