甲状腺滤泡癌样肾细胞癌1例并文献复习

目的总结甲状腺滤泡癌样肾细胞癌（TFCLTK）的临床、病理及免疫学特征,对TFCLTK的诊疗进行探讨。方法报告1例甲状腺滤泡癌样肾细胞癌,结合文献检索到的11例,分析此类肿瘤的临床特征、影像学、病理学及免疫表型特点,治疗及预后。结果肉眼观察见肾表面呈结节状,切面可见一巨大肿块,于肾下极并向肾盂内生长,肿块约8.0cm×4.3cm×5.0cm,与肾实质分界不清,切面灰白色,实性,可见散在灰褐色坏死区及灰色出血区,小囊腔形成。镜下观察见肿瘤细胞排列成甲状腺滤泡样,滤泡腔内可见红染胶体样物,肾门旁淋巴结未查见转移地肿瘤细胞。免疫组化结果：Vimentin（＋）,EMA（＋）,CK（＋）,CK7灶（＋）,NSE（＋）。CK34BE12（-）,Syn（-）,CK20（-）,CD56（-）,CD56（-）,CD10（-）,WT-1（-）,CD34（-）,CD57（-）,P53（-）,CD99（-）,TTF-1（-）,CD15（-）,Tg（-）,Ki-67LI 30%（＋）。结论甲状腺滤泡癌样肾细胞癌是具有一定侵袭性的低度恶性的肾源性肿瘤。目前已明确病理学及免疫表型特点为细胞形态学类似甲状腺滤泡癌细胞,但TTF-1和TG蛋白表达阴性。可行根治性肾切除术,预后较好。

Thyroid fonicular carcinoma-like tumor of kidney: a case report and literature review

Objective To investigate the clinical,pathologic and immunological features of thyroid fonicular carcinoma-like tumor of kidney（TFCLTK） and discuss its diagnosis and treatment.Methods 11 cases of TFCLTK were found in a search of the literature from 2006 to 2012,and one case treated in our hospital was reported.The clinical,radiological,pathological and immunological phenotype features,treatment and prognosis characteristics of the cancer were analyzed.Results Macroscopic observation： A complete kidney with perinephrit fat was resected,about the size of 13 cm×7 cm×6 cm,with nodules on the renal surface.A huge mass was shown on the section,located in the lower pole of the kidney and grown within the renal pelvis,the mass size being 8.0 cm×4.3 cm×5.0 cm,with no clear boundary of renal parenchyma.The tumor was grey and solid,scattered gray necrotic and bleeding areas were visible,and capsule lumens were formed.Microscopic observation： The tumor cells were arranged in thyroid follicular form.Follicular concretions could be seen within the red dye colloid content.No tumor cells were found in the renal hilar lymph nodes.Immunohistochemical staining： Vimentin（＋）,EMA（＋）,CK（＋）,CK7（＋）,NSE（＋）,CK34BE12（-）,Syn（-）,CK20（-）,CD56（-）,CD56（-）,CD10（-）,WT-1（-）,CD34（-）,CD57（-）,P53（-）,CD99（-）,TTF-1（-）,CD15（-）,Tg（-）,Ki-67 LI 30%（＋）.Conclusions TFCLTK is a rare and invasive tumor with low-grade malignancy.Its morphological characteristics are similar to thyroid follicular cancer cells,but TTF-1 and TG protein expressions were negative.Radical nephrectomy is one of the optimal approaches with favorable prognosis.