肾透明细胞肉瘤的临床病理学研究

目的：探讨肾透明细胞肉瘤的临床病理,免疫组织化学,电镜特点和组织起源及预后,方法：对45例患儿（男31例,女14例,年龄3个月至12岁,平均3．2岁）肿瘤标本,用HE,免疫组织化学（LSAB法）和电镜技术进行观察。结果：45例患儿中,35例随访6－192个月,骨转移15例,,肺,肝等转移6例,8例复发,20例死亡。年龄和临床分期与存活率有关。典型的组织学形态为胞质浅染,核染色质细腻,核仁不清楚的片状瘤树枝状分布的纤维血管间质分隔,此外还可见粘液型,梭形细胞型,栅栏状型,上皮样型,硬化型,富于细胞型,囊肿型和血管扩张型等组织亚型结构,免疫组织化学;45例均表达波形蛋白,上皮膜抗原,细胞角蛋白,结蛋白,肌动蛋白,S－100蛋白,神经元特异性烯醇化酶,CD99,CD34和白细胞共抗原均为阴性,电镜下9例均显示瘤细胞细胞连接很原始,细胞器相对较少。结论：肾透明细胞肉瘤好发于儿童,具特殊的病理形态,可能起源于肾原始间质细胞,易发生骨;转移,死亡率高,为预后差的儿童肾肿瘤。     

不典型肾血管平滑肌脂肪瘤临床诊治分析

目的：提高不典型肾血管平滑肌脂肪瘤（Renal angiomyolipomn，RAML）的诊治水平。方法：回顾分析14例不典型肾缸管平滑肌脂肪瘤的临床和影像学资料，并与病理结果对照。术前5例（35.7％）诊断为RAML，行肿瘤剜除术；2例（14.3％）诊断为肾癌，直接行根治性肾切除术；7例（50％）因术前诊断不明于术中行冰冻切片检查，其中6例诊断为RAML行肾部分切除术，另1例提示为肾癌行肾切除术。结果：本组14例手术均顺利，术后病理诊断均为RAML。术后14例随访6月-8a，肾功能正常。结论：不典型RAML仅靠影像学资料难以准确诊断，应综合分析临床资料、影像学资料，并结合术中冰冻切片检查做出诊断；治疗以保留肾单位的手术为主。     

肾上皮样血管平滑肌脂肪瘤肺转移1例报告并文献复习

目的：探讨肾上皮样血管平滑肌脂肪瘤病理特点及生物学行为。方法：对1例低热患者行肺肿块穿刺活检,然后行HE染色和免疫组织化学染色。复习肾肿瘤病理切片并进行文献复习。结果：穿刺活检病理分析：密集分布的上皮样细胞,细胞体积大,呈圆形、多边形;异型明显;无血管平滑肌脂肪瘤结构;免疫组织化学：人黑色素瘤蛋白阳性,平滑肌肌动蛋白阳性,上皮膜抗原阴性。病理诊断：左肺上皮样血管平滑肌脂肪瘤;考虑来源于肾。结论：上皮样血管平滑肌脂肪瘤是一种有恶性潜能的间叶性肿瘤,可以发生远处转移。     

肾血管平滑肌脂肪瘤:3例报道及对其病变性质的拓展

报道3例具有恶性特征或发生转移的肾血管平滑肌脂肪瘤(AML),对具有恶性病变性质的AML予以描述,并提出鉴别诊断。肾AML通常认为是良性肿瘤,主要由厚壁的血管、脂肪和增生的梭形细胞构成。显示x染色体非随机性克隆失活,其罕见的侵袭性生长方式及其复杂的临床过程最终导致肿瘤转移和患者死亡。而诊断中出现的问题有：①良性肾AML内上皮样成分的出现造成与恶性肾AML和肾细胞癌鉴别诊断困难;②淋巴结受累引起淋巴结内多中心病变与淋巴结内肿瘤转移性病变鉴别诊断困难;     

