肾嗜酸细胞瘤的临床病理特征

Clinicopathological features of renal oncocytoma

目的探讨肾嗜酸细胞瘤(renal oncocytoma,RO)的临床病理特征、诊断、鉴别诊断及预后。方法收集2008年1月—2021年12月陕西省人民医院病理科诊断的7例肾嗜酸细胞瘤的相关临床病理资料,进行组织学观察、免疫组织化学分析,并与同期诊断的14例嗜酸型嫌色细胞癌(eosinophilic chromophobe renal cell carcinoma,eChRCC)、27例嗜酸性透明细胞肾细胞癌(clear cell renal cell carcinoma,CCRCC)进行免疫组织化学结果比较。结果7例RO肿瘤组织主要呈实性片状、巢团状、岛状结构排列,部分病例可见肿瘤中央形成放射状硬化区域(3/7),3/7见小细胞型肿瘤细胞,5/7灶状肿瘤细胞见怪异型核;肿瘤组织边界清楚,核分裂象罕见;免疫组织化学检测显示所有病例均CK、CD117阳性和RCC、vimentin阴性,部分(CD10弱阳性2/7),CK7(3/7,1例局灶,2例散在点状)阳性;特殊染色显示胶体铁均阴性表达。结论RO为良性肾肿瘤,其具有特征性镜下排列结构及细胞学特点,联合应用CK、CD117,CK,RCC、CD10、vimentin免疫组织化学染色及胶体铁特殊染色有助于该肿瘤的诊断及鉴别诊断。

Objective To investigate the clinicopathological features,diagnosis,differential diagnosis and prognosis of renal oncocytoma(RO).Methods The clinicopathological data of 7 renal oncocytoma cases diagnosed in the Department of Pathology,Shaanxi Provincial People’s Hospital from January 2008 to December 2021 were collected,and immunohistochemical results were compared with histological observation and immunohistochemical analysis of 14 eosionphilic chromophobe renal cell carcinoma(eChRCC)cases and 27 eosinophilic clear cell renal cell carcinoma(CCRCC)cases.Results The tumor tissues of 7 RO cases were mainly arranged in solid sheet-like,nest-like and island-like structures.Stellate sclerosis area was identified in the center of the tumor in 3/7 of the cases.Focal tumor cells were observed to have strange nuclei in 5/7 of the cases,cells in 3/7 of the cases were observed to have small cell varient.The boundary of the tumor tissue was clear and no necrotic areas were seen.In immunohistochemical staining,all cases were positive for CK and CD117,negative for RCC and Vimentin,CD10 in 2/7 of the cases are weakly positive,CK7 was focal positive expression in 1 case with sporadic positive expression,2 cases with punctate positive expression.Colloidal iron was negative.Conclusion RO is a benign renal tumor with characteristic microscopic structure and cytological characteristics.Combined application of CK,CD117,CK,RCC,CD10,vimentin immunohistochemical staining and colloidal iron special staining is helpful for the diagnosis and identification of this tumor diagnosis.