成人肾母细胞瘤临床病理观察并文献复习  

Adult Wilms' tumor:a clinicopathological case study and literature review

作　　者：张修云[1] 袁静萍[1] 袁修学[2] 高利昆[1] Zhang Xiuyun Yuan Jingping Yuan Xiuxue Gao Likunl(Department of Pathology, Renmin Hospital of Wuhan University, Wuhan 430060, China Medical College of Wuhan University of Science and Technology, Wuhan 430065, China)

机构地区：[1]武汉大学人民医院病理科,武汉430060 [2]武汉科技大学基础医学院,武汉430065

出　　处：《中国组织化学与细胞化学杂志》2016年第6期535-539,共5页Chinese Journal of Histochemistry and Cytochemistry

基　　金：湖北省教育厅科学研究计划指导性项目(B2015350)

摘　　要：目的探讨成人肾母细胞瘤(Wilms'Tumor,WT)临床病理特征、诊断、治疗及预后。方法应用光镜及免疫组织化学分析1例AWT临床病理特点,并复习相关文献。结果患者男性,62岁,肾结石碎石后间断性无痛性肉眼血尿1年余。切除肿瘤组织学显示:肿瘤由未分化的胚芽组织,上皮样成分和间叶成分组成,上皮成分可见鳞状上皮及分化好的小管和乳头结构,间叶成分为软骨、横纹肌,另见大量间变细胞,伴大片坏死。免疫组织化学观察发现肿瘤细胞vimentin、PCK和CD99阳性,EMA、NSE、desmin、myogenin和WT-1部分阳性,Syn、CgA、S-100、MyoD1和TTF1均阴性。结论肾母细胞瘤是儿童常见的原发恶性肾肿瘤,但在成人是非常罕见的,老年患者诊断和治疗更加困难,依据临床和病理组织学特点可准确诊断,早期积极采取多模式治疗,可提高患者生存率。Objective To investigate the pathological characteristicss, diagnosis and treatment, prognosis of Adult Wilms＇ Tumor （ AWT）. Methods We analyzed the clinical pathological characteristics of a case of AWT by light microscopy and immunohistochemistry （IHC） and reviewed related literature. Results A 62-year-old male patient had intermittent painless gross hematuria for one year after kidney stone lithotripsy. Histologically, the tumor was composed of undifferentiated embryonic bud, mesenchymal and epithelial components. In the part of epithelial area, squamous epithelium, well differentiated tubules and papillary structures were observed, and in the mesenchymal were large numbers of anaplastic cells with massive necrosis besides cartilage and striated muscle. IHC showed the tumor cells were positive for Vimetin, PCK, CD99; partially positive for EMA, NSE, Desmin Myogenin and WT-1; while negative for Syn, CgA, S-100, MyoD1 and TI＇F1. Conclusion WT is a type of primary malignant renal tumors common in children, rare in adults, and even more difficult to diagnose and treat in the elderly. Accurate diagnosis based on clinical and histopathological features combined with early and active muhimodal treatment can improve the survival rate of AWT patients.

关 键 词：成人肾母细胞瘤 病理诊断 治疗 

分 类 号：R737.11[医药卫生—肿瘤]