肾上腺原发性肝样腺癌临床病理观察  

Clinicopathological observation of adrenal hepatoid adenocarcinoma

作　　者：刘茜[1] 陆江阳[1] 王晓虹[1] 杨毅[1] 李玲[1] 李韶然[1] 

机构地区：[1]解放军总医院第一附属医院 病理科,北京100037

出　　处：《诊断病理学杂志》2009年第1期15-17,20,共4页Chinese Journal of Diagnostic Pathology

摘　　要：目的探讨肾上腺原发性肝样腺癌的病理诊断和临床病理特点。方法对1例肾上腺肝样腺癌进行光镜、电镜观察和免疫组化标记，并复习相关文献。结果肾上腺肿瘤镜下可见腺癌和肝细胞癌样区域，两者交错分布，肝细胞癌样区域瘤细胞呈腺管状和梁索状排列，肿瘤间质较少，瘤细胞间可见血窦样结构。瘤细胞呈多边形，胞质丰富嗜酸，核异型性明显，核分裂象易见。电镜见胞质线粒体丰富、高尔基体发达，可见层状排列的粗面内质网；细胞间可见毛细胆管结构。免疫组化HepPar1、AFP和pCEA（＋），Inhibin-α（-）。全身其他脏器检查未发现肿瘤，随访13个月无复发及其他脏器转移。结论肾上腺发生的肝样腺癌具有肝细胞癌的病理学特征，依据光镜、电镜观察和免疫组化标记并除外转移，方可确诊。目前，连同本例仅见2例报道。提示在肾上腺肿瘤的诊断中要注意与这类肿瘤的鉴别。Objective To study the pathological diagnosis and clinicopathological characteristics of adrenal hepatoid adenoearcinoma. Methods A case of adrenal hepatoid adenocarcinoma was studied by light and electron microscopy and immunohistochemistry, and the relevant literatures were reviewed. Results The tumor was composed of adenecarcinomatous and hepatoid areas. The tumor cells in the hepatoid area, arranged in gland-like, sheets and cords, were polygonal and had rich eosinophilic cytoplasm, obvious atypical nuclei and more abnormal mitoses. Tumor stmma was few and sinusoidal vascularity could be found. By electron microscopy, there were rich mitoehondria in the cytoplasm and microbile duct was seen between tumor cells. Immunohistochemistry showed that HepPar1 and AFP were positive in the cytoplasm while inhibin-α was negative. No tumors were found in other organs and no recurrence and metastasis were found in the following 13 months. Conclusion Till now, there are only two cases of adrenal hepatoid adenocarcinoma reported in the literature. The diagnosis is made based on the histopathotogy by light and electron microscopy and immunohistochemistry with exclusion of the metastatic tumors. It should be differentiated from other adrenal tumors.

关 键 词：肝样腺癌 肾上腺 HepPar1 电镜 

分 类 号：R736.6[医药卫生—肿瘤]