肾上腺皮质嗜酸细胞腺瘤临床病理观察

Clinicopathological observation of adrenocortical oncocytoma

目的探讨肾上腺皮质嗜酸细胞腺瘤的临床病理特征和诊断要点。方法分析8例肾上腺皮质嗜酸细胞腺瘤的临床资料,观察其组织学形态及免疫表型特征,并复习相关文献。结果8例患者,3名女性5名男性,6例患者均为体检时偶然发现,无明显临床症状,肾上腺占位术后标本病理检查结果示:镜下肿瘤细胞边界清楚,有明显的包膜,排列呈巢状、梁状或腺泡状,周围包绕纤细的血窦样毛细血管网。肿瘤间质内可见少量成熟淋巴细胞浸润。肿瘤细胞由明显胞浆嗜酸性的大细胞组成,少数肿瘤细胞局部胞浆透亮,富含脂质,有时可见嗜酸性核内假包涵体和脂褐素。局部区域偶见怪异核细胞,核分裂罕见。免疫组织化学表型:CD56及Syn、MelanA、α-inhibin阳性,PCK灶状阳性,CgA、S-100阴性,Ki67增殖指数约为2%;特殊染色:网状纤维染色示肿瘤细胞巢状结构存在。结论肾上腺皮质嗜酸细胞瘤是一种罕见的肾上腺皮质良性肿瘤,大多数表现为无功能的腺瘤。手术切除仍然是主要的治疗方法。这种疾病可以作为良性肿瘤来治疗,SS预后尚可。

Objective To investigate the clinicopathological features and diagnosis of adrenocortical oncocytoma. Methods The clinical data of 8 cases of adrenocortical oncocytoma were analyzed. The histological and immunophenotypic features were observed and the related literatures were reviewed. Results 8 patients, including 3 females and 5 males, were collected in our hospital. 6 patients were found accidentally during physical examination without obvious clinical symptoms. Pathological examination of adrenal tumor resected by surgery showed that under the microscope, the tumor was with clear boundary and obvious envelope. The tumor cells were arranged in nest-like, alveolar-like and cord-like structure and surrounded by fine sinusoid-like capillary network. A small amount of mature lymphocyte infiltration was observed in the tumor interstitium. Tumor cells were composed of large cells with dense eosinophilic cytoplasm. Local areas of pale-staining clear cells with a lipid-filled cytoplasm were identified but in rare tumor cells, in which eosinophilic nuclear pseudoniclusion bodies and lipofusion pigmentation were also detected. Tumor cells with bizarre nuclei forms were occasionally seen in partial areas, but no obvious mitotic figures and necrosis were observed. Immunohistochemical staining showed that tumor cells were positive for CD56, Syn, MelanA, α-inhibin, and occasionally positive for PCK, while negative for S-100 and CgA. Ki67 proliferation index was about 2%. Reticulin staining demonstrated nested architecture. Conclusion Adrenocortical oncocytoma is a rare adrenocortical benign neoplasm, most of which are non-functional adenoma. Surgical resection is still the main treatment. This disease can be treated as a benign tumor. The prognosis is well.