肾黏液样小管状和梭形细胞癌临床病理学观察

Clinicopathologic analyses of mucinous tubular and spindle cell carcinoma of the kidney

目的:探讨肾黏液样小管状和梭形细胞癌(mucinous tubular and spindle cell carcinoma,MTSCC)的临床病理学特征、鉴别诊断、起源、治疗及预后。方法:观察1例MTSCC的临床病理学特征及应用Elivision法进行免疫组织化学检测,同时术后随访相关情况。结果:镜下瘤组织主要由上皮样细胞呈狭长小管状、索状排列和弥漫的梭形细胞几种结构紧密排列在黏液样基质中构成,部分迷路乳头状结构,梭形细胞区较少,似平滑肌瘤。瘤细胞形态温和,异型性小,核圆形或卵圆形,核仁不明显,核分裂象罕见。免疫组织化学检查瘤细胞CK、vimentin+,CD10、CD15-,CK34βE12、CK7、CK19在迷路样区域+,在索状、小管状区域-,迷路样区域Ki-67指数最高,达4%。患者行肿瘤及部分肾切除术,术后未行特殊治疗,随访5个月,无复发和转移。结论:MTSCC是肾原发性罕见低度恶性肿瘤,来源不定,可能起源于多种组织。肿瘤局部切除的预后不确定。

Objective： To explore the clinicopathologic features, differential diagnosis, the origin, treatment and prognosis of renal mucinous tubular and spindle cell carcinoma （MTSCC）. Method：The clinicopathologic characteristics of one case were observed, and immunohistoehemical detection was done by Elivision. Moreover, the postoperative and follow-up data were studied. Result： Microscopically MTSCC was leiomyoma-like and composed of elongated tightly packed tubules, funicular structures and spindle cells, which were neatly arranged in abundant mucinous matrix. Focally daedaleous and papillary arrangement also appeared. Tumor cells were of low nuclear grade and absent or inconspicuous nucleoli. Mitotic figures were rare. Immunohistochemieal staining showed that the tumors were positive for CK, vimentin and negative for CD10, CD15. Moreover, we could find that CK3413E12, CK7, CK19 were positive in the daedaleous and papillary area and negative in the region of the funicular and tubular area. Ki-67 index was the highest and up to 4% in the daedaleous and papillary area of the whole tumor. The patient underwent tumor resection and partial nephrectomy and didn＇t receive other special postoperative treatments. No recurrence or metastasis was found over follow up period of five months. Conclusion： MTSCC is a rare low-grade malignant tumor in the kidney primary turnout, and it probably originates from a variety of tissues. The prognosis of local excision of the turnout is uncertain.