富含脂肪成分的肾混合性上皮和间质肿瘤临床病理观察  

Fat-predominant mixed epithelial stromal tumor(MESTK):a case report and literature review

作　　者：韩桂燕 付伟伟[1] 李玉军[1] 张伟[1] 李宏[1] 

机构地区：[1]青岛大学医学院附属医院病理科,山东青岛266003

出　　处：《诊断病理学杂志》2016年第5期369-373,共5页Chinese Journal of Diagnostic Pathology

基　　金：山东省科技发展计划项目(2013GSF11866)

摘　　要：目的探讨富含脂肪成分的肾混合性上皮间质肿瘤(MESTK)的临床病理特点,以期提高对该罕见疾病的认识。方法应用组织病理学及免疫组化方法观察1例肾混合性上皮和间质肿瘤的特点,并结合文献探讨其诊断与鉴别诊断。结果患者女性,35岁。经查体发现左肾盂实性占位。大体肿块呈分叶状,切面呈实性、灰白色,可见散在小囊腔。镜下肿瘤主要由上皮和间质成分构成,上皮成分由大小不一的被覆不同上皮的腺体组成,部分腺管扩张呈微囊,伴周围丰富的间质,间质成分为束状平滑肌样或卵巢间质样,并见多量脂肪细胞分布于其中。上皮和间质细胞均无明显异型性及核分裂象。免疫组化:上皮细胞CK广泛(+),小腺管区PAX-8局灶(+),间质细胞ER、PR、SMA、desmin和CD10(+)。结论 MESTK是一种罕见的肾肿瘤,具有独特的组织病理学特点,罕有多量脂肪细胞分布于间质内,此例为国内首次报道。需与肾其他富含脂肪成分、伴有囊性变或具有上皮和间质结构的肿瘤相鉴别。Objective To explore the clinical and pathologic features of mixed epithelial and stromal tumor of the kidney which was rich in fat ingredients and improve the recognization of the rare disease. Methods Histopathological and immunohistochemical characteristics of this case of renal mixed epithelial stromal tumor were observed and combining with rebiewed literature its pathological morphology and differential diagnosis were discussed. Results A 35-year-old woman was found a left pelvis solide mass in a routine examination. Grossly the tumor had solid and cyst appearance with a gray and lobulated cut surface. Microscopically,the tumor demonstrated an admixture of spindle cells and epithelial elements consisting of different sized glands with variable lining. Part of cystically dilated glands was surrounded with rich stroma cells resembling ovarian stroma or bundles of smooth muscle and many fat cells distributing in it could be observed. Both epithelial and mesenchymal cells had no obvious atypia and fission. Immunohistochemically,the epithelial elements were positive for CK diffusely and PAX8 focally,mesenchymal components were positive for ER,PR,SMA,Desmin and CD10.Conclusion MESTK is a rare renal tumor which has unique histopathologic features. Distribution of rare large amount of fat cells in the strom of this case is the first reported in China. It should be distinguished from other tumours which possess characteristic of fatty ingredients,cystic changes or double differentiation of epithelial and stromal components.

关 键 词：肾肿瘤 混合性上皮间质肿瘤 脂肪 

分 类 号：R737.11[医药卫生—肿瘤]