肾脏混合性上皮间质肿瘤一例报告并文献复习  

Mixed epithelial and stromal tumor of the kidney (a case report and review of th e literature)

作　　者：卢剑[1] 马潞林[1] 杨郁[2] 肖春雷[1] 

机构地区：[1]北京大学附属第三医院泌尿外科,100083 [2]北京大学医学部病理系

出　　处：《中华泌尿外科杂志》2005年第9期590-592,共3页Chinese Journal of Urology

摘　　要：目的报告1例肾脏混合性上皮间质肿瘤患者的临床及病理特点.方法患者女性,50岁.有20年口服避孕药史.主诉腰部不适和血尿半年,CT及MRI示左肾上极囊实性8 cm×6 cm肿物,术前诊断囊性肾癌,2004年7月行左肾根治性切除术.结果术中发现左肾上极与周围组织严重粘连.术后见左肾上极7.9 cm×8.9 cm×9.0 cm多房囊性肿瘤,边界清楚,内充满咖啡色粘稠液体,囊腔直径0.5～2.0 cm,部分囊壁较厚呈实性.病理检查:肿瘤均由上皮和间质成分共同构成,上皮细胞呈立方状、柱状和靴钉样,可见明确的胃肠道上皮分化细胞.间质成分主要由梭形细胞构成,可见特征性呈束状分布的平滑肌组织.免疫组化:上皮细胞AE1/AE3(+),间质细胞ER(+)、PR(+)、SMA(+).术后随访8个月未见复发.结论肾脏混合性上皮间质肿瘤为良性肿瘤,罕有胃肠道上皮分化特征,需与肾脏其他良恶性肿瘤鉴别.Objective To report the clinical features and pathologic findings of 1 case of mixed epithelial and stromal tumor of the kidney. Methods The patient who had a 20-year history of taking oral contraceptive was a 50-year-old woman with pain in left flank associated with hematuria for half a year. CT and MRI revealed an 8 cm×6 cm cystic and solid mass located in the upper pole of the left kidney. A diagnosis of cystic renal carcinoma was made before operation. Radical left nephrectomy was performed in July 2004. Results The upper pole of the left kidney was found severely adhesive with peripheral tissues during operation. Grossly, the tumor exhibited a 7.9 cm×8.9 cm×9.0 cm muhilocular cyst full of coffeecolored mucoid fluid with varying size ranging from 0.5 to 2.0 cm. Focally thick-walled cysts with solid areas were seen. Microscopic findings showed the tumor was composed of a mixture of stromal elements formed by spindle cells and epithelial elements that were variable in cell types including cuboidal, columnar and hobnail cells. Differentiation of gastrointestinal tract was found in epithelial elements. Thick-walled blood vessels and distinctive bands of smooth muscle cells were present in the stromal elements, lmmunohistochemical staining revealed that the epithelial component was positive for AE1/AE3, and stromal component was positive for ER, PR, and SMA. No specific treatment was given and the patient was free of signs of recurrence 8 months after operation. Conclusions Mixed epithelial and stromal tumor of the kidney is recognized to be a kind of benign neoplasm. Differentiation of gastrointestinal tract in epithelial elements is rare. It should be distingnished from any other benign and malignant tumors in the kidney.

关 键 词：肾肿瘤 混合性上皮间质肿瘤 胃肠道上皮分化 上皮间质 间质肿瘤 混合性 肾脏 文献复习 肾根治性切除术 肿瘤患者 

分 类 号：R737.11[医药卫生—肿瘤]