肾脏上皮样血管平滑肌脂肪瘤3例临床病理特点分析.docxVIP

肾脏上皮样血管平滑肌脂肪瘤3例临床病理特点分析 (江苏大学附属武进医院病理科江苏常州213000) 【摘要】目的：探讨肾脏上皮样血管平滑肌脂肪瘤(epithelioid agiomyolipoma, EAML)的临床病理特点、鉴别诊断及生物学行为。方法：观察 3例肾脏EAML临床病理特点、免疫表型，并进行术后随访。结果：3例年龄分 别为47、50和63岁，均无结节硬化症。光镜下肿瘤主要有异型上皮样细胞组成， 弥漫或巢片状排列，部分区域有血管周上皮样排列，其中2例可见出血和坏死, 肿瘤细胞体积大，呈圆形或多边形，胞质丰富，嗜酸性颗粒状，细胞核大，核仁 明显，可见核分裂象，多核巨细胞散在其中，3例均可见经典AML成分。免疫 组化染色显示瘤细胞HMB-45阳性，SMA、Vimentin散在阳性；上皮细胞膜抗原 (EMA)、CK、S-100 CD10均阴性。2例患者术后12个月状态良好，未见肿瘤 局部复发和转移，1例患者手术后33个月颈部发现肿瘤转移结节。结论：EMAL 的病理学及免疫组化特点对诊断及鉴别诊断至关重要，而肿瘤细胞的不典型性、 出血、坏死、核分裂象活跃提示肿瘤具有恶性潜能或预后不良，须密切随访。远 处转移为该肿瘤恶性的确切证据。 【关键词】肾肿瘤；上皮样血管平滑肌脂肪瘤；免疫组织化学；恶性 【中图分类号】R730.2 【文献标识码】A 【文章编号】2095-1752 (2016) 35-0018-03 [Abstract 】Objective To in vestigate the renal epithelioid an giomyolipomas (epithelioid agiomyolipoma, EAML) the clinical pathological features, d iff ere ntial diagnosis and biological behavior.Methods To observe the clinical pathological characteristics, 3 cases of renal EAML immune phe no type, and postoperative follow-up.Results 3 cases of age 47, 50 and 63 years old, respectively, no tuberous sclerosis.Angiohyalinosis tumors are different of epithelioid cells, diffuse or flake, nest area of vascular weeks epithelioid arrangement, which 2 cases of hemorrhage and necrosis, tumor cell volume is big, assumes the circular or polygonal, abundant cytoplasm, eosinophilic granular, the nucleus, nucleolus, visible fission, multinucleated giant cells are scattered among them, 3 cases of classic AML comp orient are visible .Immuno histochemical staining showed HMB - 45 positive tumor cells, the SMA, Vimentin positive;Epithelial membrane antigen (EMA), CK, S - 100, CD10 are n egativegood condition after 12 mon ths, 2 cases with no tumor local recurrenee and metastasis, 1 case of 33 months after operation in patients with neck tumor metastases nodules.Conclusion EMAL pathology and immunohistochemical characteristics is very important to the diagnosis and differential diag no sis, and typicality, hemorrhage, n ecrosis of tumor cells and nu clear fissi on as active prompt