CAJ | 학술논문

目的：探讨肾脏黏液性小管状和梭形细胞癌（mucinous tubular and spindle cell carcinoma ，M TSCC）的临床病理学特点。方法对3例 M TSCC 进行光镜、特殊染色、免疫组织化学染色及荧光原位杂交（FISH ）检测，并复习临床资料及相关文献。结果3例 M TSCC 中，2例为男性，1例女性，年龄分别为50、71、75岁（中位71岁），例2临床表现为腰痛，3例均无肉眼血尿。肿瘤长径分别为2．0 cm 、3．5 cm 、6．0 cm（中位3．5 cm），肿瘤切面灰白色，与周围肾实质界限清晰，例2局部伴出血、坏死。组织学上肿瘤由温和一致的立方细胞紧密排列成狭长的小管结构及梭形细胞两种成分构成，例1、例3部分肿瘤细胞胞质透明，例1黏液性间质稀少；例2、例3间质内见泡沫细胞聚集。免疫表型：3例均表达 AMCAR 、CK7、CK19、EMA 、NSE 等，Ki-67低于5％。 FISH 结果：3例均无乳头状肾细胞癌的染色体异常：3、7、17染色体扩增及 Y 染色体丢失。结论M TSCC 为低级别肾细胞癌，形态学谱系广泛，免疫表型表达远曲小管上皮标记（AMCAR 、CK7、CK19、EMA 、NSE 等），主要需与乳头状肾细胞癌相鉴别，一般预后较好，术后仍须密切随访。
목적：탐토신장점액성소관상화사형세포암（mucinous tubular and spindle cell carcinoma ，M TSCC）적림상병이학특점。방법대3례 M TSCC 진행광경、특수염색、면역조직화학염색급형광원위잡교（FISH ）검측，병복습림상자료급상관문헌。결과3례 M TSCC 중，2례위남성，1례녀성，년령분별위50、71、75세（중위71세），례2림상표현위요통，3례균무육안혈뇨。종류장경분별위2．0 cm 、3．5 cm 、6．0 cm（중위3．5 cm），종류절면회백색，여주위신실질계한청석，례2국부반출혈、배사。조직학상종류유온화일치적립방세포긴밀배렬성협장적소관결구급사형세포량충성분구성，례1、례3부분종류세포포질투명，례1점액성간질희소；례2、례3간질내견포말세포취집。면역표형：3례균표체 AMCAR 、CK7、CK19、EMA 、NSE 등，Ki-67저우5％。 FISH 결과：3례균무유두상신세포암적염색체이상：3、7、17염색체확증급 Y 염색체주실。결론M TSCC 위저급별신세포암，형태학보계엄범，면역표형표체원곡소관상피표기（AMCAR 、CK7、CK19、EMA 、NSE 등），주요수여유두상신세포암상감별，일반예후교호，술후잉수밀절수방。
Objective To investigate the clinicopathological characteristics of mucinous tubular and spindle cell carcinoma (M TSCC) .Methods Three cases of M TSCC were studied by light microscopy ,spe-cial stains ,immunohistochemistry ,fluorescence in situ hybrisation (FISH) and literature review .Results The ages of the M TSCC patients range from 51 to 75 years (mean 71 years) .Case 2 had the clinical mani-festation of flank pain .No case had hematuria .Tumor sizes were 2 .0cm-6 .0cm (mean 3 .5cm) ,exhibiting a well-circumscribed ,regular ,grayish-white cut surface .Case 2 had hemorrhage and necrosis .Histologi-cal examination of the tumor showed that it consisted of cuboidal and oval or spindle cells arranged in tubu-lar and trabecular patterns .The foci of case 1 and 3 were seen in clear cells ,myxoid stroma in case 1 was not easy to see ,and macrophages were seen in the myxomatous stroma of cases 2 and 3 .M TSCC tumors exhibited positive reactions to AMCAR ,vimentin ,EMA ,CK7 ,CK19 ,NSE and other markers ,and the MIB-1 labeling index was generally very low .Fluorescence in situ hybridization did not show gains of 3 ,7 , 17 chromosomes and loss of Y chromosome of in all 3 cases .Conclusion M TSCC is low grade renal cell car-cinoma with a wide histological spectrum .Immunohistochemically ,the tumor cells are positive for proxi-mal convoluted tubules and distal convoluted tubules immunophone (AMACR ,EM A ,CK7 ,CK19 ,NSE et al) and need to be differentiated with papillary renal cell carcinoma of the Kidney .With generally good prognosis ,it still need follow-up .