肾脏黏液性管状和梭形细胞癌４例报告

目的　探讨肾脏黏液性管状和梭形细胞癌的临床病理特征。方法　回顾分析４例肾脏黏液性管状和梭形细胞癌患者的临床资料。女性３例,男性１例;年龄３５～５６岁,平均４１岁;左肾２例,右肾２例;肾上极３例,肾下极１例;肿瘤直径３.５～６.５ｃｍ,平均５５ｃｍ;无明显临床症状及体征,均为体检发现。Ｂ超检查提示,２例肾囊实性占位,为良性肿瘤;２例为厚壁型肾囊肿。ＣＴ检查提示,３例肾囊实性占位,为良性肿瘤;１例为厚壁型肾囊肿。２例行ＭＲＩ检查提示,肾脏囊实性占位,为良性肿瘤。结果　４例患者均予手术治疗,术中发现肿块与肾组织的界限清楚,易分离;肿块呈囊实性,囊壁厚薄均匀,组织致密且内壁光滑。术后病理组织学检查示：２例为低度恶性上皮细胞肿瘤,１例为恶性肿瘤（透明细胞癌不排除）,另１例为肾脏黏液性管状和梭形细胞癌。结论　肾脏黏液性管状和梭形细胞癌是一种具有良性肿瘤生长特性的低度恶性倾向的肿瘤。     

肾脏黏液性管状和梭形细胞癌的临床病理学探讨

目的探讨肾脏黏液性管状和梭形细胞癌的临床病理学特征及诊断、鉴别诊断要点。方法对2例肾脏黏液性管状和梭形细胞癌进行临床病理学及免疫组织化学分析。结果2例肾脏黏液性管状和梭形细胞癌患者，临床症状无特异性。肿瘤与周嗣组织分界清楚。镜下肿瘤呈不规则管状结构伴黏液样间质，瘤细胞呈立方形或梭形，胞浆嗜酸，核呈低级别。无核分裂或少见，无病理性核分裂。免疫组化染色EMA、AE1／AE3、Vim均阳性表达，3413E12弱或灶区阳性，S-100、SMA、HMB45、CD15、CgA及SYN均阴性，NSE在1例中有弱的表达。结论肾脏黏液性管状和梭形细胞癌是极为罕见的，明确该肿瘤的组织起源及病理特征，对于诊断及鉴别诊断有重要意义。     

肾脏黏液样小管状和梭形细胞癌1例并文献复习

目的探讨肾脏黏液样小管状和梭形细胞癌的临床特点、病理组织学特征、鉴别诊断、治疗与预后。方法分析重庆医科大学附属江津区中心医院1例肾脏黏液样小管状和梭形细胞癌的临床表现、病理组织学特点及免疫表型, 并复习国内外相关文献。结果该患者肿瘤呈膨胀性生长, 与周围肾脏组织界限清楚, 肿瘤由管状结构、梭形细胞及黏液样的间质构成, 间质出现出血、灶性坏死、泡沫细胞聚集。肿瘤细胞核级别低, 核分裂象罕见。免疫组织化学表型:CKpan、EMA、Vimentin、CK7、CK19、P504s和CK18均为阳性;RCC、CD10、CD117、CD15、CD56、Syn、CgA和Villin均为阴性。患者术后随访1年, 无复发和转移。结论黏液样小管状和梭形细胞癌是一种罕见的低级别多形性肾上皮肿瘤, 具有独特的病理组织学特点, 预后较好。     

肾黏液样小管状和梭形细胞癌临床病理观察

 目的 探讨肾黏液样小管状和梭形细胞癌的临床病理特点及鉴别诊断。 方法 观察2例肾黏液样管状和梭形细胞癌的临床资料、组织病理学及免疫组织化学特点,并复习相关文献。 结果 患者男、女各1例,年龄分别为66岁和54岁。1例因体检被发现,另1例因贫血就诊。病理检查：肉眼瘤组织切面呈实性、灰白色,边界多清楚,未见囊性变。镜下瘤组织由多少不一的小管状和梭形细胞区构成,间质富含黏液。瘤细胞部分呈立方状,胞浆透明或弱嗜酸颗粒状,核圆形或不规则形,核分裂相少见。部分细胞梭形,束状或编织样排列,似平滑肌瘤。1例以立方状细胞成分为主,另1例以梭形细胞成分为主。免疫组织化学：2例瘤细胞均呈CK(AE1/AE3)、EMA、Vimentin阳性,其中1例并呈Syn局灶阳性;而desmin、CgA、S－100、SMA、CD117、CD34、CD10、 HMB45、p53、ER及PR均阴性,Ki67指数均小于1％;术后分别随访7月和11月,均未见复发和转移。 结论 肾黏液性管状和梭形细胞癌为罕见的肾脏低度恶性肿瘤,病理诊断时需与其他肾肿瘤鉴别。     

