摘要
目的探讨乳头状肾细胞癌(papillary renal cell carcinoma,PRCC)的临床病理特征、免疫表型、鉴别诊断和预后。方法回顾性分析32例PRCC患者的临床和病理资料,采用免疫组化EnVision法染色,并对患者进行随访。其中21例行根治性肾切除术,11例行肾部分切除术。结果 770例肾上皮性肿瘤中32例为PRCC(4.2%)。镜下见PRCC主要由多少不等的乳头状和管状结构组成,被覆单层立方或多层柱状肿瘤细胞,乳头轴心及间质内可见泡沫细胞、砂砾体沉积,部分肿瘤细胞胞质内可见含铁血黄素。Ⅰ型18例,细胞呈立方形,胞质少,嗜碱性,淡染,Fuhrman分级低级别16例;Ⅱ型14例,细胞呈高柱状,胞质丰富,嗜酸性,Fuhrman分级高级别12例。Ⅰ型和Ⅱ型PRCC不同程度地表达vimentin、EMA、CK(AE1/AE3)、CK7、CD10和AMACR,均不表达CK(34βE12)和TFE-3。31例患者获得随访,1例术后肝、肺转移,4个月后死亡,3例术后1年分别出现骨、肺、肝等处转移,2年后死亡;死亡患者中Ⅱ型3例、Ⅰ型1例。其余27例均无瘤生存。高核分级、血管内癌栓、淋巴结转移、高临床分期提示患者预后较差。结论 PRCC国内少见,具有独特的病理形态特征,Ⅱ型PRCC较Ⅰ型患者预后差。PRCC细胞核分级高、出现肉瘤样成分或有透明细胞癌结构可能提示肿瘤具有侵袭性,预后不良。诊断时需结合病理组织学特征、免疫表型和细胞遗传学分析。
Purpose To analyze the clinicopathologic and immunohistochemical features,differential diagnosis and prognosis of papillary renal cell carcinoma（ PRCC）. Methods Thirty-two cases of PRCC diagnosed were reviewed. A retrospective study was performed including reviewing the clinical documents,pathological sections and immunohistochemical stainning and follow-up was made of32 cases of PRCC. Twenty-one patients were treated with radical nephrectomy,eleven patients were treated with partial nephrectomy.Results Among 770 cases of renal epithelial tumors 32（ 4. 2%） cases of PRCC were detected. Histologically,the PRCC were characterized by varying proportions of papillary and tubular architecture covered by single or multiple layer of tumor cells with scanty or voluminous basophilic or eosinophilic cytoplasm. Foam cells and psammoma bodies were seen in some papillary cores and stroma,and the cytoplasm of some tumor cells contained hemosiderin. Of these 32 patients,18 and 14 were diagnosed type-Ⅰ and type-Ⅱ PRCC,respectively. Type-I,with small cuboid cell and pale cytoplasm,16 of them were low in Fuhrman grading,Type-Ⅱ,with large colunmar cells,rich in eosinophilic cytoplasm,12 of them were high in Fuhrman grading. Immunohistochemically,the PRCC showed positive immunostaining for vimentin,EMA,CK（ AE1 /AE3）,CK7,CD10 and AMACR. All the tumors studied were negative for CK（ 34βE12） and TFE-3. Follow-up data were available for 31 cases,4 patients died of cancer specific causes,1 with type-Ⅰ and3 with type-Ⅱ tumors after surgery. The other 27 patients were alive without recurrence or metastasis. High Fuhrman grading,intravascular tumor emboli,lymph node metastasis and high clinical stage were prognostic indicators in PRCC. Conclusions PRCC with unique pathological features is not a common subtype of renal cell carcinoma in China. The presence of higher nuclear grade,sarcomatoid elements or clear cell carcinoma structure may indicate an aggressive biologic behavior and poor prognosis. Close attention to
出处
《临床与实验病理学杂志》
CAS
CSCD
北大核心
2014年第9期1011-1015,共5页
Chinese Journal of Clinical and Experimental Pathology
关键词
肾肿瘤
乳头状肾细胞癌
乳头状结构
鉴别诊断
免疫组织化学
预后
renal neoplasm
papillary renal cell carcinoma
papillary architecture
differential diagnosis
immunohistochemistry
prognosis
