肾脏黏液样小管状和梭形细胞癌临床病理分析

Mucinous tubular and spindle cell carcinoma of kidney: a clinicopathologic analysis

目的探讨肾脏黏液样小管状和梭形细胞癌(MTSCC)的临床病理学特征、诊断、鉴别诊断、治疗及预后。方法回顾性分析4例MTSCC的临床资料,进行组织病理形态学和免疫组化观察,并复习相关文献。结果 4例患者中男女各2例;年龄58~74岁,平均65岁;1例出现肾区疼痛,余3例无症状;肿瘤直径2~13 cm,平均直径6 cm;肿瘤界限清楚,镜下以具有管状结构、梭形细胞区和黏液样间质为特征,肿瘤细胞核级别低,细胞异型性小。术后随访平均34. 5月,均未发现复发和转移。免疫组化显示4例患者CK7、vimentin均弥漫(+);CK8、CK18、CK19、EMA、CD117不同程度(+);Ki-67呈低表达;而CD10、Villin均(-)。结论 MTSCC属于罕见的肾脏低度恶性肿瘤,具有特殊的临床病理学特征,预后较好。

Objective To investigate the clinicopathological features,diagnosis,differential diagnosis,treatment and prognosis of mucinous tubular and spindle cell carcinoma ( MTSCC) of kidney. Methods The clinical data of 4 cases of MTSCC were analyzed retrospectively,histopathological changes and immunohistochemical findings were reviewed,and related literatures were also reviewed. Results Of the 4 patients,two were male and two were female. The average age wass 65 years,ranged from 58 to 74 years. 1 cases had pain in the renal area and the remaining three had no symptoms. Tumors ranged in diameter from 2 ~ 13 cm,with an average diameter of 6 cm. The tumor boundary was clear,with tubular structure,spindle cell region and mucinous stroma under microscope. The tumor had a low nuclear level and low cell heterogeneity. After an average follow - up of 34. 5 months,no recurrence and metastasis were found and all survived. Immunohistochemistry showed that all 4 patients were diffuse expression of CK7 and vimentin,and expressed CK8,CK18, CK19,EMA and CD117 in different degrees. Ki67 showed low expression,while CD10 and Villin were negative. Conclusion MTSCC is a rare renal low-grade malignant tumor. It has special clinicopathological characteristics. Prognosis is good.