16例后肾腺瘤的临床病理特点及鉴别诊断  

Clinicopathological features and differential diagnosis of metanephric adenoma: a report of sixteen cases

作　　者：席晨光[1] 范宇[1] 杨新宇[1] 刘漓波[1] 王静华[1] 胡帅[1] 李妍妍[1] 何群[1] 

机构地区：[1]北京大学第一医院泌尿外科,北京大学泌尿外科研究所,国家泌尿、男性生殖系统肿瘤研究中心,北京100034

出　　处：《北京大学学报（医学版）》2016年第4期598-602,共5页Journal of Peking University:Health Sciences

摘　　要：目的：探讨后肾腺瘤的临床病理特点及鉴别诊断要点。方法：回顾性分析2004年1月至2016年3月于北京大学第一医院治疗的16例后肾腺瘤患者的临床病理资料,结合文献讨论其发生的临床影像学特点、病理诊断、鉴别诊断、治疗和预后。结果：患者女性10例,男性6例,年龄14~83岁,平均年龄33.7岁。手术以肾部分切除为主,大体上肿瘤均位于肾实质的皮质区,3例突入肾窦,镜下观察肿瘤细胞排列成小腺泡状、乳头状及肾小球样结构,可见砂砾体形成。免疫组织化学染色显示,波形蛋白表达阳性率100%,CD57表达阳性率94%,WT1表达阳性率63%,广谱CK（AE/AE3）表达阳性率75%,CK7、AMACR表达率分别为19%、13%,CD10、NSE、CD56均阴性。16例患者随访1~125个月,均无复发或转移。结论：后肾腺瘤术前影像学诊断良性肿瘤特征不显著,诊断需依据独特的病理学特征,免疫组织化学染色CD57阳性是后肾腺瘤诊断和鉴别诊断的有用指标,以肾部分切除为主的外科治疗可达到治愈,临床预后好。Objective ： To study the clinicopathological features and differential diagnosis of metanephric adenoma （MA）. Methods： The clinieopathological data of 16 cases with MA diagnosed and treated in Peking University First Hospital from 2004 to 2016 were retrospectively analyzed, and the clinical characteristics, pathologic parameters, differential diagnosis, treatment options and prognosis of MA were analyzed with literature review. Results： The patients included 10 females and 6 males. The age of patients ranged from 14 to 83 years （mean = 33.7 years）. The partial nephrectomy was carried out for most patients. All cases were located in renal codex with 3 growing into the renal sinus. Histologically, the tumor was composed of tubules, papillary or glomeruloid structures and psammoma bodies were focally seen. Immunohistochemical study showed that all the cases expressed vimentin, and 94% cases expressed CD57, 63% WT1, 75% AE1/AE3, 19% eytokeratin 7 （CK7） and 13% a-methylacyl-CoA racemase （AMACR）, and negative expressions for MA included CD10, neuron-specific enolase （NSE） and CD56. Follow-up information from 1 to 125 months was available in all the patients; and none of the patients showed any evidence of recurrence and metastasis. Conclusion： The benign tumor characteristics of MA are not obvious for preoperative imaging diagnosis, and the diagnosis of MA should be based on the unique pathological features. Positive immunostain of CD57 is a useful indicator for MA diagnosis and differential diagnosis. The partial nephrectomy surgical treatment can achieve good clinical cure with good prognosis.

关 键 词：肾肿瘤 腺瘤 诊断 鉴别 免疫组织化学 预后 

分 类 号：R682.3[医药卫生—骨科学]