肾上腺皮质癌6例临床病理分析

Clinicopathologic features of adrenal cortical carcinoma

目的探讨肾上腺皮质癌的临床病理学特征、诊断及鉴别诊断、治疗与预后。方法对6例肾上腺皮质癌进行临床资料、病理形态及免疫组化分析。结果肾上腺皮质癌6例,女性4例,男性2例,年龄23~60岁,平均53岁;功能性3例,无功能性3例。镜下可见瘤细胞异型明显,多边形,细胞质丰富,大部分嗜酸,核染色质呈粗颗粒状,可见核分裂象;瘤细胞呈巢、片状生长,可见侵犯包膜。免疫组化:肿瘤细胞melan-A、inhibin-α和p53(+),Cg-A(-),其中2例MSH2、MSH6(-),MLH1、PMS2(+)。结论肾上腺皮质癌的诊断,应将临床和病理形态学特征相结合,免疫组织化学具有重要的鉴别诊断作用。提高对肾上腺皮质癌的认识,对避免误诊是至关重要的。

Objective To explore the clinicopathologic characteristics, diagnosis and differential diagnosis, prognosis and treatment of adrenal cortical carcinoma. Methods Clinical data, pathological changes and immunohistochemical staining were observed in 6 patients with adrenal cortical carcinoma. Results There were six cases including four women and two men, aged from 23 to 60 years, average age of 53 years; 3 cases were functioning and 3 cases were nonfunctioning. Microscopic examination showed that the tumor cells were polygonal, rich and eosinophilic cytoplasm, and coarse granular nuclear chromatin; tumor cells arranged in nests or sheets and invaded into the capsule. Immunohistochemical staining showed that tumor cells positively expressed Melan-A, inhibin - c~ and p53, negatively expressed Cg-A; two of them negatively expressed MSH2 and MSH6, and positively expressed MLH1 and PMS2. Conclusion The diagnosis of adrenocortical carcinoma is based on clinical features and main histopathologic architectural changes. Immumohistochemical staining may be helpful in diagnosis and differential diagnosis of adrenocortical carcinoma. It is essential to enhance awareness of pathological characteristics of adrenal cortical carcinoma to avoid misdiagnosis.