2例肾嗜酸细胞瘤的诊治体会

Diagnosis and treatment of renal oncocytoma (Report of 2 cases)

目的 :探讨肾嗜酸细胞瘤的诊断和治疗。方法 :报告 2例肾嗜酸细胞瘤 ,结合文献资料复习讨论。结果 :肿瘤均位于左肾中上段 ,行根治性左肾切除及单纯左肾切除。肿瘤切面灰褐色或黄褐色 ,质软 ;镜检瘤细胞均呈圆形或类圆形 ,胞质富含浓染嗜酸颗粒 ,核泡状 ,瘤细胞呈巢状、管状、微囊状或卵圆形片状排列 ,瘤组织中心部可见玻璃样变无细胞区 ;免疫组化 :bcl 2 (+)、PCNA(++)或 (- )。结论 :肾嗜酸细胞瘤系肾脏的良性倾向肿瘤 ,术前诊断较困难 ,瘤体中心区星形瘢痕是本病的特征性影像学改变 ,本病可能潜在恶性变 ,治疗以保肾手术首选 。

Purpose:To study the diagnosis and treatment of renal oncocytoma. Methods:Two cases of renal oncocytoma were reported here and the literatures were reviewed.Results:The tumors all located in the upper middle part in left kidney. A radical nephrectomy and a single nephrectomy were performed separately. On histopathological study, the gross color of the tumor section was grey brown or yellow brown with a soft texture. Under microscopic examination, the tumor was characterized by diffuse sheets of homogeneous round or similar round cell containing aboundant axyphil pellets and bubble shaped nucleus along with bizarre big nucleus occasionally, and the cells arranged as nest, tubular, microsaccate or ovoid shape structure and a centre hyaline change could be seen simultaneously. Immunohistochemical assay showed positive reaction for bcl 2 and PCNA or negtive for vimentin. Conclusions:The renal oncocytoma is a benign tendency disease which is difficultly diagnosed before operation. The central star shaped scar is its image feature. Kidney preserving surgical operation is the first choice treatment which should be followed up because of its potential malignancy.