双侧重复肾输尿管畸形合并右侧后肾腺瘤1例并文献复习  

The right renal metanephric adenoma with bilateral duplex kidney and ureter: a case report and literature review

作　　者：李玉梅 曹志星 吴晓媚 谢亚峰 赵晔 周宾 吕威 莫海波 

机构地区：[1]广东省珠海市第二人民医院病理科,广东珠海519510

出　　处：《临床与病理杂志》2015年第4期685-689,共5页Journal of Clinical and Pathological Research

摘　　要：目的:探讨后肾腺瘤的临床、影像学及病理学特点。方法:应用光镜观察及免疫组织化学方法,对1例发生在右侧重复肾输尿管畸形切除术后的后肾腺瘤进行临床病理分析,并复习相关文献。结果:肿瘤位于肾实质,界限清楚;镜下瘤细胞胚胎样,呈小腺泡状、不规则管状排列,可见乳头状结构及肾小球样结构,间质少,见砂粒体,细胞小,无异型性及核分裂像;免疫组织化学结果:Vimentin、CKpan、W T-1、CD57阳性,EMA、CK7、CD10、CD34、NSE、AMACR阴性,Ki-67增殖指数小于1%;术后随访40个月,无复发及转移。结论:后肾腺瘤的临床及影像学表现无特异,诊断需依据其独特的组织学特征,并结合免疫组织化学染色;治疗上,宜采取保留肾单位的手术,但其生物学行为及细胞起源的不确定性,需进行长期的随访。Objective： To explore the clinical, imaging and histopathological features of metanephric adenoma（MA）. Methods： The reported MA was found 7 years after the resection of right duplex kidney and ureter. The resected tissue was analyzed by microscope and immunohistochemical stain, with literature review. Results： q-he tumor was located in renal parenchyma with clear border. Histologically, the tumor was composed of acinus, irregular tubules and papillary architectures lined by small embryonic cells. Also glomeruloid bodies were focally seen. The stroma was essentially acellular, and focally psammoma bodies were observed. Immunohistochemical study showed that the tumor cells were positive with Vimentin, CKpan, WT-1, and CD57, and negative with EMA, CK7, CD10, CD34, NSE and AMACR. The proliferative index of Ki-67 staining was less than 1%. No local recurrence and distant metastasis occurred during 40 months＇ postoperative follow-up. Conclusion： The Clinical and imaging manifestations of MA is not typical, and the diagnosis should be based on histological features and immunohistochemical stain. Nephron-sparing surgery is eligible for the treatment of MA. Considering the uncertainty of the biological behavior and cellular origin ofMA, a long-term follow up is necessary.

关 键 词：后肾腺瘤 重复肾输尿管 诊断 鉴别诊断 

分 类 号：R691.1[医药卫生—泌尿科学] R737.11[医药卫生—外科学]