泌尿道肾源性腺瘤11例临床病理特征分析

Clinicopathological features of nephrogenic adenoma:Analysis of 11 cases

目的探讨肾源性腺瘤的临床病理学特征、诊断与鉴别诊断。方法回顾性分析11例肾源性腺瘤的临床资料、组织学形态及免疫组化结果,并进行随访。结果11例患者年龄36~89岁(平均:62.5岁,中位:64岁),男女比例为2.7:1;临床表现与病史及发生部位相关,多表现为腰痛、肉眼血尿或进行性排尿困难,发生部位:膀胱6例,输尿管3例,前列腺2例。肿瘤直径为1~30 mm。组织学表现:细胞常排列呈乳头状、小管-囊状,小管周围围绕红染的基底膜样物质,管-囊腔内可见嗜酸性分泌物或蓝染黏液;细胞形态温和,呈立方状、鞋钉样或扁平状,缺乏核分裂象及坏死;间质水肿、黏液样或玻璃样变性,伴炎性背景。除1例失访,10例均获得随访结果,随访时间2~55个月(中位:28.5个月),8例无病生存,2例带病(尿路上皮癌)生存。结论肾源性腺瘤是少见的发生在尿路上皮的良性病变,不管是临床表现、膀胱镜检查,还是病理形态及免疫表型来看,均易误诊为恶性肿瘤,免疫组化染色PAX8阳性具有鉴别诊断价值,但要警惕潜在的陷阱。

Objective To investigate the clinicopathological features,diagnosis and differential diagnosis of nephrogenic adenoma.Methods The clinical information,histological morphology and immunohistochemical results of 11 cases of nephrogenic adenoma were retrospectively analyzed and followed up.Results The patients age at presentation ranged from 36 to 89 years(mean:62.5 years,median:64 years).The ratio of male to female was 2.7:1.The clinical manifestations were related to the history and site of lesion,showed lumbago,gross hematuria or progressive dysuria.There were 6 cases occurred in bladder,3 cases in ureter,and 2 cases in prostate.Grossly,the tumors were measured in size between 1 mm to 30 mm.Histologically,cells arranged in papillary,tubule and cystic.The tubules were surrounded with basement membrane-like materials.Eosinophilic secretions or blue-stained mucin could be seen in the lumens.The cells were cubic,hobnail-like or flat,lacking mitotic fiqures and necrosis.The stromal were with edema,myxoid or hyalinosis,inflammation background.10 patients were obtained follow-up data(range:2 to 55 months,median:28.5 months)excluding,8 were alive without the disease,2 were alive with urothelial carcinoma.Conclusions Nephrogenic adenoma is a rare benign lesion occurring in the urothelium,which is likely misdiagnosed as a malignant tumor in aspects of clinical manifestations,cystoscopy,pathological morphology and immunophenotype.Immunohistochemical PAX8 positive is useful in differential diagnosis,but we should be alert of the potential pitfalls.