DNA倍体分析及Ki-67检测对肾实质小肿瘤性质和意义的探讨

目的 探讨肾实质小肿瘤的性质及其生物学行为,为临床进一步治疗和预后判断提供病理学依据。方法 应用流式细胞术和免疫组织化学方法,对48个直径≤3cm的小肿瘤和39个直径＞3cm的大肾癌的DNA倍体形式及Ki-67增殖状态进行了比较研究。结果 48个小肿瘤中,6个腺瘤均为二倍体,Ki-67增殖指数（PR）均＜1％。42个透明、颗粒细胞型小肿瘤异倍体出现率为16.7%,与39例大肾癌的33.3%差异无统计学意义;42个小肿瘤部Ki-67 PR与分级相关。结论 小肿瘤中既有腺瘤也有腺癌,肿瘤大小不能作为区分它们的标准。DNA倍体及Ki-67 PR可作为肾实质肿瘤生物学行为和预后判断的重要指标。

DNA ploidy analysis and Ki-67 examination on renal neoplasms: investigation of degree of malignancy and biological behavior of small renal tumors

Objective To investigate the degree of malignancy and the biological behavior of small renal tumors and provide a pathological basis for clinicians in determination of further treatment and prognosis. Methods Flow cytometry and immunohistochemical studies were performed on 48 small tumors with diameters less than 3 cm. and 39 renal cell carcinomas with diameters larger than 3 cm in comparison to assess their DNA ploidy status and Ki 67 PR (proliferation rate). Results Of the 48 small renal tumors, 6 adenoma were all diploid with low PR (<1%). Aneuploid rate of 42 small renal tumors with clear and granular cell type was 16.7%, showing no statistical difference with the 33.3% aneuploid rate of 39 large renal cell carcinomas. 42 small renal tumors had a lower mean PR than large renal cell carcinoma. DNA ploidy correlated closely with nuclear grade, stage and histological type. There existed a close relation between PR and grade. Conclusion Small renal tumors consist of both adenoma and carcinoma, therefore tumor size can not be used as a criterion in their differential diagnosis. DNA ploidy and Ki 67 PR are important indicators for predicting the biological behavior and prognosis of renal parenchymal tumors.