多房囊性肾细胞癌7例临床病理分析

摘要

目的 探讨多房囊性肾细胞癌 (multilocular cystic renal cell carcinoma,MCRCC)的临床病理特征、诊断及鉴别诊断.方法对7例MCRCC进行光镜观察、免疫组化标记,并复习相关文献.结果 患者均为成人,男性6例,女性1例,年龄29～75岁(平均52岁).超声和(或)CT示多囊性肿块,边界清楚,其间隔内未见膨胀性实性结节.眼观:肿瘤由纤维性假包膜围绕,切面见大小不等的囊腔,内含浆液性或血性液体.镜检:肿瘤囊壁被覆少许透明细胞或上皮缺如,核分裂少或无,呈Fuhrman核级Ⅰ级.囊内成分并非肿瘤性凝固性坏死而是蛋白样物,纤维性囊壁中发现透明细胞巢,使之成为形态学诊断线索.免疫组化标记透明细胞CD10、CK、vimentin阳性,CD68阴性.结论 MCRCC是一种罕见的肾细胞癌组织学亚型,预后良好.易与透明细胞肾细胞癌囊性变及囊性肾瘤等混淆.%Purpose To explore the clinicopathological features, diagnosis and differential diagnosis of multilocular cystic renal cell carcinoma ( MCRCC ). Methods Seven cases of MCRCC were reported by light microscopy and immunohistochemical study with review of related literatures. Results All patients were adults ( six males and one female ) and their ages ranged from 29 to 75 years ( mean, 52 years ). Ultrasonogram ( US ) and/or CT revealed a well-demarcated multicystic mass without expansile solid nodules in the thin septa. Grossly, the cut surface of the tumor showed small and large cysts which were filled with serous or hemorrhagic fluid and separated the tumor from the kidney by fibrous pseudocapsule. Microscopically, the cyst walls of tumors were often devoid of epithelium or occasionally covered with a few layers of clear cells showing Fuhrman grade 1 nuclear features with less mitotic activity. Meanwhile, no coagulative necrosis but proteinaceous components were found in all cases. Sometimes, the septa contained aggregates of epithelial cells with transparent cytoplasm. Thus, these characteristics of morphology strongly suggested as a diagnostic clue. Immunohistochemi-cally, the clear cell was positive for CD10, CK and vimentin, but negative for CD68. Conclusion MCRCC is a rare histological subtype of renal cell carcinoma with more favorable prognosis. It should be distinguished from some mimics such as clear cell renal cell carcinoma with cystic change and cystic nephroma.