拟似黏液性小管状和梭形细胞癌的乳头实性状肾细胞癌2例报道及文献复习

The solid papillary renal cell carcinoma: a report of 2 cases and review of the literature

目的:探讨实性乳头状肾细胞癌(s PRCC)临床病理特点及其与黏液性小管状和梭形细胞癌(MTSC)鉴别。方法:对2例s PRCC进行光镜、特殊染色、免疫组织化学染色及荧光素原位杂交(FISH)检测,并复习临床资料及相关文献。结果:2例s PRCC均为男性,年龄分别为50岁和71岁,例2临床表现为腰痛。肿瘤长径分别为2.0 cm、3.5 cm,切面灰白色与周围肾实质界限清晰,例2局部伴出血、坏死。组织学上2例瘤细胞均呈圆形或卵圆形,排列成管状,部分区域瘤细胞相互挤压形成实性片状,例1部分区域瘤细胞排列成梁状,肿瘤边缘见少量乳头状结构,但无脉管轴心,间质内含少量黏液及砂粒体样钙化小体;例2间质内见泡沫细胞聚集,实性片状区域黏液性间质明显。免疫表型:2例均表达AMCAR、CK7、CK19、EMA、vimentin等,Ki-67<5%。FISH结果显示2例均有7号、17号染色体扩增及Y染色体丢失。结论:s PRCC为罕见的乳头状肾细胞癌亚型,形态学及免疫组织化学与MTSC有较多重叠性,常难以区分,FISH检测可有效帮助鉴别。

Objective：To investigate the clinicopathological characteristics of the solid papillary renal cell carcinoma（ sPRCC）, and its differential diagnosis from mucinous tubular and spindle cell carcinoma（MTSC）. Methods：Two sPRCC cases were investigated by light microscopy, special stains, immunohistochemistry, fluorescence in situ hybridization （ FISH）, and the literature was reviewed. Results ： Two sPRCC patients were male,51 and 71 years old, the lumbago was their clinical manifestation. The tumor size of two cases were 2.0 cm and 3.5 cm, the cut surface of tumors were grayish-white, well-circumscribed, and local hemorrhage and necrosis. Histological examination of two tumors showed that the tumor ceils were cuboidal or oval and arranged in tubular pattern, and the part cells tightly packed and arranged in solid sheet. The partial region tumor cells in 1 case arranged in beam, a small amount of papillary structures without vascular axis were found in tumor margin, and a small amount of slime and sand body calcification corpuscle were found in intercellular substance. Foam cell aggregation and mucous mesenchyme in intercellular substance were found in another case. The positive expressions of AMACR,Vimentin,EMA, CK7 and CK19 were found in two cases, and the Ki-67 was less than 5%. FISH showed that chromosomes 7 and 17 amplified, and chromosomes Y lost in two cases. Conclusions ：The sPRCC is rare papillary renal cell carcinoma, the morphology and immunohistochemistry of which are similar with MTSC. The FISH examination can effectively identify the sPRCC from MTSC.