肾黏液性小管状和梭形细胞癌临床病理特征（附1例报告并文献复习）

肾脏黏液性小管状和梭形细胞癌（mueinous tubular and spindle cell carcinoma,MTSCC）是2004年WHO泌尿和男性生殖系统肿瘤分类新确立的一种区分于肾脏其它肿瘤的低度恶性肾上皮性肿瘤,临床少见,易于与恶性度高的肉瘤样癌、集合管癌等相混淆,因此临床和病理医师很有必要加深对此病的认识。现报道本院2008年3月收治的1例已确诊的MTSCC的临床资料,并结合相关文献总结其临床特点及病理组织学特征。     

肾脏黏液样小管状和梭形细胞癌1例临床病理观察并文献复习

目的：探讨肾脏黏液样小管状和梭形细胞癌（mucinous tubular and spindle cell carcinoma,MTSCCa）的临床病理特征和鉴别诊断要点及生物学行为。方法：对1例肾脏黏液样小管状和梭形细胞癌进行临床病理学观察和免疫表型研究并复习相关文献。结果：组织学显示肿瘤与周围肾组织分界清楚,切面实性、灰白色,肿瘤细胞多呈分支小管状、条索状排列,瘤细胞呈立方形、短梭形或低柱状,核圆形,大小相对一致。其他组织学表现：泡沫样巨噬细胞聚集、典型的透明细胞。免疫组化：肿瘤细胞CK（pan）、CK7、EMA、S-100、Vimen—tin阳性,SMA、Desmin、HCK（3413E12）阴性。结论：MTSCCa是一种罕见的低级别多形性肿瘤,组织学谱系在不断扩大。须与其他类型肾细胞癌鉴别。     

肾脏黏液样小管状和梭形细胞癌1例并文献复习

肾脏黏液样小管状和梭形细胞癌(mueinous tu-bular and spindle cell carcinoma of kidney,MTSCC-K)为低度恶性肾脏上皮肿瘤,是肾细胞癌的一种亚型,临床较为罕见,诊断困难.河北省沧州中西医结合医院收治MTSCC-K 1例,现结合相关文献报道如下.     

肾黏液小管状和梭形细胞癌一例并文献复习

肾黏液管状梭形细胞癌（mucinous tubular and spindle cell carcinoma，MTSCC）是指具有黏液样小管状和梭形细胞特点的肾癌，属于低级别的多形性肾脏上皮肿瘤，是一种非常少见的疾病。2007年10月，我院收治1例，报告如下。     

肾黏液小管状和梭形细胞癌1例报告并文献复习

目的:探讨肾黏液小管状和梭形细胞癌的临床病理特点及诊断、鉴别诊断.方法:对1例肾黏液小管状和梭形细胞癌进行临床病理学及免疫组织化学分析.结果:肾黏液小管状和梭形细胞癌患者临床无特殊表现,肿块与周围肾组织分界清楚.镜下观察:肿瘤呈不规则管状结构、间质呈黏液状,瘤细胞呈立方形或梭形、胞浆嗜酸,核形规则,核分裂少见.免疫组化染色AE1/AE3、EMA、Vimentin阳性表达,S-100、Desmin、SMA、CD34、HMB45、CD10、CD15、CgA、Syn、NSE、CD99阴性表达,Ki-67(3%).结论:肾黏液小管状和梭形细胞癌为少见肿瘤,明确该肿瘤的组织起源及病理特征,对于病理与临床诊断和鉴别诊断有重要意义.     

