原发性甲状腺样滤泡性肾细胞癌的临床病理特征及影像表现  

Clinicopathological and Radiologic Characteristics of Primary Thyroid-like Follicular Renal Cell Carcinoma

作　　者：刘峰[1] 李睿弢[1] 田昭俭[1] 岳振营[2] 吕海莲[1] 杨新国[1] LIU Feng;LI Rui-tao;TIAN Zhao-jian;YUE Zhen-ying;LV Hai-lian;YANG Xin-guo(Department of Radiology,Shengli Oilfield Central Hospital,Dongying 257034,Shandong Province,China;Department of Pathology,Shengli Oilfield Central Hospital,Dongying 257034,Shandong Province,China)

机构地区：[1]山东省东营市胜利油田中心医院放射科,山东东营257034 [2]山东省东营市胜利油田中心医院病理科,山东东营257034

出　　处：《罕少疾病杂志》2023年第2期50-52,共3页Journal of Rare and Uncommon Diseases

基　　金：国家临床重点专科基金项目[国卫办医函(2018)292号]。

摘　　要：目的探讨原发性甲状腺样滤泡性肾细胞癌(TLFRCC)的临床病理及影像学表现,提高对本病的认识。方法回顾性分析本院经手术病理证实的2例TLFRCC的临床病理和影像学表现,结合文献对其临床病理特征及影像表现进行总结分析。结果本组2例TLFRCC均为女性,年龄分别为54岁、66岁,病变均位于单侧肾,左肾右肾各1例。肿瘤最大径分别为2.5cm和2.6cm。2例CT平扫均表现为肾下极突出肾脏轮廓之外结节状肿块,1例呈略高密度,另1例呈等密度;3期增强扫描2例病灶边界清楚,1例呈不均匀明显强化,另1例未见明显强化。1例行MRI平扫,T_(2)WI呈混杂高信号及颗粒状等低信号,边缘清楚见低信号环,T_(1)WI呈等、低信号,DWI未见明显扩散受限,ADC呈高信号。术中2例肿瘤均为肾实质突出肾脏表面具有包膜的单发结节状肿物,镜下见肿瘤细胞由大小不一的具有特征性的甲状腺滤泡样结构组成,滤泡样结构内见大量甲状腺胶质样物质沉积。免疫表型,肿瘤细胞强阳性表达CK7、PAX-8,而TTF-1、TG、AMACR、RCC表达缺失。结论TLFRCC是一种肾原发罕见的上皮性低度恶性肿瘤,具有类似甲状腺滤泡癌的病理形态特征。确诊需要结合临床病史、影像学检查、病理形态学及免疫组织化学检查。Objective To investigate the clinicopathological features and radiologic findings of Primary Thyroid-like Follicular Renal Cell Carcinoma(TLFRCC),and to make a further understanding of the disease.Methods Two patients with pathologically proved TLFRCC are reviewed retrospectively.CT,MRI,HE and immunohistochemistry with the related literature are reviewed.Results The patients of these two cases are both females,aged 54 and 66 years.The lesions are located in unilateral kidney,one in left,the other one in right.The maximum diameters of the tumors are 2.5 cm and 2.6 cm.Plain CT scans of the cases showed nodular mass outside the outline of the kidney with prominent subrenal pole.One case shows slightly high density and the other shows equal density.As the 3-phase contrast-enhanced scans display,these two cases had clear lesion boundary.One case shows uneven and obvious enhancement,and the other one has no obvious enhancement.The MRI plain scan is implemented by us for one of the cases.The corresponding T_(2)WI shows mixed high signal and granular low signal while the low signal ring can be clearly observed at the edge.T_(1)WI shows equal and low signal.DWI shows no obvious diffusion limitation.And ADC shows high signal.Gross examination shows that the renal parenchyma is prominent.There is a single nodular mass with capsule on the surface of the kidney.Under the microscope,the tumor cells are composed of characteristic thyroid follicular like structures of different sizes.Moreover,a large amount of thyroid colloid was deposited in the follicular.Immunophenotype,tumor cells strongly express CK7 and Pax-8,while TTF-1,TG,AMACR and RCC are absent.Conclusion TLFRCC is an extremely rare subtype of renal cell carcinoma,with morphological characteristics similar to thyroid follicular carcinoma.The diagnosis needs comprehensive evaluation by combining its clinical history,imaging examination,pathomorphology and immunohistochemistry.

关 键 词：癌 肾细胞 滤泡癌 甲状腺样 免疫组织化学 体层摄影术 X线计算机 磁共振成像 

分 类 号：R737.11[医药卫生—肿瘤]