多囊性肾透明细胞癌的病理学诊断

目的：探讨多囊性肾透明细胞癌的临床病理特点。方法：对1例多囊性肾透明细胞癌进行了免疫组化染色,并进行文献复习。结果：本例右肾肿物18年。大体见肿物由多发不等的囊腔组成。镜下囊内壁主要由单层立方或柱状上皮被覆,部分为多层并有乳头形成。瘤细胞胞质透亮,无明显异型性。癌细胞免疫表型cytokeratin、CEA和vimentin呈阳性表达。本例诊断为多囊性肾透明细胞癌。结论：多囊性肾透明细胞癌是一种罕见的肾癌病理类型。临床上主要采用根治切除术。本瘤的生物学行为属于低度恶性肿瘤。     

透明细胞（管状）乳头状肾细胞癌临床病理学分析

目的：探讨透明细胞（管状）乳头状肾细胞癌（clear cell tubulopapillary renal cell carcinoma,CCTPRCC）临床病理学特征。方法：复习2012年至2014年肾细胞癌病理学切片,筛选CCTP-RCC病例。观察CCTP-RCC巨检及镜检特征,行免疫组化染色以及分子遗传学检测。结果：肾细胞癌中CCTP-RCC占2.0%（4/201）。肿瘤平均直径2.8 cm（范围1.2~4.5 cm）。囊性、乳头状、管状以及实性生长方式出现频率分别是100%（4/4）、100%（4/4）、100%（4/4）以及75%（3/4）。4例（100%）细胞轻度异型性。Fuhrman细胞核分级2级3例（75%）,1级1例（25%）。细胞核远离基底膜的细胞占17.5%（范围10%~20%）,其他位置占82.5%（范围80%~90%）。4例（100%）见平滑肌组织,3例（75%）见发育不全血管。3例（75%）T1a,1例（25%）T1b,所有病例均为I期肿瘤。免疫组化CK7 4例（100%）弥漫强阳性;CD10 3例（75%）阴性反应,1例（25%）局灶弱阳性。分子遗传学4例FISH检测17号染色体为二倍体。平均随访时间15.5（3~23）个月,所有病例没有局部复发、淋巴结转移以及远处转移。结论：CCTP-RCC是一种少见的RCC亚型;病理诊断应结合生长方式、细胞学以及间质表现三方面综合分析;典型免疫表型是CK7弥漫强阳性,CD10阴性或局灶阳性。     

δ-catenin在肾透明细胞癌中的表达及其临床意义

目的探讨δ-catenin在肾透明细胞癌(Clear cell renal cell carcinoma,cc RCC)组织中的表达情况,并分析其临床意义。方法采用免疫组化SP法和Western blot检测98例cc RCC组织及40例癌旁组织中δ-catenin蛋白的表达;应用Real-time PCR检测20例cc RCC及癌旁新鲜组织中δ-catenin m RNA的表达;分析δ-catenin蛋白表达与临床病理参数及预后的关系。结果δ-catenin m RNA和蛋白在cc RCC中表达水平显著高于癌旁正常组织(0.05)。δ-catenin蛋白的阳性表达与cc RCC患者性别、淋巴结转移及血行转移相关(0.05)。δ-catenin蛋白高表达的患者预后明显差于低表达的患者(0.05)。COX多因素回归分析显示,δ-catenin蛋白表达水平是影响cc RCC患者预后的独立危险因素。结论δ-catenin在cc RCC发生发展中发挥重要作用,可作为cc RCC预后判断的生物标志物。     

透明细胞性肾细胞癌中MYBL2表达及临床意义

目的 探讨骨髓母细胞增生症病毒癌基因同源物样2(MYB proto-oncogene like 2,MYBL2)在透明细胞性肾细胞癌(clear cell renal cell carcinoma,ccRCC)中的表达及其与临床病理特征的相关性.方法 应用qRT-PCR法检测ccRCC及癌旁正常肾组织中MYBL2 mR...     

