肾集合管癌临床病理分析

摘要

Objective:To investigate the collecting duct carcinoma of the kidney ( collecting duct rare carcinoma, CDC ) in diagnosis and differential diagnosis of clinical and pathological features. Methods:clinical pathology and electron microscope and immunohistochemistry was performed on 5 patients with CDC,and review of the literature. Results:the tumor cells were tubular,papillary and cord like arrangements, with interstitial fibrosis and inflammatory cell reaction, tumor adjacent to the collecting duct epithelial cells were atypical;immunophenotyping showed the tumor cells CKpan,CK 7, CK 19,PAX 8,EMA were(+),part vimentin(+),CK 20(2/5),CD 10,P 63,Villin(-). Electron mi-croscope observation of tumor cell cytoplasm is rich,lumen meet a few bad development of short and small microvilli,visible bad development of cellular connection. Conclusion:CDC is a highly malignant renal epithelial tumors, are rare, misdiagnosis, diagnosis should be differentiated with papillary renal cell carcinoma,adenoid structure of urothelial carcinoma,renal medullary carcinoma and metastatic ad-enocarcinoma,immunohistochemistry and electron microscopy is helpful in the diagnosis and differential diagnosis.%目的：：探讨罕见的肾集合管癌( collecting duct carcinoma,CDC)的临床病理特征、诊断及鉴别诊断。方法：对5例 CDC 进行临床病理学和电镜观察及免疫组化标记,并复习相关文献。结果：肿瘤细胞呈腺管状、乳头状及条索状排列,伴间质纤维化和炎症细胞反应,肿瘤旁集合管上皮细胞可见异型增生；免疫表型示肿瘤细胞CKpan、CK 7、CK 19、PAX 8、EMA均(+),vimentin部分(+)(2/5),CK 20、CD 10、P 63、Villin均(-)。电镜观察肿瘤细胞胞浆较丰富,细胞腔面见少量发育不好的短小微绒毛,可见发育不好的细胞连接。结论：CDC是一种高度恶性的肾上皮性肿瘤,较罕见,易误诊,诊断时应与乳头状肾细胞癌、腺样结构的尿路上皮癌、肾髓质癌及转移性腺癌等鉴别,免疫组化及电镜有助于诊断及鉴别诊断。