多房性囊性肾细胞癌与囊性肾瘤临床病理观察

摘要

目的：探讨多房性囊性肾脏病变临床病理特征、鉴别诊断以及治疗与预后。方法对1例多房性囊性肾细胞癌（multilocular cystic renal cell carcinoma ，MCRCC）与1例囊性肾瘤（cystic nephroma， CN）标本进行临床病理学观察，并结合国内外文献进行复习。结果例1男性，45岁，CT发现右肾下极6cm ×5cm ×4．5cm占位。镜检：肿瘤为多房性囊性结构，囊壁为纤维结缔组织，囊内衬单层立方上皮，胞浆透亮，可见多灶性透明细胞聚集区。免疫组化：肿瘤细胞CK（＋），EMA（＋），CD68（）。病理诊断：（右肾）MCRCC。术后随访6年，目前情况良好。例2女性，33岁，CT示左肾下极2．5 cm ×2 cm ×1．7 cm占位。镜检：囊壁为纤维性分隔，内衬单层上皮，细胞扁平至柱状，部分呈鞋钉样，有轻度异型性。免疫组化：肿瘤细胞CK（＋），EMA（＋）。病理诊断：（左肾） CN。术后随访7年，目前情况良好。结论 MCRCC与CN都是比较少见的肾脏肿瘤，在大体形态和影像学上具有相似性，病理诊断是关键，两者预后都较好。%Objective To study the clinicopathologic features , differential diagnosis , treatment and prognosis of multilocular cystic kidney disease .Methods One case of multilocular cystic renal cell carcinoma (MCRCC)and one case of cystic nephroma(CN)were observed and the literatures were reviewed.Results Case1, male, 45 years old , who was found by CT a lesion about 6cm ×5cm ×4.5cm in the inferior pole of the right kidney .Microscopy:the tumor is in cystic structure consist of fiber connective tissue lining with single-layer cubical epithelium . The cytoplasm of tumor cells is bright and the clear cell clusters are visible . Immunohistochemistry:tumor cells CK ( +) , EMA ( +) , CD68 (-) .Pathological diagnosi ( right kidney ) MCRCC.Six years follow-up after operation, the patient is now still in good condition .Case 2, female, 33 years old, CT examination shows a tumor of 2.5cm ×2cm ×1.7cm size in the inferior pole of left kidney .Microscopy:the cysts wall were consist of fiber tissue , lining with simple epithelium , flat to columnar , some like boots nail with mild atypia.Immunohistochemistry: tumor cells CK ( +), EMA ( +).Pathological diagnosi ( left kidney ) CN.Seven years past , the patient is good now .Conclusions Both CN and MCRCC are uncommon renal tumor .There are similar symptoms and images between them .Pathology is the key to diagnosis .Both of them have good prognosis .