以皮角为表现的肾透明细胞癌皮肤转移1例

患者男,55岁。右枕部红褐色皮角样增生物3个月,进行性增大1个月。2010年确诊为"肾癌"并行右肾摘除术。皮肤科情况:右枕部可见一长约2.0cm圆锥形红褐色增生物,顶部球状角化,外观似"跳棋状",基底部直径约0.8cm,质硬,皮损周围红肿。皮损组织病理示:顶端表面破溃结痂,肉芽组织增生,真皮浅层见结节状肿瘤组织,肿瘤由巢状、腺泡状透明细胞构成,细胞核轻度异型,细胞巢周围可见丰富的血窦及毛细血管。免疫病理示:EMA(+),CD10(+),vimentin(+),CK7(-),CK20(-)。诊断:肾透明细胞癌皮肤转移。术后患者拒绝化疗,现仍在随访观察中。

A Case of Menifestation as Cutaneous Horn Due to Clear Cell Carcinoma of Kidney Metastatic to Skin

A 55-year-old male had presented with a red-brown cutaneous horn-like proliferation on his right occipitalia for three months and the lump had progressive increasing for one month.He was diagnosed kidney cancer in 2010 and his right kidney was resected.Physical examination showed one sorrel puffiness on patient’s right occipitalia about 2.0cm in height,0.8cm in basal diameter,spherical keratinization on the top,look like the "draughts",firm and red and swollen around the skin lesion.Histopathology showed the rupture and scab on the top surface,the proliferation of granulation tissue and nodosity tumor tissue in the superficial layer of dermis.The tumor was composed of nest-like or aciniform clear cells.The cells’ nuclei showed mild heteromorphism.Cell nests surrounded by rich blood sinus and capillary.Immunopathology revealed that EMA,CD10 and vimentin were positive,CK7 and CK20 were negative.Diagnosis:cutaneous metastasis due to clear cell carcinoma of kidney.After skin tumor resecting,the patient refused chemotherapy and is still in the follow-up observation.