肾嗜酸细胞瘤和嫌色性肾细胞癌的临床病理分析与比较

Analysis and comparison of clinical pathology between renal oncocytoma and chromophobe renal cell carcinoma

目的：探讨并比较肾嗜酸细胞瘤（renal oncocytoma,RO）和嫌色性肾细胞癌（chromophobe renal cell carcinoma,CRCC）的临床病理特征、诊断和治疗方法及预后特点。方法：回顾性研究2013~2016年收治的20例RO及25例CRCC患者的临床资料,结合影像学资料、肉眼与光镜观察以及免疫组织化学染色,统计分析两者临床病理特征的差异。结果：影像学中出现典型星状瘢痕或坏死钙化灶有助于鉴别RO与CRCC,差异有统计学意义（P〈0.05）;统计分析EMA、Vimentin、CD10、CK7、CD117、Claudin-7在RO与CRCC组织中的表达情况,发现CK7、Claudin-7在RO与CRCC中表达差异有统计学意义（P〈0.05）,可作为鉴别指标;RO患者术后随访3~49个月,未发现复发和转移。CRCC患者随访2~40个月,2例术后1年出现转移灶后死亡。结论：根据两种肿瘤的临床、影像学方面的差别,术前可进行鉴别诊断,但确诊仍需病理学诊断。两者在形态学方面各有特征,免疫表型相似,预后较好,手术切除后极少发生复发和转移。其鉴别诊断主要在于细胞学特征及免疫组织化学标记,对手术选择及术后治疗均有很大意义。

Objective：To study and compare the clinicopathological features,diagnosis,treatment and prognosis between renal oncocytoma（RO）and chromophobe renal cell carcinoma（CRCC）.Method：From 2013 to 2016,20 cases of RO and 25 cases of CRCC were retrospectively studied.Results of gross and light microscopic observation,immunohistochemical staining and other imaging data were used to detect the difference of clinicopathological features between RO and CRCC.Result：The typical imaging stellate scar or necrosis calcification help for identifying RO and CRCC,and the difference was statistically significant（P〈0.05）.Typical histologic features can identify them.Statistical analysis of EMA,Vimentin,CD10,CK7,CD117,Claudin-7 found that the expression difference of CK7 and Claudin-7 were statistically significant（P〈0.05）between RO and CRCC,which can be used as identification index.After being followed up for 3-49 months,20 cases of RO weren＇t found recurrence or metastasis.After being followed up for 2-40 months,two patients died of postoperative metastases in 25 cases of CRCC.Conclusions：Differential diagnosis could be done before operation according to the difference in clinic and imageology between two cancers,but definite diagnosis relys on pathology.Two cancers have unique morphological features respectively and share similarity in immunophenotype.Differential diagnosis is based on the cytological features and IHC.Accurate diagnosis has a great significance in operation selection and postoperative treatment.