肺原发性恶性外周神经鞘瘤的临床病理分析

目的 探讨肺脏原发性恶性外周神经鞘瘤(MPNST)的临床病理学特征及诊断、鉴别诊断要点。方法 对2例肺MPNST进行临床病理学分析及免疫组织化学与超微结构研究。结果 2例光镜下均显示MPNST的形态特点，免疫组织化学显示S-100蛋白、MBP、Vim、NSE肿瘤细胞呈阳性表达，电镜观察1例可见特征性Luse小体。结论 肺原发性MPNST极为罕见，临床诊断较困难。根据其光镜病理形态特征，S-100蛋白、MBP免疫组织化学检测和(或)电镜检查可确诊。结合文献，该肿瘤早期无明显临床症状，一般发现时已属晚期，预后差。病理学上应与肺脏平滑肌肉瘤、纤维肉瘤、单相型滑膜肉瘤、肉瘤样癌鉴别。     

浅表性脂肪瘤样痣9例临床病理学观察

目的探讨浅表性脂肪瘤样痣的临床病理特征、鉴别诊断。方法分析9例浅表性脂肪瘤样痣临床资料、组织学特征，对其中6例进行特殊染色并结合文献进行讨论。结果本组男5例、女4例，发病年龄1～42岁。临床上，7例为多发(经典)型，2例为局限型。皮损分布于臀部、尾骶部、大腿后上方、头部和腘窝，呈群集状丘疹和结节。病理特征为在真皮胶原组织内见成熟无包膜的脂肪细胞团，特殊染色示胶原纤维增厚、弹力纤维减少。结论浅表性脂肪瘤样痣的诊断依赖临床病理的特征，在组织形态上浅表性脂肪瘤样痣应与Go1tz综合征、结缔组织痣鉴别。     

肾脏上皮样血管平滑肌脂肪瘤的病理观察

目的对肾脏上皮样血管平滑肌脂肪瘤（epithelioid agiomyolipoma,EAML）的病理诊断、鉴别诊断和预后进行分析。方法2例肾脏EAML（其中1例为复发病例）,复习其临床资料,病理学检查包括常规病理学、免疫组织化学和超微结构,并进行随访。结果光镜下肿瘤均主要由具有多形性和不典型性的上皮样细胞组成,部分区域有明显的血管周上皮样排列;可见出血和坏死;并可见静脉内瘤栓;淋巴结内可见上皮样肿瘤细胞累及。免疫组织化学肿瘤细胞（包括淋巴结内肿瘤）HMB45、平滑肌肌动蛋白（SMA）、神经元特异性烯醇化酶（NSE）和波形蛋白弥漫阳性;S-100、melanpan和CD68散在阳性;而上皮细胞膜抗原（EMA）、AE1／AE3、CK7、CD117、肌肉特异性肌动蛋白（MSA）、结蛋白、白细胞共同抗原（LCA）、CD20、CIM5RO、CD30、CD15、嗜铬素（CgA）、突触素（Syn）、bcl-2、雌孕激素受体（ER、PR）和p53均为阴性。电镜检查可见一些肿瘤细胞内有黑色素小体样的致密颗粒、肌丝、密体,肿瘤细胞外可见不连续的基膜。2例患者手术后10个月状态良好,无肿瘤局部复发和转移征象。结论血管周上皮样排列、寻找经典血管平滑肌脂肪瘤的结构和肿瘤细胞表达HMIM5和SMA对于诊断和鉴别诊断至关重要。而细胞的不典型性、出血坏死和核分裂象可能只表明肿瘤的恶性潜能：淋巴结受累、肾静脉瘤栓不是恶性的诊断依据：只有远处转移才是恶性的证据。     

肝脏单形性上皮样血管平滑肌脂肪瘤

目的：探讨肝脏单形性上皮样血管平滑肌脂肪瘤的临床病理学特征及诊断、鉴别诊断要点。方法：对1例单形性上皮样血管平滑肌脂肪瘤进行临床病理学分析及免疫组织化学研究。结果：肝脏单形性上皮样血管平滑肌脂肪瘤临床多无症状,光镜下单形性上皮样血管平滑肌脂肪瘤由形态多样的上皮样细胞构成,胞质透明或嗜酸,无脂肪组织及异常血管;免疫表型;HMB45阳性,SMA及vimentin部分阳性,desmin少数阳性,S－100蛋白弱阳性,cytokeratin及AFP阴性,CD34血管内皮细胞阳性。结论：肝脏单形性上皮样血管平滑肌脂肪瘤是极为罕见的间叶性肿瘤,组织起源至今不明,其诊断及鉴别诊断主要依靠病理组织学及免疫组织化学。     

