管状囊性肾癌例临床病理报告.docVIP

管状囊性肾癌2例临床病理报告 　　[摘要] 本文报道了2例管状囊性肾癌患者，均为男性，因肉眼血尿入院检查发现肾脏肿物，肿物巨检均为囊实性。镜下肿瘤组织成分均由大小不一小管及小囊腔构成，其间见胶原纤维，肿瘤细胞胞浆嗜伊红，核浆比大，可见明显核仁，囊腔内衬扁平细胞至高柱状鞋钉样细胞，Fuhrman分级基本为Ⅲ级。1例伴有乳头成分。免疫组织化学染色显示，2例肿瘤均阳性表达VIM、PAX-8、P504S。随访结果显示，2例患者分别于术后36、39个月死亡。结合相关文献复习认为，管状囊性肾癌好发于男性，肿物巨检呈囊实性，镜下见特征性大小不一囊腔和小管，上皮细胞核仁明显，主要应与以多房囊性生长方式为主的肾肿瘤相鉴别。本文2例患者随访结果提示其恶性程度较高。 中国论文网 /6/viewhtm　　[关键词] 肾肿瘤；囊性病变；病理；诊断；鉴别 　　[中图分类号] R737.11 [文献标识码] A [文章编号] 1673-7210（2016）06（c）-0177-03 　　[Abstract] This paper reports 2 cases of patients with tubulocystic renal cell carcinoma， they were both of male. The clinical symptoms were hematuria when revealed renal tumor. Gross examination results were both cystic masses. Histopathologic examination of 2 cases revealed different sizes of tubules and cysts， collagen fibers， atypical nucleus， prominent nucleolus， cystic cavities lined with flat to tall columnar hobnail-shaped cells. Fuhrman grading were mainly Ⅲ. One case contained papillary ingredients. Immunohistochemiscal showed VIM， PAX-8， P504S positive in 2 cases. Follow-up results showed that 2 patients died of 36， 39 months respectively. Combined with related research concludes with caution that renal tubulocystic carcinoma is a rare tumor and occurs in males more frequently. Microscopically， the tumor consists of well-circumscribed cystic lesions lined by cells with prominent nucleolus. The differential diagnoses include those renal tumors with multilocular cystic structure. Follow-up results indicate that it has the higher degree of malignancy. 　　[Key words] Kidney neoplasms； Cystic lesions； Pathology； Diagnosis； Differentiation 　　管状囊性肾癌是近年发现且逐渐被认识的一种罕见肾脏肿瘤，至今全世界报道该肿瘤约50例，国内亦仅有少量研究[1-9]。2016版世界卫生组织泌尿肿瘤分册首次将管状囊性肾癌列入[10]。为对管状囊性肾癌有更深入的认识，本文回顾分析复旦大学附属中山医院（以下简称“我院”）诊治的2例肾管状囊性癌患者临床、病理组织形态学及免疫表型特点，并复习相关文献予以探讨。 　　1 病例资料 　　病例1：患者男性，69岁，因“出现无痛性肉眼血尿9个月”于2009年8月18日入我院治疗，无特殊感染及手术史。经B超检查显示：左肾见一大小约6.2 cm×3.8 cm的占位性病变，左侧输尿管结石及左肾积水。行左肾切除术。术后肾脏标本巨检示：左肾中上极被膜下见一囊实性肿块，大小5.5 cm×3.0 cm，部分囊壁外实性区呈灰黄细乳头状，质地中等，肿瘤界限欠清。镜下显示：肿瘤周围无明显包膜，见大小不一囊腔，