肾血管平滑肌脂肪瘤临床病理分析

摘要

Objective:To observe the clinicopathologic characteristics of renal angioleiomyolipoma and review re-lated articles,then discuss its diagnosis and differential diagnosis. Methods:Observing the clinicopathology and im-munohistochemical staining of 18 renal angioleiomyolipoma cases,following up them and reviewing related articles. Results:Six cases were classified as classical type,5 cases as liomyoma type,3 cases lipomyoma type,4 cases epithe-lioid type. One of the classical type case was multiple angioleiomyolipoma. Microscopic examination:Angioleiomyoli-poma was composed of thick-walled vessels,smooth muscles and adipose tissues by different proportions. The smooth muscle cells showed fusiform shape/epithelium structure and heteromorphism invariably. The epithelioid cells have plenty transparence/acidophilia cytoplasm,big anachromasis nucleus and large manifest nucleolus,polynuclear tumor cells/ganglion-like cells can also be seen. IHC results:The positive markers were HMB45,Mart-1,Vimentin,SMA, Desmin,S-100,Ki-67 were positive in different degree,the vessels showed CD34 positive,and p-CK,EMA were negative. Conclusion:Renal AML is benign tumor,while giga-tumor volume,epithelioid cell appearance,accompany with necrosis,nuclear atypia,high nuclear proliferation and plenty mitosis,may consider its malignancy,thus,should be closely followed up.%目的：：观察肾血管平滑肌脂肪瘤( AML)的临床病理特点并复习相关文献,探讨肾AML的诊断及鉴别诊断。方法：对18例肾AML进行临床病理学及免疫组化观察、随访,并复习相关文献。结果：6例属经典型,5例属肌瘤型,3例属脂肪瘤样型,4例为上皮样型。经典型中1例为多发性。镜检：肿瘤由不同比例的厚壁血管、平滑肌和脂肪组织组成,平滑肌细胞呈梭形/上皮样,可有一定异型性；上皮样细胞胞质丰富,透明/微嗜酸性,核大深染,核仁大而明显,可见多核瘤细胞/神经节样细胞。免疫组化：HMB45、Mart-1、Vimentin、SMA均阳性,CD34血管阳性,p-CK、EMA阴性,Desmin、S-100、Ki-67不同程度阳性。结论：肾AML是良性肿瘤；然而,当肿瘤体积巨大、出现上皮样细胞成分并伴有坏死、核异型性明显、核增殖活性高及核分裂象多时,应考虑为恶性,需长期密切随访。