肾嫌色细胞癌和嗜酸细胞腺瘤的形态学、组织化学和免疫表型的比较研究  

Chromophobe renal cell carcinoma and renal oncocytoma:A comparative study of morphology,histochemistry and immunophenotype

作　　者：肖立[1] 陆孝禹[1] 陈忠伟[2] 杨文涛[2] 朱雄增[2] 

机构地区：[1]华东医院病理科,上海200040 [2]复旦大学附属肿瘤医院病理科,上海200032

出　　处：《临床与实验病理学杂志》2005年第4期422-426,共5页Chinese Journal of Clinical and Experimental Pathology

摘　　要：目的探讨肾嫌色细胞癌(chromophoberenalcellcarcinoma,CRCC)和嗜酸细胞腺瘤(oncocytoma)的临床病理学特征、诊断和鉴别诊断。方法对手术切除的13例肾嫌色细胞癌和6例肾嗜酸细胞腺瘤进行眼观、光镜和电镜观察,Hale胶体铁和免疫组化染色。结果嫌色细胞癌以实体结构为主,胞质半透明或嗜酸颗粒状,核皱缩,有核周空晕;其中6例(46%)为嫌色细胞癌嗜酸变型;电镜下见胞质内微泡和管泡状嵴线粒体;Hale胶体铁染色12/13阳性。嗜酸细胞腺瘤以巢状结构为主,胞质嗜酸颗粒状,核圆伴小核仁;1例(16.7%)出现核异型性;电镜下见胞质内层状嵴线粒体;Hale胶体铁染色阴性。免疫组化两者均表达Ecadherin、EMA,不表达CD10、CK20、vimentin;CK7在10/13例嫌色细胞癌中呈强阳性表达,2/6例嗜酸细胞腺瘤呈灶性表达。结论肾嫌色细胞癌和嗜酸细胞腺瘤形态学各有特征,免疫表型相似,鉴别诊断基于生长方式和细胞学特征,Hale胶体铁染色和电镜检查是区分二者的有效手段。Purpose To study the clinicopathological features, diagnosis and differential diagnosis of renal chromophobe cell carcinoma （CRCC） and renal oncocytoma. Methods 13 cases of CRCC and 6 cases of renal oncocytoma were observed with gross, microscopic and ultrastructural examinations,as well as detected by Hale＇s iron and immunohistochemical stains. Results CRCC was comprised of solid structures with variable proportions of translucent and granular eosinophilic cells, showing wrinkled nuclei, and preinuclear halos. 6 cases were classified as eosinophilic variants of CRCC. Ultrastructural study revealed cytoplasmic microvescicles and mitochondria with tubulocystic cristae. Positive Hale＇s colloidal iron staining was detected in 12/13 cases. Whereas oncocytoma was comprised of nests with granular eosinophilic cells, showing round nuclei with inconspicuous nucleoli. Cellular atypia was evident in 1 case （ 16.7% ）. Ultrastructurally, the tumor cells revealed cytoplasmic mitochondria with lamellar cristae. Hale＇s colloidal iron staining was negative in all the cases. Of two tumors,E-cadherin and EMA were positive,but CD10, CK20 and vimentin were negative. CK7 stained strongly positive in 10/13 cases of CRCC, whereas focally positive in 2/6 cases of oncocytoma. Conclusions CRCC and renal oncocytoma have unique morphological features respectively, and share similarity in immunophenotype. Differential diagnosis is based on the growth patterns and cytological features. Haleg colloidal iron staining and ultrastructural examination are much helpful in distinguishing the two tumors.

关 键 词：肾肿瘤 嫌色细胞癌 嗜酸细胞腺瘤 形态学 免疫表型 组织化学 

分 类 号：R737.11[医药卫生—肿瘤] R730.261.23[医药卫生—临床医学]