嗜酸性实性囊性肾细胞癌4例临床病理分析

Eosinophilic solid and cystic renal cell carcinoma: clinicopathologic analysis of four cases

目的探讨嗜酸性实性囊性肾细胞癌(eosinophilic solid and cystic renal cell carcinoma,ESC RCC)的临床病理学特征及其分子机制。方法采用免疫组化法检测4例ESC RCC中不同抗体的表达,分析其临床特点、病理学形态、诊断及鉴别诊断、预后,并复习相关文献。结果4例ESC RCC患者均为女性,中位年龄66岁。镜下肿瘤组织主要由胞质红染的嗜酸性细胞构成,实性区腺管状排列,其内可见微囊和巨囊性区域,可见胞质内嗜碱性或嗜酸性粗细不等的颗粒状彩斑。免疫表型:肿瘤细胞表达PAX8和CK20,可出现Melan-A和Cathepsin K的表达,不表达CK7、CD117。2例获得随访,生存时间2~26个月。结论ESC RCC具有独特的临床病理学特征,组织学形态较为典型,免疫组化检测可明确诊断,患者预后良好。

Purpose Eosinophilic solid and cystic renal cell carcinoma(ESC RCC)is a newly recognized renal tumor.The purpose of this study is to describe the clinicopathological features and research progress of ESC RCC.Methods Immunohistochemical method was used to detect the expression of different antibodies in 4 ESC RCC cases.The clinical features,histologic findings,diagnosis,differential diagnosis and prognosis were analyzed,and the revelant literatures were reviewed.Results All the 4 patients with ESC RCC were female,and none of them had the clinical features of tuberous sclerosis complex.The median age was 66 years old.The neoplastic cells had abundant eosinophilic cytoplasm.The solid pattern was arranged in a tightly compact acinar growth.Microcystic and macrocystic patterns could be seen within the tumor.The most characteristic features were the fine or coarse cytoplasmic stippling(basophilic to purple cytoplasmic granules).Immunohistochemical staining showed that tumor cells expressed PAX8 and CK20,and the expression of Melan-A and Cathepsin K was detected,but no CK7 and CD117.The overall survival of 2 patients was 2-26 months.Conclusion ESC RCC has unique clinicopathological characteristics with typical morphology.Immunohistochemistry can be helpful to confirm the diagnosis,and the tumor has an indolent clinical course.