肾透明细胞肉瘤的临床病理及免疫表型特征

目的 探讨肾透明细胞肉瘤（clear cell sarcoma of the kidney,CCSK）的临床病理特点、免疫表型特征及鉴别诊断。方法 应用HE和免疫组化vimentin、bcl-2、desmin、S-100蛋白、CD99、CD34、CDll7、CK、EMA染色,观察2例CCSK的病理组织学形态,并复习文献。结果 镜下见瘤细胞为上皮样或短梭形,被分枝状纤维血管间质分隔成巢团状,部分区域见黏液样变性微囊肿和细胞外胶原玻璃样变类似骨样组织的硬化型等形态变异。免疫组化示：瘤细胞vimentin和bcl-2弥漫阳性,余为阴性。结论 CCSK是一种罕见的儿童期恶性肾肿瘤,诊断主要依靠组织病理学和免疫组化,熟悉其形态学变异有利于与其它类似病变如肾母细胞瘤、先天性中胚叶肾瘤、肾恶性横纹肌样瘤、原始神经外胚叶肿瘤等鉴别。     

肾脏黏液样小管状和梭形细胞癌临床病理分析

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4例MTSCCa标本进行组织病理学和免疫组化染色观察,并复习临床资料及相关文献。结果该肿瘤好发于女性,发病年龄17～82岁（平均53岁）,临床症状不明显。组织学：肿瘤与周围肾组织分界清楚,切面实性、灰白色,肿瘤细胞形态呈双相（小管状和梭形细胞）或三相（小管状、梭形和脊索瘤样或黏液样）。其他组织学表现：泡沫样巨噬细胞聚集、典型的透明细胞和乳头状或乳头结构。免疫组化显示复合性免疫表型。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,免疫组化表型及组织学形态与乳头状肾细胞癌（PRCCa）有重叠。     

鼻腔鼻窦型血管外皮瘤临床病理分析

目的探讨鼻腔鼻窦型血管外皮瘤的临床病理学特征及诊断和鉴别诊断及其组织发生。方法结合其临床和影像学特点,应用HE、嗜银网状纤维染色、免疫组织化学和电镜对6例鼻腔鼻窦型血管外皮瘤的病理改变进行了分析,并对其中5例进行了随访。结果男性4例,女性2例,年龄56—71岁,平均60．5岁;肿瘤均位于右鼻腔,分别为鼻中隔1例、中鼻道1例、右总道1例、鼻腔＋筛窦2例、右眼球＋筛窦＋左右额窦1例,临床上表现为鼻塞、鼻出血、鼻腔分泌物增多及眼球胀痛、视力减退、流泪、头痛等症状。巨检：病变呈息肉样2例、呈棕色光滑肿块3例、呈灰白碎组织1例。镜下观察呈弥漫分布的短梭形细胞,规则,核分裂象少见,胞质透明或嗜酸性,血管丰富,薄壁,并可见管壁玻璃样变,鹿角状血管少见,瘤细胞多以单相排列,也可呈束状、席纹状、环状及编织状。免疫组织化学检测显示瘤细胞波形蛋白6／6阳性、平滑肌肌动蛋白5／6阳性和CD34 3／6阳性,超微结构显示瘤细胞胞质内有肌动蛋白丝,细胞间有未发育完全的连接结构。随访5例,2例复发。结论鼻腔鼻窦型血管外皮瘤是一种真正起源自血管外皮细胞,具有特殊临床病理特征、少见的中间型或低度恶性肿瘤,需结合肿瘤的组织形态和免疫组织化学特点做出诊断和鉴别诊断。     

