膀胱移行细胞癌比较常见.PPTVIP

泌尿系统肿瘤 Zhu keqing 竺可青 Pathology Department Zhejiang University School of Medicine 2013-4-9 肾细胞癌，肾腺癌 本癌不太多见，男性中年较多，临床较隐蔽，难早期发现。 肉眼：结节状，可有假包膜，在肾上极较多，色带土黄，易出血坏死 镜检：由含类脂及糖原的透明细胞构成，核不大，核浆比例小。腺体样结构（现认为其来自肾小管），亦可呈巢状；间质较少。 肾癌临床病理特点： (1)无痛性血尿；但常为隐匿性； (2)血道转移； (3)常有意外的远隔转移（如转至鼻尖）； (4)逆行转移：男性左肾癌可侵入左肾静脉→左精索内静脉→逆行引起左附睾发生转移。（右侧精索内静脉直接流入下腔V，故无此现象）； (5)异位内分泌现象较其它癌为多。 肾母细胞瘤 Nephroblastoma 亦名：肾胚胎性腺肉瘤，Wilm氏瘤 来源：胚胎性肾母细胞，可分化为腺体及纤维、软骨等间叶组织；细胞分化差。其发生与抑癌基因WT1异常有关。一般见于3岁左右儿童。 肉眼：大结节状，境界清楚，灰白，肾组织受压萎缩，肾盂肾盏变形。 镜检：有腺癌和纤维肉瘤两种成份，二者均有恶性特征，有时移行。瘤细胞有时可分化成类似肾小球或肾小管的结构，有时见分化较好的软骨。 膀胱癌 Carcinoma of bladder 膀胱移行细胞癌比较常见，临床上发生无痛性血尿。 肉眼：多呈乳头状突出表面。检查标本时需特别注意乳头基底宽或细，切面有无向下浸润。由于乳头很脆，常折断脱落，尿沉淀涂片镜检可查出癌细胞。 镜检：移行上皮癌，可分Ⅰ～Ⅲ级。Ⅰ级为低度恶性，Ⅱ级细胞层次明显增多，有一定异型性。Ⅲ级可不形成乳头，而是癌巢。移行上皮乳头状瘤，细胞几乎无异型性，但一般认为其极易恶变，须按癌处理。 临床特点：无痛性血尿;膀胱刺激症状;尿路阻塞。 * TUMORS BENIGN Papillary Adenoma Fibroma/Hamartoma Angiomyolipoma Oncocytoma MALIGNANT Renal Cell Carcinoma (Clear Cell Carcinoma, Adenocarcinoma) Urothelial (Transitional) Three most common forms Clear Cell Carcinomas Papillary Renal Cell Carcinomas Chromophobe Renal Carcinomas RENAL CELL CARCINOMA TOBACCO RELATED, STRONGLY SOME HEREDITARY/FAMILIAL MOST are “CLEAR CELL”, a few PAPILLARY YELLOW grossly, “CLEAR” cells microscopically STRONGLY tend to invade the renal VEIN early, in preference to lymphatics. These tumors are derived from the renal tubular epithelium, and hence they are located predominantly in the cortex. Renal carcinomas represent 80% to 85% of all primary malignant tumors of the kidney, and 2% to 3% of all cancers in adults. Most renal cancer is sporadic, but unusual forms of autosomal-dominant familial cancers occur, usually in younger individuals. Although they account for only 4% of renal cancers, familial variants have been enormously instructive in studying renal carcinogenesis. Von Hippel-Lindau (VHL) syndrome: Half to two-thirds of patients with VHL, characterized by hemangioblastomas of the cerebellum and retina, develop renal cysts and bilateral,