甲状腺滤泡癌样肾肿瘤一例报告并文献复习

Clinicopathological study of thyroid follicular carcinoma-like renal tumor

目的探讨甲状腺滤泡癌样肾肿瘤的临床病理特点、免疫表型和鉴别诊断。方法患者，女，25岁。因高血压20个月，体检发现右肾占位性病变，于2011年2月28日入院。血压200／130mmHg（1mmHg=0．133kPa），甲状腺、心肺、腹部检查均未见异常，肾区无叩击痛。血尿常规、生化常规、血儿茶酚胺类物质、甲状腺功能指标检查结果均正常。CT检查示右肾上极类圆形结节灶，边界清晰，最大截面积为2．2em×3．0cm，密度不均，肾动脉受压下移。临床诊断为右肾肿瘤。全麻下行右肾肿瘤剜除术。术中见肿瘤位于右肾门上前内侧，边界清楚，与周围轻度粘连。手术完整剜除肿瘤组织及其包膜。术后患者血压降至正常。结果病理检查：圆形肿物1个，直径2．5cm，包膜完整，切面灰红灰白色，见多个小囊腔，囊内含胶冻状物。镜下：肿瘤组织排列成甲状腺滤泡样，滤泡腔内含有丰富的嗜酸性胶质。免疫组化染色：EMA、Vimtin、CK7、CK20均为阳性，CD117、TTF－1、TG、CgA、Syn均为阴性。病理诊断：甲状腺滤泡癌样肾肿瘤。术后随访1年，肿瘤无复发或转移。结论甲状腺滤泡癌样肾肿瘤是一种十分罕见的肾上皮细胞肿瘤，目前尚未归属于任何已知的肾细胞癌亚型，提高对这一肿瘤的认识可避免误诊和不适当的治疗。

Objective To investigate the features of clinical pathology, phenotye and differential diagnosis of thyroid follicular carcinoma-like renal tumor. Methods A 25-year-old female patient was hospitalized in February 28, 20il because of hypertension for 20 months. Physical examination revealed a right renal space-occupying lesions without percussion pain. Blood pressure was 200/130 mm Hg （ 1 mm Hg = 0. 133 kPa）. Thyroid, heart, lung, and abdominal examination showed no abnormalities. Blood, urine rou- tine, biochemical examination, blood catecholamines, and thyroid function test results were normal. CT examination showed that a visible circular nodules with clear boundary was in the upper pole of the right kidney, and the maximum section about 2.2 cm ×3.0 cm withuneven density andrenal artery was pressed down. Clinical diagnosis was right renal tumor, and right renal tumor was removed under general anesthesia. Intraoperative tumor was located in the right renal hilumwithclear boundary, and the surrounding mild adhesions. Postoperative blood pressure wasnormal. Results General inspection of the specimen：a 2.5 cm diametermasswith intact capsule. The color of the section of the mass is gray red and gray. Multiple small cysts are seen in the section and the cysts contain jelly material. Microscope inspection： the tumor tissue is arranged like thyroid follicular and the follicular contains much acidophil colloid. Immunohistochemistry： the tumor cell is EMA （ ＋ ）, Vimtin （ ＋ ）, CK7 （ ＋ ）, CK20 （ ＋ ）, CDll7（-）, TTF-1 （-）, TG （-）, CgA （ - ）, Syn （ - ）. Conclusions Thyroid follicular carcinoma-like renal tumors is a very rare kidney epithelial cell tumor, which is attributable to any known subtypes of renal cell carcinoma. To improve the understanding of it can avoid misdiagnosis and prevent inappropriate treatment.