透明细胞乳头状肾细胞癌1例

<正>患者女性,60岁,因右侧输尿管结石入院,自诉偶有右腰部酸胀感,无发热,无尿频、尿急、尿痛,无肉眼血尿;查体:心肺听诊无殊,腹软,未及包块,未及压痛、反跳痛,右肾区轻叩痛,左肾区无叩痛;腹部CT示右肾实质内见直径1. 6 cm等低密度结节影突出肾轮廓,增强后动脉期强化类似肾皮质,后期密度减低,呈相对略低密度,报告提示右肾占位,肾癌可能。行右肾部分切除术,送病理检查。     

基于免疫细胞计数的系统性炎症反应指数在预测肾透明细胞癌患者预后中的作用研究

目的探讨由外周血淋巴细胞、中性粒细胞及单核细胞计数而来的这种全新的系统性炎症反应指数(systemic inflammation response index,SIRI)在评估肾透明细胞癌(clear cell renal cell carcinoma,ccRCC)患者预后中的价值。方法选取2012年1月初至2015年2月底在陆军军医大学第一附属医院接受手术治疗并经病理确诊为ccRCC的患者135例。收集所有患者的临床病理资料,根据术前外周血淋巴细胞、中性粒细胞和单核细胞计数绝对值计算SIRI。应用ROC(receiver operating characteristic curve)确定SIRI最佳分界值并对所有患者进行分组,比较不同组间患者临床病理资料的差别,Kaplan-Meier描绘生存曲线,最后应用Cox比例风险回归模型分析影响患者预后的独立因素。结果根据ROC确定SIRI最佳分界值为1.86。135例患者中低SIRI组(即SIRI1.86组)108例,高SIRI组(即SIRI≥1.86组)27例。不同SIRI组间患者肿瘤大小、N分期、Fuhrman分级差异显著(P0.05),具有统计学意义。低SIRI组无进展生存期和总体生存期均长于高SIRI组;影响ccRCC患者预后的独立因素包括TNM分期、Fuhrman及SIRI。结论作为衡量机体全身炎症反应状态的一项重要参考指标,SIRI是影响cc RCC患者预后独立危险因素,有望成为预测患者术后生存状况的炎性标志物。     

肾透明细胞癌应该基于核仁情况进行分级

肾细胞癌的Fuhrman分级着重于细胞核的大小、形状及核仁是否明显。尽管该分级已广泛应用于临床研究,但是关于其分级标准的预后意义和可重复性仍有争议。值得注意的是许多病理学医生仅根据核仁是否明显判定肾透明细胞癌的分级,然而其准确性尚未得到证实。     

肾透明细胞癌行保留肾单位手术后复发风险预测模型的构建

目的 探讨局限性肾透明细胞癌(ccRCC)患者行保留肾单位手术(NSS)后复发的相关危险因素,建立NSS术后5年复发风险的预测模型.方法 回顾性分析2006年1月至2019年7月于北京大学第三医院行NSS患者的临床资料,采用单因素和多因素回归分析影响ccRCC术后复发的相关因素,并建立预测NSS术后5年复发风险的列线图...     

基于贡献度排序的肾透明细胞癌串扰通路分析

基于基因信号传导通路理解生物过程,已成为探索疾病致病机理的重要手段。通常采用单一通路中差异表达基因数量的方法来衡量通路对疾病发生和后续发展的影响,而忽略基因间的相互扰动影响及通路间的串扰关系。因此,提出一种基于通路贡献度排序的串扰分析方法,以分析通路间的相互串扰在肾透明细胞癌(KIRC)致病机理中的影响。首先,利用信号通路影响分析(SPIA)方法对KIRC相关的通路进行贡献度排序;其次,结合距离相关性(DC)算法,分别计算在患病样本和健康样本中高贡献度信号通路之间的串扰值;最后,计算患病样本和健康样本通路串扰差值,筛选出串扰变化值高于0.1的串扰通路。结果表明,在21条KIRC患病前后串扰关系变化值较大的串扰通路中,爱泼斯坦-巴尔病毒信号通路与ErbB信号通路患病和健康样本串扰关系差值变化为-0.12,肾细胞癌信号通路与ErbB信号通路差值变化为-0.20,帕金森病信号通路与蛋白质在内质网中加工信号通路差值变化为-0.14,金黄色葡萄球菌感染信号通路与11条信号通路之间的串扰均发生了显著的变化,差值变化在0.11~0.13之间。同时,分子生物学分析可验证这些通路间串扰的显著变化对KIRC的发生和发展具有重要影响。该方法可有效地探索已知及潜在与KIRC致病机理密切相关的失调信号传导通路。     

