肾集合管癌的临床病理分析  

Carcinoma of the collecting ducts of Bellini:a clinicopathological study

作　　者：肖立[1] 陆孝禹[1] 朱雄增[2] 

机构地区：[1]复旦大学附属华东医院病理科,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》2008年第2期195-198,共4页Chinese Journal of Clinical and Experimental Pathology

摘　　要：目的观察肾集合管癌的临床病理特点,探讨其病理诊断与鉴别诊断。方法对2例肾集合管癌的临床特点、病理学检查进行观察,采用免疫组化EnVision法检查CK7、CK19、CK20、34βE12、vimentin、CD10、P504S、E-cadherin的表达。并选择9例Ⅱ型、核分级为Ⅲ级的乳头状肾细胞癌、6例伴广泛肾实质侵犯的肾盂高级别尿路上皮癌与肾集合管癌进行形态学与免疫表型的比较。结果肾集合管癌占同期上皮性肿瘤的0.66%,血尿为主要临床表现,1例患者术后3月死于肺转移。肿瘤均位于肾髓质,以管状结构为主,伴有肉瘤样分化,广泛侵犯肾实质,间质纤维化及中性粒细胞反应,周围集合管可见异型增生;免疫组化CK19及vimentin(+,2/2)、CK7及34βE12(+,1/2),CK20、CD10、P504S、E-cadherin均阴性。Ⅱ型乳头状肾细胞癌、尿路上皮癌未见集合管上皮异型增生;乳头状肾细胞癌表达vimentin(+,8/9)、CD10及P504S(+,7/9)、CK7(+,3/9)、CK19(+,1/9),34βE12、E-cadherin、CK20均阴性;尿路上皮癌CK7、CK19、34βE12均(+,6/6),E-cadherin(+,5/6),CK20(+,4/6),CD10、p504s、vimentin均阴性。结论集合管癌是一种少见、高度恶性的肾上皮性肿瘤,形态和免疫表型多样化。灰白色肿块位于髓质、周围集合管上皮异型增生,无肾盂尿路上皮异型增生及原位癌存在可与乳头状肾细胞癌、尿路上皮癌鉴别。CD10、CK19、34βE12、P504S、E-cadherin的染色有助于鉴别诊断。Purpose To study the clinicopathological features, diagnosis and differential diagnosis of renal carcinoma of the collecting ducts of Bellini （CCDB）. Methods 2 cases of CCDB were observed clinically and morphologically, detected by immunohistochemical staining of CKT, CK19, CK20, 34βE12, vimentin, CDIO, P504S, E-cadherin, and compared to 9 cases of papillary renal cell carcinoma （PRCC） with type 2 and Fuhrman grading Ⅲ, 6 cases of urothelial carcinoma （UC） of the renal pelvis with high grade and broad parenchymal invasion. Results CCDB accounted for 0.66% of total renal carcinomas in the same period, usually presented haematuria, 1 of the 2 cases died of lung metastases 3 month later after operation. Tumors were located in the medullary zone, consisted of tubular structure with sarcomatoid differentiation, infiltrated renal parenchyma diffusely with desmoplastic stroma and neutrophilia, and displayed epithelial dysplasia in collecting ducts nearby. Immunohistochemially, CK19, vimentin were positive （2/2）, CK7 and 34βE12 positive （1/2） ,CK20, CD10, P504S, E-cadherin were negative. Whereas epithelial dysplasia was not seen in PRCC and UC. PRCC expressed vimentin（8/9）, CD10 （7/9） , P504S（7/9）, CK7（3/9）, CK19（ 1/9）, but 34βE12, E-cadherin and CK20 were negative. UC expressed CK7, CK19, 34βE12 （6/6） , E-cadherin （5/6） and CK20 （4/6） , but CD10 and P504S were negative. Conclusions CCDB is a rare and high grade renal cell carcinoma with morphological and immunohistochemical varieties. The greywhite appearance with medullary location, epithelial dysplasia in collecting ducts, and no urothelial dysplasia and UC in-situ are the major criteria for differential diagnosis from PRCC and UC. Immunohistos emical staining of CD10, CK19, 3413E12, P504S, and Ecadherin is helpful in the differential diagnosis.

关 键 词：肾肿瘤 集合管癌 形态学 免疫组织化学 

分 类 号：R737.11[医药卫生—肿瘤]