甲状腺滤泡癌样肾细胞癌临床病理观察

Thyroid fonicular carcinoma-like tumor of kindney: a case report and literature review

目的探讨甲状腺滤泡癌样肾细胞癌(TLFCK)的临床病理特点、免疫表型及鉴别诊断。方法对1例TLFCK进行临床病理分析及免疫组化研究,并进行文献复习。结果肿瘤为境界清楚灰白色肿块,最大直径3 cm。镜下肿瘤周围有一层纤细的假包膜,90%区域的肿瘤细胞排列成甲状腺滤泡样,局灶实性。免疫组化:肿瘤细胞CKpan、CK19和PAX-2弥漫(+),vimentin散在(+),而TG、TTF-1、WT-1、CD10、Cg A、CD56和villin均(-)。术后随访1年半,无复发及转移。结论 TLFCK是一种罕见类型的肾癌,诊断主要依据病理学形态和免疫组化,需要与转移性甲状腺癌、神经内分泌癌、恶性畸胎瘤、上皮型肾母细胞瘤鉴别。

Objective To investigate the clinicopathological features,immunophenotype and differential diagnosis of thyroid-like follocular carcinoma of the kidney（ TLFCK）. Methods A case of TLFCK was analyzed with conventional histopathological and immunohistochemical stains,and the relative literatures were reviewed. Results The tumor showed a well-demarcated mass in gross appearance that measured 3 cm in greatest diameter. Microscopically,the tumor had a thin fibrous capsule and was composed of a predominant thyroid-like follicular pattern（ 90%） with solid areas.Immunohistochemical staining showed tumor cells were diffusely positive for CKpan,CK19,PAX- 2,sparsely posivitve for vimentin,but negative for TG,TTF- 1,WT- 1,CD10,Cg A,CD56 and villin. No tumor recurrence or metastasis were observed after 18 months of postsurgery follow-up. Conclusions TLFCK is a rare subtype of renal cell carcinoma. The diagnosis of TLFCK mainly relies on histopathological and immunohistochemical finding. Differential diagnosis includes metastastic thyroid cancer,neuroendocrine carcinoma,malignant teratomas and epithelial patterns nephroblastoma.