左肾黏液样小管状和梭形细胞癌1例并文献复习

目的:探讨肾黏液样小管状和梭形细胞癌患者的临床病理特征、治疗方法、疗效评价及预后。方法:回顾性分析我们收治的1例左肾黏液样小管状和梭形细胞癌患者的临床病理资料,并复习相关文献。患者女,54岁。因左侧腰部疼痛就诊,CT检查提示左肾下极见大小约44 mm×37 mm×31 mm团块样影。结果:行左肾部分切除术,术后病理诊断:左肾黏液样小管状和梭形细胞癌。免疫组化:肿瘤细胞P-CK（+）,EMA（+）,CD68（PGM1）（-）,CK7（+）,CAM5.2（-）,PAX-8（+）,CK20（-）,Inhibin-a（-）,RCC（-）,Vimentin（+）,CD10（-）。术后患者恢复良好,康复出院,随访至今未见复发及转移。结论:肾黏液样小管状和梭形细胞癌是一类罕见的肾细胞癌,恶性程度相对较低,预后相对较好,治疗方法目前主张手术治疗,但术后仍需注意规律随访。     

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

Mucinous tubular and spindle cell carcinoma is a rare tumor described in the 2004 WHO classification as a new entity with a relatively indolent behavior. We report a case of 53-year-old woman presenting a well-circumscribed tumor confined in the right kidney. The histologic findings consisted of tightly packed, small, elongated tubules separated by pale mucinous stroma. The tumor cells were cuboidal to spindled with eosinophilic cytoplasm and lower nuclear grade. The tumor was immunoreactive for cytokeratin CK 7 and CK19, and had negative staining for CD10. The morphological and immunohistochemical features were consistent with mucinous tubular and spindle cell carcinoma of kidney. Because of the favorable prognosis with this type of tumor, mucinous tubular and spindle cell carcinoma must be differentiated from papillary renal cell carcinoma, especially the variant with sarcomatoid dedifferentiation.     

Mucinous Tubular and Spindle Cell Carcinoma of the Kidney: A Case Report

Background

Mucinous tubular and spindle cell carcinoma (MTSC) is a rare and newly described type of renal cell carcinoma (RCC) with relatively indolent behavior. Although there are small series of this clinical entity in the literature, its histogenetic origin or line of differentiation remains unclear.

Patients and Methods

A 67-year-old woman was hospitalized for flank pain; imaging studies revealed a 6.5-cm mass in the right kidney. She was referred for fine needle aspiration of the lesion, which showed an epithelial tumor with round to oval nuclei associated with strands of metachromatic stromal tissue. Cytopathologic diagnosis was consistent with RCC.

Results

Subsequent right heminephrectomy was performed and the surgical pathology specimen showed an MTSC of the kidney. The patient has done well postoperatively, with 24 months of benign follow-up.

Conclusion

A precise differential diagnosis between MTSC and other renal carcinomas (e.g. papillary RCC with sarcomatoid transformation) is important for predicting patient prognosis. Even though MTSC is a rare cause of renal masses, it should be included in the differential diagnosis, especially because its imaging might be misleading, mimicking other benign renal diseases. Heminephrectomy is the preferred treatment in these subjects.Key Words: Mucinous tubular and spindle cell carcinoma, Renal carcinoma, Kidney     

Leiomyoma of the kidney

This is the report of a 27-year old woman with a symptomatic leiomyoma of the left kidney. Symptoms consisted of a mild discomfort at the left flank and a walking difficulty. A left radical nephrectomy was performed. The tumor measured 15 cm in its largest diameter and was composed of elongated cells which demonstrated positive reactivity with anti-desmin and anti-actin antisera and negative reactivity for S-100 protein and cytokeratins. Histologic differential diagnosis is with other spindle cell renal tumors such as leiomyosarcoma, mesoblastic nephroma, angiomyolipoma, fibroma, schwannoma and sarcomatoid renal cell carcinoma.     

Histological features of hypovascular or avascular renal cell carcinoma: the experience at four university hospitals

Background. We aimed to evaluate the pathological features of hypovascular or avascular renal cell carcinoma (RCC), by the retrospective review of the histological features that coincide with hypovascular or avascular RCC. Methods. Seven hundred and ninety-one patients who underwent both preoperative angiography and nephrectomy were examined. Of these patients, the 126 patients (15.9%) who showed hypovascular or avascular angiographic features were selected. Patients with hemorrhage or cyst(s), or with at least 50% necrosis or more in the tumor, and those with renal tumor metastatic to the kidney were excluded. The criteria proposed by the World Health Organization (1998) were adopted for the histological classification. Results. Papillary RCC was the most frequently observed hypovascular or avascular renal tumor (44 cases; 34.9%). The vascularity differed among the variants, i.e., some cases had a basophilic and solid variant with avascular features, while the remaining cases had wide stromal organization showing hypovascular features. The second most frequently observed hyporascular or avascular RCC was chromophobe cell carcinoma (35 cases; 27.8%). No difference in vascularity was detected between variants, except for 2 cases with sarcomatoid changes (avascular features). The third most frequently observed hypovascular or avascular RCC was cyst-associated RCC (29 cases; 23%). All of the 7 RCCs originating in a cyst showed avascular features, and the remaining 22 cystic RCCs showed hypovascular features. The remaining hypovascular or avascular RCCs were cases of clear cell carcinoma accompanied by sarcomatoid changes (8 cases; 6.3%), spindle cell carcinoma (5 cases; 4.0%), and collecting-duct carcinoma (5 cases; 4.0%). Conclusion. Hypovascular or avascular RCC can be categorized as non-clear cell carcinoma and some clear cell carcinoma accompanied by sarcomatoid changes. Received: December 7, 2001 / Accepted: February 18, 2002     

