79例非透明性肾细胞癌新旧组织学分类的比较分析  

Non-clear cell renal carcinoma： comparative analysis of the new and old histological classification in 79 cases

作　　者：崔巍[1] 张艳辉[1] 陈明[1] 刘素香[2] 刘岩雪[2] Ximing J Yang 姚欣[1] 

机构地区：[1]天津医科大学肿瘤医院天津市肿瘤防治重点实验室泌尿外科,300060 [2]天津医科大学肿瘤医院病理科,300060 [3]60611 Chicago, IL,USA, Northwestern Memorial Hospital, Northwestern University, Feinberg School of Medicine

出　　处：《中华肿瘤杂志》2010年第10期772-776,共5页Chinese Journal of Oncology

基　　金：基金项目：天津市应用基础及前沿技术研究计划项目（07JCYBJC17000）

摘　　要：目的 比较2004年世界卫生组织（WHO）肾细胞癌组织学分类标准与旧分类标准的异同,总结容易出现的诊断差异及可能原因,纠正对肾细胞癌传统病理分类的观念.方法 天津医科大学肿瘤医院1998年2月至2005年12月间,根治性肾切除术后病理诊断为非透明性细胞癌79例,按2004年WHO肾癌组织学分类标准进行重新分类,并收集相关临床资料进行分析.结果 重新分类后,透明性肾细胞癌14例,乳头状肾细胞癌23例,嫌色性肾细胞癌34例,肾集合管癌1例,未分类的肾细胞癌1例,混合型肾细胞癌5例（透明及乳头状肾细胞癌混合型2例,透明及嫌色性肾细胞癌混合型2例,乳头状及嫌色性肾细胞癌混合型1例）,肾嗜酸细胞瘤1例.结论 以往,部分嫌色性肾细胞癌与乳头状肾细胞癌易被诊断为颗粒细胞癌,主要原因相似的嗜酸性颗粒样胞浆特点以及对嫌色性肾细胞癌及乳头状肾细胞癌的组织学特点认识不清.旧有诊断中颗粒细胞癌的结构特点可见于多种肾细胞癌,但不是一种独立的肾癌类型,应从分类中去除.对于混合两种或以上不同类型肾细胞癌的诊断标准有待定义与完善.Objective To compare the old classification and 2004 WHO histological classification of renal cell carcinoma, summarize the differences and possible reasons, and correct the traditional pathological concepts of kidney cancer. Methods Specimens of 79 cases histopathologically diagnosed as non-clear cell renal cell carcinomas after radical nephrectomy during 1998 to 2005 in Tianjin Medical University Cancer Hospital were reclassified according to the 2004 WHO renal cell carcinoma histological classification system. Results After reclassification, threr were 14 cases of clear cell renal cell carcinoma （CCRCC）, 23 cases of papillary renal cell carcinoma （PRCC）, 34 cases of chromophobe renal cell carcinoma （ChRCC）, one collecting duct renal cell carcinoma, one unclassified renal cell carcinoma,5 cases of mixed cell renal cell carcinoma （ CCRCC ＋ PRCC 2 cases, CCRCC ＋ ChRCC 2 cases, PRCC ＋ChRCC 1 case）, and one oncocytoma diagnosed. Conclusions Some chromophobe renal cell carcinomas and papillary renal cell carcinomas were easier to be diagnosed as granular cell renal cell carcinoma in the past. The eosinophilic cytoplasm similar to that in the granular cells, and some confusion between PRCC and ChRCC are the main reasons. The cellular characteristic features of granular renal cell carcinoma can be found in many types of renal tumors. Granular cell renal cell carcinoma is not an independent entity,therefore, it should be removed from the histological classification of renal cell carcinoma. The diagnosis standard of mixed renal cell carcinoma （MRCC） need to be determined and consummated.

关 键 词：肾肿瘤 组织学 病理学 诊断 

分 类 号：R686[医药卫生—骨科学]