透明细胞肾细胞癌(CCRCC)合并多发性乳头状瘤(PA)1例

 肾脏的乳头状瘤（papillary adenoma，PA）是一种镜下常表现为乳头状或小管状结构的肿瘤，直径小于15 mm。透明细胞肾细胞癌（clear cell renal cell carcinoma，CCRCC）是最常见的肾脏恶性肿瘤，镜下肿瘤常由含透明或嗜酸胞浆的肿瘤细胞构成。这两种肿瘤同时发生的情况较为罕见，现报道1例发生于肾脏的CCRCC同时合并多发性PA的病例。该病例中CCRCC和PA均表现为典型的镜下特征，且未出现第3、7、17号染色体的扩增，影像科和泌尿外科医师在术前及术中只注意到CCRCC而忽视了多发性PA。多发性PA中有些病灶极其微小，只有显微镜下检查才能发现。该病例提示：接受部分肾切除术的CCRCC患者可能合并PA，术前应做好排查工作，病理检查关注标本主要病变的同时重视其他可能的病灶。

Multiple papillary adenomas (PA) coexisting with clear cell renal cell carcinoma (CCRCC):a case report

Papillary adenoma (PA) of kidney is defined as a lesion measuring less than 15 mm and featuring papillary or tubular architecture along with nuclei of low grade.Clear cell renal cell carcinoma (CCRCC) is the most common seen group of malignant neoplasms consists of cells with clear or eosinophilic cytoplasm.The coexistence of these two kinds of tumor is rare and was only reported in one piece of literature to date.We report a thought-provoking case in which CCRCC is coexisting with multiple PAs.The CCRCC shows no difference with other common cases while the PAs share the same clinical and pathological features with other ones and demonstrates no amplifying of 3,7 or 17 chromosome.However,the multiple PAs were neglected by imaging doctors and surgeons,and some tiny lesions were not found until the observation under microscope.This case reminds that patients accepting partial nephrectomy for CCRCC may have PAs,so attention should be paid to the image studies along with routine pathological examination of kidney for that there may exists two or more kinds of lesions.