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目的 观察乳头状肾细胞癌 (PRCC)的形态特点 ,并对其诊断和鉴别诊断要点、预后及组织发生进行探讨。方法 对 33例直径 >1.0cm、乳头结构占 5 0 %以上的PRCC进行研究。每一例均采用光镜观察 ,利用组织芯片行免疫组化染色 ,检测EMA、CK7、CD10、Vim和 34βE12 ,并进行随访观察。结果 5 16例肾上皮性肿瘤中检出PRCC 33例 (6 .4 % )。镜检可见典型的乳头及梁状、管状、微小结、假复层等不明显的乳头形式 ;间质内的泡沫细胞、沙砾体及肿瘤细胞吞噬含铁血黄素亦是其独特之处。 33例中 ,嗜碱型 10例 ,细胞呈立方形 ,胞浆少 ,淡染 ,Fuhrman分级 9例为低级别 ;嗜酸型 2 2例 ,细胞呈高柱状 ,胞浆丰富 ,嗜酸性 ,Fuhrman分级 19例为高级别 ;余 1例为透明细胞型。 10例嗜碱型仅远曲小管标志EMA或CK7为 (+) ,近曲小管标志CD10均为 (- ) ,7例Vim为 (+) ;2 2例嗜酸型中 ,9例EMA或CK7为 (+) ,10例CD10为 (+) ,6例Vim为 (+) ;33例 34βE12均为 (- )。2 4例获随访 ,3年生存率 6 4 .3% (9/ 14 ) ,5年生存率 5 0 .0 % (7/ 14 )。结论 乳头状肾细胞癌为独立类型的恶性肿瘤 ,具有独特的病理形态特点 ,其临床预后较嫌色细胞癌差。
Objective To observe the morphological characteristics of papillary renal cell carcinoma (PRCC), and to explore its diagnosis and differential diagnosis, prognosis and tissue development. Methods 33 cases of PRCC with diameter> 1.0cm and nipple structure more than 50% were studied. Each case was observed by light microscopy, immunohistochemical staining using tissue microarray, detection of EMA, CK7, CD10, Vim and 34βE12, and follow-up observation. RESULTS: PRCC was detected in 53 cases of renal epithelial tumors (6.3%). Microscopic examination revealed a typical nipple and beam, tubular, micro-knot, pseudostratified obvious nipple forms; interstitial foam cells, gravel and tumor cells phagocytosis hemosiderin is also unique. In 33 cases, there were 10 basophilic cells with small cytoplasm and light cytoplasm. Fuhrman grade was lower in 9 cases. There were 22 cases of eosinophilic cells with high columnar shape, abundant cytoplasm, eosinophilicity, Fuhrman 19 cases were classified as high grade and the remaining 1 case was clear cell type. Ten cases of basophilic type were only distal tubule markers EMA or CK7 (+), proximal tubule markers CD10 were (-), seven cases of Vim (+); 2 2 cases of eosinophilic, 9 cases of EMA or CK7 (+), 10 cases of CD10 (+), 6 cases of Vim (+); 33 cases of 34βE12 are (-). Twenty - four patients were followed up, with a 3 - year survival rate of 6.43% (9/14) and a 5 - year survival rate of 5.0% (7/14). Conclusion Papillary renal cell carcinoma is an independent type of malignant tumor with unique pathological features. Its clinical prognosis is worse than that of chromophobe.