Clinical Implications of HSC70 Expression in Clear Cell Renal Cell Carcinoma

Purpose: The role of heat shock protein 70 (HSC70) in the progression of clear cell renal cell carcinoma (ccRCC) is unclear. This study explored the effect of the HSC70 on the survival of ccRCC patients.Methods: Immunohistochemical analysis was performed to determine HSC70 expression in samples obtained from 121 ccRCC patients with at least 5 years of follow-up. We also analyzed the association between HSC70 expression and clinicopathological characteristics. Furthermore, the association of overall survival (OS) with HSC70 expression was analyzed using Kaplan-Meier curves. Finally, we used the Oncomine and CCLE databases to determine the effects of HSC70 mRNA expression on ccRCC.Results: HSC70 expression was associated with distant metastasis and death of ccRCC patients. HSC70 was expressed in the nucleus and/or cytoplasm of ccRCC cells. The incidence of distant organ metastasis and death was higher in patients with HSC70 expression than in those without it. Survival analysis revealed that patients with HSC70 expression had significantly shorter OS. Oncomine analyses also showed that the HSC70 mRNA was significantly upregulated in ccRCC tissues.Conclusions: HSC70 expression was related to adverse prognosis, and patients with HSC70 expression had a worse prognosis than those without HSC70 expression. HSC70 may thus serve as a potential therapeutic target for ccRCC.     

DNA 修复基因与肾透明细胞癌相关性的研究进展

肾细胞癌 (renal cell carcinoma, RCC) 深刻且广泛地影响全人类, 肾透明细胞癌 ( clear cell renal cell carcinoma, ccRCC) 是其最主要病理亚型。 在过去 30 年, 肾细胞癌的生物分子机制被不断挖掘, 随 着 DNA 修复途径及相关基因研究深入, 逐渐发现了他们之间的联系。 细胞总是暴露在各种损伤因素下, 导 致基因组损伤, 若 DNA 修复系统功能缺陷, 导致基因组不稳定, 最终细胞凋亡或转变为癌细胞。 DNA 修 复基因 (DNA repair gene, DRG) 与 ccRCC 在易感性, 预后及治疗方面具有显著的生物学相关性, 为进一 步探索 ccRCC 与 DNA 损伤修复之间的分子机制, 确定 ccRCC 新的分子标志物, 寻找合适免疫抑制物治疗 靶点奠定了一定的基础。     

Insulin Receptor Expression in Clear Cell Renal Cell Carcinoma and Its Relation to Prognosis

Purpose

Both insulin and insulin-like growth factor (IGF)-1 signaling are key regulators of energy metabolism, cellular growth, proliferation, and survival. The IGF-1 receptor (IGF-1R) is overexpressed in most types of human cancers including renal cell carcinoma (RCC) with poor prognosis. Insulin receptor (IR) shares downstream effectors with IGF-1R; however, the expression and function of IR in the tumorigenesis of renal cancer remains elusive. Therefore, we examined the expression of IR and its prognostic significance in clear cell RCC (CCRCC).

Materials and Methods

Immunohistochemical staining for IR was performed on 126 formalin-fixed paraffin-embedded CCRCC tissue samples. Eight of these cases were utilized for western blot analysis. The results were compared with various clinico-pathologic parameters of CCRCC and patient survival.

Results

IR was expressed in the nuclei of CCRCC tumor cells in 109 cases (87.9%). Higher IR expression was significantly correlated with the presence of cystic change, lower Fuhrman nuclear grade, lower pathologic T stage, and lower TNM stage, although it wasn''t significantly related to diabetes status and patient survival. Western blot analyses supported the results of the immunohistochemistry studies.

Conclusion

IR expression in CCRCC may be associated with favorable prognostic factors.     

