CAJ | 학술논문

目的探讨肾嫌色细胞癌的临床病理学特征、免疫表型特点及预后.方法收集2003至2011年青岛大学医学院附属医院、解放军第四○一医院及青岛市立医院共42例嫌色细胞癌的临床资料,分析其临床病理特点,进行Hale胶体铁染色,并采用免疫组织化学(EnVision法)检测相关免疫标志物.同时与40例肾透明细胞癌及10例嗜酸细胞瘤作对照.结果男性17例,女性25例,年龄39 ～ 78岁(平均57岁).肿瘤大小为2～ 19 cm(平均7.3 cm).镜下观察:瘤组织主要呈实性片状排列,由胞质空亮、细网状排列的嫌色细胞或胞质嗜酸、具核周空晕的嗜酸细胞构成.瘤细胞大小不一,核不规则,核仁不明显,核分裂象较少见.所有肿瘤对Hale胶体铁染色均为阳性.免疫表型:嫌色细胞癌高表达上皮细胞膜抗原( EMA,100.0％,42/42)、CK7( 95.2％,40/42)、肾脏特异性钙黏素( Ksp-cad,92.9％,39/42)、CK18(88.1％,37/42)和CD117(61.9％,26/42),CD10和PAX2阳性率为31.0％ (13/42)和28.6％(12/42).波形蛋白较少表达,而CAⅨ和TFE3均不表达.31例得到随访,随访时间2 ～ 77个月(平均29个月),3例分别于术后3、8及13个月死于肿瘤转移,28例健在.结论肾嫌色细胞癌好发于中老年人,预后较好.植物细胞样排列、大小不等、多少不一的嫌色细胞和具核周空晕的嗜酸细胞是本瘤重要的形态特征.Hale胶体铁染色及免疫组织化学染色EMA、CK7、Ksp-cad和CD117阳性对肾嫌色细胞癌的病理诊断及鉴别诊断具有重要作用.
목적 탐토신혐색세포암적림상병이학특정、면역표형특점급예후.방법 수집2003지2011년청도대학의학원부속의원、해방군제사○일의원급청도시립의원공42례혐색세포암적림상자료,분석기림상병리특점,진행Hale효체철염색,병채용면역조직화학(EnVision법)검측상관면역표지물.동시여40례신투명세포암급10례기산세포류작대조.결과 남성17례,녀성25례,년령39 ～ 78세(평균57세).종류대소위2～ 19 cm(평균7.3 cm).경하관찰:류조직주요정실성편상배렬,유포질공량、세망상배렬적혐색세포혹포질기산、구핵주공훈적기산세포구성.류세포대소불일,핵불규칙,핵인불명현,핵분렬상교소견.소유종류대Hale효체철염색균위양성.면역표형:혐색세포암고표체상피세포막항원( EMA,100.0％,42/42)、CK7( 95.2％,40/42)、신장특이성개점소( Ksp-cad,92.9％,39/42)、CK18(88.1％,37/42)화CD117(61.9％,26/42),CD10화PAX2양성솔위31.0％ (13/42)화28.6％(12/42).파형단백교소표체,이CAⅨ화TFE3균불표체.31례득도수방,수방시간2 ～ 77개월(평균29개월),3례분별우술후3、8급13개월사우종류전이,28례건재.결론 신혐색세포암호발우중노년인,예후교호.식물세포양배렬、대소불등、다소불일적혐색세포화구핵주공훈적기산세포시본류중요적형태특정.Hale효체철염색급면역조직화학염색EMA、CK7、Ksp-cad화CD117양성대신혐색세포암적병리진단급감별진단구유중요작용.
Objective To study the clinicopathologic features,immunohistochemical profiles and prognosis of chromophobe renal cell carcinoma (ChRCC). Methods Forty-two cases of ChRCC were retrieved from the archival files of the Affiliated Hospital of Qingdao University,401 Hospital of PLA and Qingdao Municipal Hospital from 2003 to 2011. The clinical and pathologic features of the tumors were reviewed.Hale colloidal iron staining was performed and EnVision immunohistochemistry was used to detect the expression of a series of immunologic markers.Forty cases of clear cell renal cell carcinoma and 10 cases of renal oncocytoma were selected as controls.Results The patients included 17 males and 25 females.The age of patients ranged from 39 years to 78 years (median age =57 years).On gross examination,the tunors ranged from 2 cm to 19 cm in greatest dimension (mean size =7.3 cm).Histologically,the tumors were mainly composed of solid sheets,acini or tubules of malignant cells.The tumor cells contained clear finely reticular ( “chromophobe” ) and eosinophilic cytoplasm with perinuclear clearing.The nuclear outline was irregular and wrinkled.Nucleoli were inconspicuous and mitotic figures were barely seen.Hale colloidal iron stain was positive in all cases,Immunohistochemically,the tumor cells were variably positive for EMA ( 100％,42/42),CK7 ( 95.2％,40/42 ),Ksp-cad ( 92.9％,39/42 ),CK18 ( 88.1％,37/42 ),CD117(61.9,26/42),CD10 (31.0％,13/42 ) and PAX2 ( 28.6％,12/42 ).They were negative for vimentin,CA Ⅸ and TFE3.The follow-up period in 31 patients ranged from 2 to 77 months ( average duration =29months).Three patients died of tumor metastasis 3,8,13 months respectively after the operation.Twentyeight patients were still alive without evidence of tumor recurrence.Conclusions ChRCC predominantly occurs in middle-aged and elderly patients.It often carries a favorable prognosis.The presence of plant celllike morphology,pale cells with uniform reticular microvesicular appearance and perinuclear clearing are characteristic histologic features. The diffuse positivity for Hale colloidal iron stain and EMA/CK7/Kspcadherin/CD117-positive immunoprofiles are also useful in differential diagnosis.