Sigmoid colon metastasis from sarcomatoid renal cell carcinoma

The sarcomatoid histological type of renal cell carcinoma is a clinically aggressive variant of parenchymal tumor, typically resistant to systemic treatment. We report the case of a 65-year-old female patient who had undergone a left radical nephrectomy for a sarcomatoid renal cell carcinoma together with enucleation of a mass of the right kidney and a contralateral nodule diagnosed as clear cell carcinoma. One year later lung, adrenal and sigmoid colon metastases from sarcomatoid renal cell carcinoma were detected and the patient was started on systemic immunotherapy with interleukin-2 and interferon-alpha. Computed tomography showed marked disease progression and the patient died 3 weeks later. Sigmoid colon metastasis from a primary sarcomatoid renal cell carcinoma has never been described in the literature.     

Sarcomatoid renal cell carcinoma: a comprehensive review of the biology and current treatment strategies

Recent advancements in the molecular characterization of renal cell carcinoma altered the classification system and now kidney cancer is divided into several distinct histologic subtypes. Although once a separate histologic category, sarcomatoid renal cell carcinoma is no longer considered a separate tumor type because it can occur with all histologic subtypes. Limited research on tumors with sarcomatoid change has led to minimal progress in the understanding and treatment of these tumors. Because the sarcomatoid variant of renal cell carcinoma can account for approximately one in six cases of advanced kidney cancer, we hope to familiarize clinicians with these tumors by describing the historic background, histologic features, molecular characterization, diagnosis, prognosis, treatment strategies, and active clinical trials of this aggressive type of tumor.     

肺肉瘤样癌的临床病理分析

目的探讨肺肉瘤样癌（pulmonary sarcomatoid carcinoma,PSC）的临床病理学特征,以提高对肺肉瘤样癌的早期诊断。方法回顾性分析6例肺肉瘤样癌的临床特征、影像学表现及病理学特征。结果6例患者最常见的呼吸系统临床表现为咳嗽、咳痰（100．O％）,其次5例为痰中带血（83．3％）和4例胸痛（66．7％）;影像学表现为增强CT扫描可见肿块实体部分轻度强化,转移淋巴结环形强化1例,肺内转移3例,纵隔转移2例,腋窝淋巴结转移2例,胸膜及胸壁侵犯3例,胸腔积液3例,肋骨转移1例,肝转移1例,脑转移2例;病理诊断3例为多形性癌,2例梭形细胞癌,1例为巨细胞癌。结论肺肉瘤样癌临床少见,其临床表现无特异性,肺部增强cT检查具有一定的特异性,诊断仍需依靠病理学检查,免疫组织化学有助于确诊。     

肾集合管癌10例分析

目的：研究肾集合管癌的临床病理特征。方法：回顾性研究肾集合管癌的临床及病理资料并进行随访。结果10例肾集合管癌占肾癌的2．1％,主要症状为血尿、腰腹痛。9例行肾癌根治术,1例行肿瘤剜除术。肿瘤主要位于肾髓质,呈灰白色或淡黄色,侵袭性生长;以腺管乳头状结构为主,部分混有肉瘤样癌,腺样囊性癌、条索及巢状癌。Fuhrman病理分级;G2,1例;G3,4例;G4,5例,TNM综合病理分期：Ⅰ期4例,Ⅱ2例,Ⅲ期1例,Ⅳ期3例,6例死于肾癌转移,其中1例术后19个月死于心脏病;2例无瘤生存,1例失访。平均生存时间13．3个月。结论肾集合管癌临床症状19个月死于心脏病;2例无瘤生存;1例失访。平均生存时间13．3个月。结论肾集合管癌临床症状明显,临床病理分期高,进展快,主要治疗方法为肾癌根治术,多数病例于术后数月发生转移或死亡。