Immunophenotypes of Glycogen Rich Clear Cell Carcinoma

Purpose

Glycogen rich clear cell carcinoma (GRCC) of the breast is a rare subtype of invasive ductal carcinoma and involves a poor prognosis. In the literature, less than 150 cases have been reported. Many researchers have attempted to characterize GRCC according to electron microscope, flow cytometry, or clinical data. However, an organized study of the immunophenotype of GRCC has yet to be reported.

Materials and Methods

Here, we present three cases of GRCC and their immunohistochemical profiles.

Results

Histologically, all three cases contained periodic acid stain (PAS) positive and d-PAS labile granules in their clear cytoplasm. Case I showed positivity for only estrogen receptor (ER) and c-erbB2. Case II exhibited positivity for progesterone receptor and negativity for ER and c-erbB2. Case III presented with triple negative invasive carcinoma. The expression pattern of E-cadherin was concordant with epidermal growth factor receptor and c-kit, but discordant with ki-67. Among these three cases, p53-positive cases exhibited a low proliferative index (ki-67: 15%), while p53-negative cases showed a high proliferative index (ki-67: 50-60%).

Conclusion

In conclusion, the immunophenotype of GRCC is not uniform, but is similar to that of conventional ductal carcinoma.     

Glycogen-rich Clear Cell Carcinoma of the Urethra: An Ultrastructural Study

A 49-year-old black woman developed a urethral glycogen-rich clear cell carcinoma. She was treated with anterior pelvic exenteration. The resected lymph nodes, vagina, uterine cervix, endometrium, ovaries, and urinary bladder were free of neoplasm. Histologically the neoplasm consisted of clear cells growing in sheets and occasional papillary structures. In some areas, hobnail cells were present. Ultrastructurally, the cells had apical caps, short microvilli, and complex cell bases, and contained abundant glycogen. These features were identified in one, but not the other of two previously reported cases. Because glycogen-rich clear cell carcinomas of the lower urinary tract do not resemble ultrastructurally mesonephric remnants or carcinomas known to arise from them, these glycogen-rich clear cell carcinomas should not be called “me-sonephromas” as has been the practice.     

Glycogen-rich Clear Cell Carcinoma of the Urethra: An Ultrastructural Study

A 49-year-old black woman developed a urethral glycogen-rich clear cell carcinoma. She was treated with anterior pelvic exenteration. The resected lymph nodes, vagina, uterine cervix, endometrium, ovaries, and urinary bladder were free of neoplasm. Histologically the neoplasm consisted of clear cells growing in sheets and occasional papillary structures. In some areas, hobnail cells were present. Ultrastructurally, the cells had apical caps, short microvilli, and complex cell bases, and contained abundant glycogen. These features were identified in one, but not the other of two previously reported cases. Because glycogen-rich clear cell carcinomas of the lower urinary tract do not resemble ultrastructurally mesonephric remnants or carcinomas known to arise from them, these glycogen-rich clear cell carcinomas should not be called “me-sonephromas” as has been the practice.     

Glycogen-rich Clear Cell Carcinoma of the Breast An Autopsy Case

An autopsy case of glycogen-rich clear cell carcinoma (GRCCC) which arose in the right breast of a 72 year old woman is reported. Light microscopic examination of the small finger tip-sized tumor revealed solid alveolar proliferation of clear cells containing abundant glycogen. Im-munohistochemically, most of the clear tumor cells were stained for epithelial membrane antigen (EMA) and alpha lactalbumin, whereas a few eosinophilic tumor cells were positive for S 100 protein, EMA and actin. Electron microscopically, aggregates of glycogen particles, numerous empty glycogen lakes, microvilli, tight junctions and basal lamina were identified. Autopsy disclosed marked metastases to the liver, lung, adrenal, skin and lymph nodes. Primary breast cancer was confirmed by exclusion of a primary at any other site. It is suggested that although rare, GRCCC of the breast is as aggressive as usual invasive ductal carcinoma, and is associated with severe nodal and blood borne metastases, followed by death. Acta Pathol Jpn 39: 469 472, 1989.