肾常见上皮性肿瘤53例免疫表型及胶状铁染色的研究

Immunophenotyping and colloidal iron staining of common renal epithelial tumors

目的研究肾嗜酸细胞腺瘤和肾细胞癌(RCC)的免疫表型特征及胶状铁染色情况。方法收集肾嗜酸细胞腺瘤9例、嫌色性肾细胞癌(ChRCC)12例、乳头状肾细胞癌(PRCC)Ⅰ型8例、PRCCⅡ型和透明性肾细胞癌(CCRCC)各12例,共53例,观察组织学特征,并检测免疫组化表达情况和胶状铁染色结果。结果 CK阳性染色在肾嗜酸细胞腺瘤定位于胞质,在ChRCC、PPCC和CCRCC定位于胞膜。CD10阳性染色在肾嗜酸细胞腺瘤和ChRCC定位于胞质,在PRCC和CRCC则定位于胞膜。结论①肾嗜酸细胞腺瘤和ChRCC的免疫表型及胶状铁染色结果有差别,这些差别可以帮助二者鉴别诊断。CK(-)或胞质(+)、CK7和胶状铁染色(-)支持肾嗜酸细胞腺瘤,而CK胞膜(+)、CK7(+)和胶状铁染色(+)支持ChRCC。②ChRCC、PRCC和CCRCC的免疫表型和胶状铁染色结果不同,这些差异可实现三者之间的鉴别。CK7和CD117(+)、CD10(-)或胞质(+)、vimentin和Rcc.ma(-)及胶状铁染色(+)支持ChRCC;CK7和CD117(-)、CD10胞膜、vimentin和Rcc.ma(+)及胶状铁染色(-)支持PRCC或CCRCC。③CCRCC和PRCC的免疫表型基本相同,而CD15(+)支持CCRCC。④PRCC-Ⅰ型和Ⅱ型的免疫表型基本相同,而CK7(+)支持PRCC-I型。多数情况下,单凭组织形态学就能做出上述4种肿瘤的病理诊断,因此组织形态学仍然是基础,而免疫组化和胶状铁染色只是辅助鉴别手段,用于少数形态学诊断困难的病例。

Objective To explore the immunohistochemical features and results of colloidal iron staining in renal oncocytoma and renal cell carcinoma（RCC）.Methods Nine cases of renal oncocytoma,12 chromophobe RCC（ChRCC）,8 papillary RCC（PRCC）-Ⅰ,12 PRCC-Ⅱand 12 clear cell RCC（CCRCC）were collected.Histological characteristics were observed.Immunohisto-chemistry for CK,CK7,CK20,CD10,CD15,CD117,vimentin（Vim）,E-cadherin（E-cad）,Rcc.ma and colloidal iron staining were performed on all cases.Results CK expression was observed in the cytoplasma of renal oncocytoma and the membrane of ChRCC,PRCC and CCRCC.CD10 expression was observed in the cytoplasma of renal oncocytoma and ChRCC and the membrune of PRCC and CCRCC.Conclusions The immunohistochemical features and results of colloidal iron staining in renal oncocytoma and ChRCC were different,which could differentiate renal oncocytoma from ChRCC.Membrane,expression of CK7 and positive pattern of colloidal iron staining supported ChRCC.The immunohistochemical characteristics and results of colloidal iron staining in ChRCC,PRCC and CCRCC could be used to differentiate ChRCC from PRCC or CCRCC.Expression of CK7,CD117 and positive results of colloidal iron staining supported ChRCC.Membrane expression of CD10,expression of Vim and Rcc.ma supported CCRCC.Although the immunohistochemical features of PRCC and CCRCC were almost identical,expression of CD15 supported CCRCC.Although the immunohistochemical features in types Ⅰ and Ⅱ of PRCC are almost identical,expression of CK7 supports type I of PRCC.For majority of these tumors,morphological characteristics are the basis of pathological diagnosis.Only some difficult cases with atypical morphology depend on the immunohistochemical features and result of colloidal iron staining.