Colorectal adenocarcinoma involving the prostate: report of 9 cases

We present 9 consult cases, the largest series to date, of colorectal adenocarcinoma involving the prostate. Mean age of patients at diagnosis was 61 years (range, 42-78 years). Six cases were initially diagnosed on needle biopsy and the others by transurethral resection. Three cases were diagnosed before biopsy of the colon, which led to the discovery of a primary colonic tumor. The mean interval between the detection of the primary colonic tumor and prostatic involvement in the other 6 cases was 30 months (range, 1-52 months). At diagnosis, the stages of colorectal carcinomas were pT1 (n=2), pT2 (n=2), pT3 (n=2), and pT4 (n=3). Two cases involved the prostate after the recurrence of rectal adenocarcinoma at the anastomotic site of the previous colonic resection. In most cases, the tumors were typical moderately differentiated with occasional poorly differentiated foci. Other histologic features included desmoplastic stromal reaction (100%, n=9), necrosis (77.8%, n=7), chronic inflammatory response (77.8%, n=7), cribriform pattern (66.7%, n=6), villous architecture (22.2%, n=2), mucin production (22.2%, n=2), signet-ring cells (11.1%, n=1), and perineural invasion (11.1%, n=1). Immunohistochemical stains were positive for beta-catenin in 6 of 6 cases, CDX2 in 6 of 6 cases, carcinoembryonic antigen in 7 of 7 cases, CK20 in 5 of 6 cases, high-molecular-weight cytokeratin in 5 of 6 cases, and alpha-methylacyl-CoA racemase in 3 of 6 cases. Stains were negative in all cases for prostate-specific antigen, P501S (prostein), and CK7. Six patients (66.7%) died of disease within an average of 34 months (range, 8-88 months) after diagnosis of prostatic involvement. There are critical therapeutic and prognostic implications for distinguishing between prostatic adenocarcinoma and colorectal carcinoma involving the prostate. Colorectal adenocarcinoma should be considered on prostate sampling when carcinoma exhibits either "dirty" necrosis, tall columnar epithelium with mucin production, mucin-positive signet-ring cells, villous architecture, or associated inflammation. Immunohistochemical stains for beta-catenin, CDX2, carcinoembryonic antigen, high-molecular-weight cytokeratin, prostate-specific antigen, P501S (prostein), CK20, and CK7 can be helpful in making a definitive diagnosis.     

肾脏上皮样色素性透明细胞肿瘤病理形态观察

目的 探讨上皮样色素性透明细胞肾脏肿瘤形态学特点,加强对该肿瘤的认识,减少误诊.方法 回顾性分析2000余例肾脏肿瘤,符合上皮样色素性透明细胞肿瘤3例,通过HE、免疫组织化学EnVision法观察3例肿瘤形态学特点,对其中1例行超微结构观察,同时复习相关文献.结果 女性2例,男性1例,2例形态学表现为透明细胞癌样,1例见透明细胞和嗜酸性细胞构成乳头结构.免疫组织化学上皮标记及S-100蛋白均为阴性,HMB45均为阳性,2例Melan A阳性.电镜末见黑色素小体结构.结论 色素性透明细胞上皮样肿瘤是非常罕见的肾脏肿瘤,病理学特征兼有肾细胞癌、上皮样血管平滑肌脂肪瘤与黑色素瘤等肿瘤特征,免疫组织化学有利于鉴别诊断.其可能是上皮样血管平滑肌脂肪瘤的一种亚型.     

The vanishing testis: a histomorphologic and clinical assessment

Of patients with cryptorchidism, 5% have no palpable gonad. Physical examination or scrotal exploration demonstrates tissue nubbins or small nodules that constitute the vanishing testis syndrome. At the University of Chicago Hospitals (Chicago, IL; 2004-2008), 30 surgical pathology specimens from 29 patients with this clinical diagnosis underwent scrotal exploration. Histologic and immunohistochemical comparison was done with 7 fetal testes, 8 surgically removed nonneoplastic testes, and 2 cryptorchid testes. Routine histologic studies showed no seminiferous tubules in 18 cases (60%), fibrosis in all (100%), calcifications in 16 (53%), and hemosiderin deposits in 9 (30%). In 12 cases with seminiferous tubules (40%), there were Sertoli cells only. Scrotal exploration in such cases is clinically driven and results in the removal of any tissue present. Although published studies suggest the risk for future tumor development is low, possibly absent, the definitive removal of a testicle is established by an awareness of the histologic spectrum exhibited by testicular remnants.     

