后肾腺瘤临床病理及免疫组化观察分析

文章编号:100025404(2008)2122047204论著

后肾腺瘤临床病理及免疫组化观察分析

孙慧勤,郭德玉,章　容,赵友光,阎晓初,于冬梅,柳凤轩 (第三军医大学西南医院病理学研究所,重庆400038)

摘　要:目的　探讨后肾腺瘤(metanephric adenoma,MA)的病理特征及鉴别诊断方法。方法　应用常规病理、免疫组化方法观察本所近年诊断的2例MA手术切除标本,结合相关临床资料(从病史中摘取)分析其病理特点。结果　2例大体均为类圆形灰白色肿块,大小各约1、4c m,有薄层包膜,与周围组织分界清楚。组织学上具有独特的形态结构特点:瘤细胞较小,核大质少,无异型性,呈规则的小管、小团状及肾小球样等结构排列。免疫组化分析:V i m entin阳性,W T1阳性或部分阳性,CK灶性阳性,C D57有1例散在和小灶性阳性,另1例片状强阳性,E MA、CK7、Cg A、CD10均为阴性。2例均发生于中老年女性,其中1例在同一肾脏的另一部位还有肾细胞癌。结论　作为WHO分类中一种少见的良性肾肿瘤类型,MA在形态学上具有独特的组织结构特点,免疫表型表现为W T1、C D57、V i m entin、CK多有表达,其中V i m entin恒定出现,W T1、CD57、CK表达强度和范围各有不同,而E MA、CK7、Cg A、C D10多无表达;要注意与W li m s瘤、肾乳头状细胞癌、后肾腺纤维瘤等进行鉴别。

关键词:后肾腺瘤;临床病理;免疫组化表型特征

中图法分类号:R730.21;R730.261;R737.11 文献标识码:A

C li n i copa tholog i c and imm unoh istochem i ca l fea tures of m et anephr i c adenoma

S UN Hui2qin,G UO De2yu,Z HANG Rong,ZHAO You2guang,Y AN Xiao2chu,Y U Dong2mei,L I U Feng2xuan(I nstitute of Pathol ogy,South west Hos p ital,Third M ilitary Medical University,Chongqing400038,China)

Abstract:O b j ec ti ve　T o study the clinicopathol ogic,i m munohist oche m ical features and differential diag2 nosis of metanephric adenoma(MA).M e tho d s　T wo cases ofMA recently diagnosed in our institute were ob2 served and analyzed in the gr oss,hist ol ogically and i m munohist oche m ically.Pathol ogical features were conclu2 ded based on clinical inf or mati on extracted fr om the medical records and literature revie w.R e su lts　Both tumors were masses of r ound in shape,gray2white in col or,and1or4c m in size,envel oped with a thin cap sule with a clear boundary in macr oscop ic vie w.They als o had distinct feature in hist ol ogy as s mall cells with high rati o of nucleus t o cyt op las m,no nuclear atyp ia or m it otic figures.The tumor exhibited well2organized tubules, s mall cell nests,‘gl omerul oid bodies’,and shar p ly de marcated fr o m the adjacent renal parenchy ma.I m muno2 hist oche m ical phenotype of exp ressi on p r ofiles were as diffused vi m entin,diffused or partially positive W T1,fo2 calized CK,s potty or s mall focal of CD57in one case while str ong patchy exp ressi on in another case.The ex2 p ressi on of E MA,CK7,Cg A,CD10were negative.Both cases were m iddle t o old2aged fe males.I n one case there was renal cell carcinoma l ocated else where in the sa me kidney.Co nc lu s i o n　MA,a rare novel f or m of benign renal neop las ma in the WHO classificati on,has distinct architecture in tissue structure.MA has charac2 teristic phenotypes,as consistent exp ressi on of vi m entin and frequent exp ressi ons of W T1,CD57,and CK, which are vari ous in both intensity and distributi on,but E MA,CK7,Cg A,CD10are negative.So far,it is be2 lieved t o a benign tumor and should be differentiated fr om W il m s tumor,pap illary renal cell carcinoma (PRCC),metanephric adenofibr o ma etc.

Key words:metanephric adenoma;clinical pathol ogy;i m munophenotyp ic feature

作者简介:孙慧勤,女,云南省昆明市人,博士,副主任医师,副教授,主要从事肿瘤病理学及血管生成方面的研究。电话:(023)68765455,

E2mail:huiqinsun02@yahoo.co

收稿日期:2008203203;修回日期:2008204210

后肾腺瘤(metanephric adenoma,MA)是一种少见的肾脏肿瘤,1992年由B risigotti命名[1],其后被归为一独立的腺瘤,2004年版WHO肾脏肿瘤分类中新增加了“后肾肿瘤”(metanephric tu mors)大类,其中包括

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第30卷第21期2008年11月

第　三　军　医　大　学　学　报

ACT A　AC ADE M I A E　ME D I C I N AE　M I L I T AR I S　TERTI A E

Vol.30,No.21

Nov.2008