肾脏黏液样小管状和梭形细胞癌的临床病理观察

Clinicopathological observation of mucinous tubular andspindle cell carcinoma of kidney

目的 探讨肾脏黏液样小管状和梭形细胞癌(MTSCC)的临床病理特点及鉴别诊断。方法 回顾性分析8例MTSCC的临床病理特点、免疫表型并复习相关文献。结果 患者年龄33~76岁,平均61.8岁;女5例,男3例;6例为体检发现,2例因腰痛就诊发现。肿瘤最大径0.9~9.0 cm。所有患者手术后未行进一步治疗,随访3~116个月,均无复发及转移。病理特点为肿瘤边界较清,肿瘤细胞排列呈小管状、条索状,可见梭形细胞区,间质黏液样变,3种成分比例不一。免疫组织化学显示,8例患者均表达PAX-8、CK7、Vimentin、P504S、CK8/18,EMA、CD10、RCC、CA9、TFE-3均不同程度表达,增殖指数(Ki-67)均≤10%,均不表达CD117。结论 MTSCC是一种少见的低度恶性肿瘤,穿刺活检和不典型病例易漏诊误诊,应加强对该病变的认识,避免漏诊误诊。

Objective To investigate the clinicopathological features and differential diagnosis of mucinous tubular and spindle cell carcinoma(MTSCC)of the kidney.Methods The clinicopathological features and immunophenotypes of eight patients with MTSCC were retrospectively analyzed and related literatures were reviewed.Results The patients ranged in age from 33 to 76 years old,with an average age of 61.8.There were five females and three males.A total of six cases were found by physical examination,and two cases were found because of low back pain.The maximum diameter of the tumors ranged from 0.9 to 9.0 cm.All the patients were followed up for 3-116 months without further treatment after operation,and there was no recurrence or metastasis.The pathological features were clear tumor boundary,small tubular and cord-like tumor cells,spindle-shaped cell areas,interstitial mucinous degeneration,and different proportions of the three components.Immunohistochemistry showed that PAX-8,CK7,Vimentin,P504S,CK8/18,EMA,CD10,RCC,CA9 and TFE-3 were all expressed in different degrees,the proliferation index(Ki-67)was≤10%,and none of them expressed CD117.Conclusion MTSCC is a rare low-grade malignant tumor,and the biopsy cases and atypical cases are easily missed and misdiagnosed.Therefore,the understanding of this disease should be strengthened to avoid missed diagnosis and misdiagnosis.