Epithelioid angiomyolipoma of the liver: a clinicopathologic study of 5 cases

This study aimed to study the clinicopathologic characteristics of epithelioid angiomyolipoma, a variant of angiomyolipoma (AML) in the liver; and to discuss the diagnostic challenges. Five cases of primary liver epithelioid AML were retrieved from our archives from January 2003 to October 2012. The clinicopathologic features of each case were retrospectively reviewed. All 5 patients were female, with age ranging from 36 to 70 years (median, 41 years). The size of the tumor ranged from 1.2 to 25 cm. Histologically, the tumor comprised polygonal cells with granular eosinophilic cytoplasm and accompanied by immunohistochemical expression of HMB-45 ± Melan-A. Variations in growth pattern and cytology were observed. Estrogen receptor was negative in all 5 cases. None showed cytologic atypia, coagulative necrosis, increased mitotic count, or vascular invasion. Epithelioid AML is an uncommon primary liver tumor with a female predominance. The size of the tumor can be variable. This tumor might impose diagnostic difficulty both clinically and histologically. Immunohistochemical staining with melanocytic markers is a promising means to confirm the pathologic diagnosis. A careful assessment of aggressive histologic features is recommended to stratify the risk of aggressive behavior of this tumor.     

Histologic classification of penile carcinoma and its relation to outcome in 61 patients with primary resection

A retrospective review of the clinical and pathologic features of 61 cases of penile squamous cell carcinoma (SCC), all treated by primary surgical resection at the Memorial Sloan Kettering Cancer Center during the period 1949-1992, was undertaken. Inguinal lymph node dissection material was evaluated in 40 cases. All carcinomas were of squamous cell type and were classified as follows: usual type, 36 cases (59%); papillary, not otherwise specified (NOS), 9 cases (15%), basaloid, 6 cases (10%); warty (condylomatous), 6 cases (10%); verrucous, 2 cases (3%), and sarcomatoid, 2 cases (3%). A high rate of nodal metastasis and poor survival were found for the basaloid and sarcomatoid neoplasms (5 of 7 patients with metastasis, 71%, and 5 of 8 dead of disease, 63%). Only 1 patient with a verruciform tumor (defined as a tumor of nonspecific papillary, warty, or verrucous type) had inguinal node metastasis and none died from penile cancer. An intermediate rate of metastasis and mortality (14 of 26, 54%, and 13 of 36, 36%, respectively) was found for typical SCC. Penile carcinomas are morphologically heterogeneous, and there is a correlation of histologic type and biologic behavior. This mandates accurate histologic subtyping by the pathologist.     

Tissue effects of salivary gland fine-needle aspiration. Does this procedure preclude accurate histologic diagnosis?

Recent reports have alluded to various tissue effects secondary to fine-needle aspiration (FNA), particularly infarction observed in resected salivary gland masses, precluding accurate histologic diagnosis. Our experience with the use of 25-gauge needles indicates otherwise. We retrospectively reviewed 94 resected salivary gland masses previously sampled by FNA, looking for infarction, hemorrhage, needle track tumor seeding, and fibrosis. We assessed the significance of these complications and their impact on the histologic diagnosis. The median interval from FNA to excision was 25 days. Variable degrees of infarction and hemorrhage were present in 7 cases (7%) and 9 cases (10%), respectively. Infarction ranged from 5% to 80% (average, 20%), while hemorrhage averaged less than 20% of the material on the tissue sections. Significant infarction was present in acinic cell carcinomas (3/7), but histologic diagnosis was not compromised, and tissue alterations were absent. We conclude that FNA of salivary gland lesions using 25-gauge needles is safe and does not significantly alter the histologic diagnosis. The tissue effects observed did not preclude accurate diagnostic interpretation in any case.     

间叶性软骨肉瘤23例临床病理和免疫表型分析

目的 探讨间叶性软骨肉瘤的临床病理和免疫表型特点.方法 复习23例骨及软组织间叶性软骨肉瘤的临床和病理学资料,对其中14例进行免疫组织化学(EnVision法)染色.结果男性14例,女性9例,年龄范围12～47岁,其中原发于骨的病变13例,原发于软组织5例,早期症状以局部肿块和疼痛为主.镜下组织学特点为含有原始间叶性小细胞和分化良好的软骨成分,二者有移行过渡,可见"骺板样软骨".原始间叶性小细胞免疫组织化学染色阳性表达Sox9(14/14)、CD99(12/14)、波形蛋白(6/14)、CD56(4/14)、CD57(4/14)、神经元特异性烯醇化酶(3/14)、结蛋白(1/14);Ⅱ型胶原、S-100蛋白、上皮细胞膜抗原、PCK、突触素、嗜铬粒素A、CD34、c-erbB2均阴性.结论间叶性软骨肉瘤少见,结合组织病理形态特征及免疫组织化学染色对病理鉴别诊断有较大帮助.

