肾嗜酸细胞腺瘤5例报告

Renal oncocytonui (A report of 5 cases)

目的 提高肾嗜酸细胞腺瘤的诊治水平。方法 回顾性分析1995～2000年收治的5例肾嗜酸细胞腺瘤病人的临床表现、影像学、病理学、免疫组化及随访资料。结果 5例中4例术前误诊为肾癌或肾盂癌行肾切除术,1例术中证实为良性肿瘤行肿瘤剜除术。临床无特异。该肿瘤CT扫描密度均匀一致,瘤体中央有星状结构为其特征,但MRI在诊断小于5cm的病变时优于CT。肉眼观察瘤体边界清楚,切面呈红褐色,均质状、无出血及坏死灶。光镜下瘤细胞排列成腺泡状或管状,胞浆含丰富的嗜酸性细颗粒,细胞无明显异型性和核分裂像。电镜下胞浆内见大量线粒体。免疫组化染色:Cytokeratin(+),EMA(+),Vimcntin(-)。结论 肾嗜酸细胞腺癌是一种良性实质性上皮肿瘤,其影像学特征有助于术前诊断,依据病理组织学、免疫组化及电镜特点,可与肾癌鉴别。

Objective To improve the diagnosis and treament of renal oncocytoma. Methods The clinical data of 5 cases with renal oncocytoma from 1995 to 2000,including imaging, pathology, immunohistochemnical and follow- up was retrospectively analyzed. Results The clinical finding of the disease is not characteristic.4/5 was misdiagnosed to renal cancer or pyelic cancer, and ncphrectmy was performed. One of them was demonstrated as benign tumor during operation and tumor resection was performed. Homogeneous attenuation with a central , marginated stellate area was the characteristic feature of renal oncocytoma on CT scan,but when the tumor was smaller than 5cm, the effect of MRL was superior to CT. On light microscopy,there was strong cosinophilic cytoplasm with granules,the Tumor cells being tubular or adenoid in patern with no necrosis and very rare or no mitosis. Enormous mitochondria was noted on electromi-croscopy.Thc cytokcratin and EMA have been positive, whereas vimentin was negative. Conclusions Renal oncocy-tonva is benign,its differentiation from renal carcinoma is clinically important.The diagnosis could be further established on microscopic and immunohistochcmical studies.