后肾腺瘤临床病理及免疫组化观察分析  

Clinicopathologic and immunohistochemical features of metanephric adenoma

作　　者：孙慧勤[1] 郭德玉[1] 章容[1] 赵友光[1] 阎晓初[1] 于冬梅[1] 柳凤轩[1] 

机构地区：[1]第三军医大学西南医院病理学研究所,重庆400038

出　　处：《第三军医大学学报》2008年第21期2047-2050,共4页Journal of Third Military Medical University

摘　　要：目的探讨后肾腺瘤(metanephric adenoma,MA)的病理特征及鉴别诊断方法。方法应用常规病理、免疫组化方法观察本所近年诊断的2例MA手术切除标本,结合相关临床资料(从病史中摘取)分析其病理特点。结果2例大体均为类圆形灰白色肿块,大小各约1、4cm,有薄层包膜,与周围组织分界清楚。组织学上具有独特的形态结构特点:瘤细胞较小,核大质少,无异型性,呈规则的小管、小团状及肾小球样等结构排列。免疫组化分析:Vimentin阳性,WT1阳性或部分阳性,CK灶性阳性,CD57有1例散在和小灶性阳性,另1例片状强阳性,EMA、CK7、CgA、CD10均为阴性。2例均发生于中老年女性,其中1例在同一肾脏的另一部位还有肾细胞癌。结论作为WHO分类中一种少见的良性肾肿瘤类型,MA在形态学上具有独特的组织结构特点,免疫表型表现为WT1、CD57、Vimentin、CK多有表达,其中Vimentin恒定出现,WT1、CD57、CK表达强度和范围各有不同,而EMA、CK7、CgA、CD10多无表达;要注意与Wlims瘤、肾乳头状细胞癌、后肾腺纤维瘤等进行鉴别。Objective To study the clinicopathologie, immunohistochemical features and differential diag- nosis of metanephrie adenoma （MA）. Methods Two cases of MA recently diagnosed in our institute were observed and analyzed in the gross, histologically and immunohistochemically. Pathological features were concluded based on clinical information extracted from the medical records and literature review. Results Both tumors were masses of round in shape, gray-white in color, and 1 or 4 cm in size, enveloped with a thin capsule with a clear boundary in macroscopic view. They also had distinct feature in histology as small cells with high ratio of nucleus to cytoplasm, no nuclear atypia or mitotic figures. The tumor exhibited well-organized tubules, small cell nests, ＇ glomeruloid bodies＇ , and sharply demarcated from the adjacent renal parenchyma. Immuno- histochemical phenotype of expression profiles were as diffused vimentin, diffused or partially positive WT1, focalized CK, spotty or small focal of CD57 in one case while strong patchy expression in another case. The expression of EMA, CK7, CgA, CD10 were negative. Both cases were middle to old-aged females. In one case there was renal cell carcinoma located elsewhere in the same kidney. Conclusion MA, a rare novel form of benign renal neoplasma in the WHO classification, has distinct architecture in tissue structure. MA has characteristic phenotypes, as consistent expression of vimentin and frequent expressions of WT1, CD57, and CK, which are various in both intensity and distribution, but EMA, CK7, CgA, CD10 are negative. So far, it is believed to a benign tumor and should be differentiated from Wilms tumor, papillary renal cell carcinoma （PRCC）, metanephric adenofibroma etc.

关 键 词：后肾腺瘤 临床病理 免疫组化表型特征 

分 类 号：R730.21[医药卫生—肿瘤] R730.261[医药卫生—临床医学]