Abstract：

Objective To study the clinicopathologic and immunohistochemical features of mesenchymal chondrosarcoma. Methods The clinical and histologic features of 23 cases of mesenchymal chondrosarcoma were analyzed. Immunohistochemical study was also performed in 14 of the cases. ResultsThe age of patients ranged from 12 to 47 years. Fourteen of them occurred in males. Thirteen cases involved the bony skeleton and 5 cases affected the soft tissue. The patients presented with pain and/or swelling. Histologically, the tumor consisted of a mixture of undifferentiated small round cells and hyaline cartilage. Transition between the two components was demonstrated and growth plate-like cartilage was observed. Immunohistochemical study showed that the small round cells were positive for Sox9 (14/14), CD99(12/14), vimentin (6/14), CD56 (4/14), CD57(4/14), neuron-specific enolase (3/14) and desmin(1/14). They were negative for Coll-Ⅱ, S-100 protein, epithelial membrane antigen, pan-cytokeratin, synaptophysin, chromogranin A, CD34 and c-erbB2. Conclusions Mesenchymal chondrosarcoma is a rare malignant tumor. Thorough histologic examination, when coupled with immunohistochemical findings, is helpful in arriving at a correct diagnosis.     

Immunoreactivity for epithelial and neuroendocrine antibodies are useful in the differential diagnosis of lung carcinomas

The histologic classification of pulmonary neoplasms can have important implications regarding appropriate management of patients. Although the histologic classification of lung tumors is predominantly based on morphology, ancillary studies such as immunohistochemistry can be used in difficult cases, and the diagnosis of large cell neuroendocrine carcinoma requires confirmation of neuroendocrine differentiation by immunohistochemistry or electron microscopy. We immunostained 142 lung tumors for B72.3, keratin 34betaE12, keratin 7, keratin 14, keratin 17, synaptophysin, and chromogranin to determine the utility of neuroendocrine markers and epithelial markers in the differential diagnosis. Among neuroendocrine carcinomas (small cell carcinoma and large cell neuroendocrine carcinoma), 84% (37 of 44) were chromogranin positive, 64% (21 of 36 small cell, 6 of 6 large cell neuroendocrine) were synaptophysin positive, 5% (2 of 43) were keratin 34betaE12 positive, 9% (4 of 44) were keratin 7 positive, and 5% (2 of 37) of small cell carcinomas and 50% (3 of 6) of large cell neuroendocrine carcinomas were B72.3 positive. Among non-neuroendocrine carcinomas, 5% (5 of 98) were chromogranin positive, 3% (3 of 96) were synaptophysin positive, and 97% (95 of 98) were positive for either keratin 34betaE12 or keratin 7 and 99% (97 of 98) were positive for either keratin 34betaE12, keratin 7 or B72.3. An antibody panel consisting of keratin 7, keratin 34betaE12, chromogranin, and synaptophysin separated 132 of 141 tumors (94%) into distinct groups. We conclude that immunostaining with both neuroendocrine markers and epithelial markers can be useful in the differential diagnosis of lung neoplasms.     

肾脏上皮样型血管平滑肌脂肪瘤临床病理分析

目的 探讨肾脏上皮样型血管平滑肌脂肪瘤(EAML)的临床病理特点及诊断与鉴别诊断.方法 通过对3例EAML临床病理学观察与免疫组化标记及复习有关文献,讨论其组织学特征及临床生物学行为.结果 3例年龄分别为28、40和32岁,均有腰痛病史,其中1例伴有肉眼血尿,均无结节硬化症.眼观:肿瘤位于肾脏,直径大小分别为6 cm、8 cm和3 cm.3例境界清楚,例2伴囊性变.肿瘤无包膜,2例出血、坏死明显,质脆或韧.镜检:瘤细胞体积大或巨大,呈多边形,胞质丰富,嗜酸性或空泡状,核仁明显,可见核内包涵体,多核巨细胞散在其中.瘤细胞弥漫性或巢团状排列.2例瘤组织出血、坏死明显,呈浸润性边缘.3例未见典型AML图像.免疫组化染色显示瘤细胞HMB-45阳性,SMA和vimentin散在性阳性,CK、EMA和CD10均阴性.结论 EAML是一种单一方向分化的,含有大上皮样细胞的肿瘤,瘤细胞较为特异的表达HMB-45.辅以免疫组化可以与其它肾脏肿瘤相鉴别.