肾原发性孤立性纤维性肿瘤临床病理观察

目的 探讨原发于肾的孤立性纤维性肿瘤的临床病理特点及鉴别诊断要点.方法 复习2例肾孤立性纤维性肿瘤患者的临床资料,并对其进行组织学观察和免疫组化标记.结果 2例肾原发性孤立性纤维性肿瘤患者均为女性,年龄分别为33岁和63岁.临床主要表现为肾区钝痛,无尿频、尿急、尿痛,无血尿.CT检查示肾占位.组织学特征为瘤组织呈束状、波纹状排列,瘤细胞呈梭形,局部富于瘤细胞,间质血管丰富,部分呈血管瘤样或血管外皮瘤样结构,有明显的束状胶原.免疫表型：瘤细胞CD34、CD99和bcl-2（＋）,SMA局灶性（＋）;而HMB45和CD10（-）.结论 孤立性纤维性肿瘤具有低度恶性潜能,发生在肾极少见,以手术治疗为主,预后较好.确诊主要依靠组织病理学,并辅以免疫组化标记.

Solitary fibrous tumor of the kidney: a report of two cases and review of literature

Objective To explore the clinicopathologic characteristics and differential diagnosis of solitary fibrous tumor (SFT) of the kidney. Methods We reviewed two cases of SFT in the kidney and examined the histological and immunohistochemical (using EnVision-plus method) features. Results Both cases of SFT occurred in female, aged 33 and 63 respectively. Dull pain in the flank was the most common presenting symptom.Urine frequency, irritation, pain and hematuria were absent. CT images showed space-occupying in the kidney. The histological characteristics showed a tumor with bunchy or wavy-like arrangements. Neoplastic cells were spindle with focally high celluarity. Plenty of blood vessels were identified in the stroma: partial hemangioma or hemangiopericytoma-like structure with palpable bunchy collagen. Immunohistochemical analysis showed that the tumor cells were diffusely positive for CD34, CD99, BCL-2 and focally positive for SMA while negative for HMB45 and CD10. Conclusions The SFT of the kidney is very rare and has the characteristics of low malignant potential. The main treatment of the SFT is surgery with a good prognosis. Definite diagnosis should be based mostly on pathological examination in assistance with immunohistochemical analysis.