肾脏黏液性管状和梭形细胞癌的临床病理特征

目的 探讨肾脏黏液性管状和梭形细胞癌(MTSCC)的临床病理特征、组织发生和预后.方法 收集5例肾MTSCC进行组织病理学、组织化学、免疫组织化学(EnVision)及电镜观察,随访3～52个月,并复习相关文献.结果 5例患者女性4例,男性1例.3例因腰酸、腰部不适而就诊,2例系体检偶然发现.大体观察:肿瘤与周围组织分界清楚,切面实性,灰白灰黄或灰红色,1例高级别MTSCC切面可见明显坏死.镜下观察:低级别MTSCC主要由小管状结构、梭形细胞及黏液样基质构成,细胞形态较温和,核分裂象稀少.1例高级别MTSCC细胞呈梭形或多边形,未见小管状及黏液样基质,细胞明显异形,核分裂象易见.免疫组织化学染色显示,波形蛋白(5/5)、CKpan(5/5)、CK7(5/5)、CK19(5/5)、34βE12(1/5)、上皮细胞膜抗原(EMA,5/5)、E-cadherin(3/5)、CD10(1/5)、P504S(5/5)、CAM5.2(5/5)有阳性表达;Ki-67阳性指数4例小于或等于5%,1例高级别者达15%.超微结构显示管腔内可见短的微绒毛,局部核膜有内陷.4例随访3～52个月,未见肿瘤复发和转移.结论 肾MTSCC好发于女性,是一种罕见的肾肿瘤,临床多为低级别MTSCC,预后良好;对高级别MTSCC患者因其预后较差,手术后须密切随访观察.

Abstract：

Objective To investigate the clinicopathological features, histogenesis and prognosis of mucinous tubular and spindle cell carcinoma (MTSCC). Methods Five MTSCCs were studied with histochemical, immunohistochemical staining, electron microscopy, and review of the related literatures. Results Four cases of MTSCC were females and one was male. Three patients presented with flank discomfort and two were incidentally found with health examination. In gross examination, the tumors were circumscribed. The cut surface was solid, gray-white, yellow or red. Necrosis was present in one case of high-grade MTSCC. Microscopically, low-grade MTSCC was mainly consisted of tubular, spindle cell and mucinous stroma with relatively bland morphology, and mitoses were rare. While in the high-grade area of one case, the cells were spindle or polymorphic with severe atypia and high mitotic activity, without mucinous stroma and tubular structure. Mucin was positive for Alcian blue. The neoplastic cells were positive for vimentin (5/5), CKpan (5/5), CK7 (5/5), CK19 (5/5), 34βE12 (1/5), EMA (5/5), E-cadherin (3/5),CD10 (1/5), P504S (5/5), and CAM5.2 (5/5). The Ki-67 index was low (≤5%) in the low-grade component, while it was high (15%) in the high-grade component. Ultrastructural study showed short microvilli along glandular lumens. The nuclear membrane was focally invaginated. Four cases were followed up for 3 to 52 months, and recurrence and metastasis were not found.Conclusions MTSCC occurs predominantly in females and it is a rare kidney neoplasm. Most of MTSCCs are low-grade and the prognosis is relatively good. However, the patients of high-grade MTSCC should be closely followed up.

Mucinous tubular and spindle cell carcinoma of kidney: a clinicopathological study

Objective To investigate the clinicopathological features, histogenesis and prognosis of mucinous tubular and spindle cell carcinoma (MTSCC). Methods Five MTSCCs were studied with histochemical, immunohistochemical staining, electron microscopy, and review of the related literatures. Results Four cases of MTSCC were females and one was male. Three patients presented with flank discomfort and two were incidentally found with health examination. In gross examination, the tumors were circumscribed. The cut surface was solid, gray-white, yellow or red. Necrosis was present in one case of high-grade MTSCC. Microscopically, low-grade MTSCC was mainly consisted of tubular, spindle cell and mucinous stroma with relatively bland morphology, and mitoses were rare. While in the high-grade area of one case, the cells were spindle or polymorphic with severe atypia and high mitotic activity, without mucinous stroma and tubular structure. Mucin was positive for Alcian blue. The neoplastic cells were positive for vimentin (5/5), CKpan (5/5), CK7 (5/5), CK19 (5/5), 34βE12 (1/5), EMA (5/5), E-cadherin (3/5),CD10 (1/5), P504S (5/5), and CAM5.2 (5/5). The Ki-67 index was low (≤5%) in the low-grade component, while it was high (15%) in the high-grade component. Ultrastructural study showed short microvilli along glandular lumens. The nuclear membrane was focally invaginated. Four cases were followed up for 3 to 52 months, and recurrence and metastasis were not found.Conclusions MTSCC occurs predominantly in females and it is a rare kidney neoplasm. Most of MTSCCs are low-grade and the prognosis is relatively good. However, the patients of high-grade MTSCC should be closely followed up.