肾黏液样小管状和梭形细胞癌临床病理观察

 目的 探讨肾黏液样小管状和梭形细胞癌的临床病理特点及鉴别诊断。 方法 观察2例肾黏液样管状和梭形细胞癌的临床资料、组织病理学及免疫组织化学特点，并复习相关文献。 结果 患者男、女各1例，年龄分别为66岁和54岁。1例因体检被发现，另1例因贫血就诊。病理检查：肉眼瘤组织切面呈实性、灰白色，边界多清楚，未见囊性变。镜下瘤组织由多少不一的小管状和梭形细胞区构成，间质富含黏液。瘤细胞部分呈立方状，胞浆透明或弱嗜酸颗粒状，核圆形或不规则形，核分裂相少见。部分细胞梭形，束状或编织样排列，似平滑肌瘤。1例以立方状细胞成分为主，另1例以梭形细胞成分为主。免疫组织化学：2例瘤细胞均呈CK(AE1/AE3)、EMA、Vimentin阳性，其中1例并呈Syn局灶阳性；而desmin、CgA、S－100、SMA、CD117、CD34、CD10、 HMB45、p53、ER及PR均阴性，Ki67指数均小于1％；术后分别随访7月和11月，均未见复发和转移。 结论 肾黏液性管状和梭形细胞癌为罕见的肾脏低度恶性肿瘤，病理诊断时需与其他肾肿瘤鉴别。

Mucinous Tubular and Spindle Cell Carcinoma of Kidney:Clinicopathologic Observation

Objective To investigate the clinicopathological features and differential diagnosis of mucinous tubular and spindle cell carcinoma（MTSCC） of kidney. Methods Two cases of MTSCC of kidney were studied with clinical data,histopathologic,and immunohistochemical staining and review the related literatures. Results The age of patients was 66 and 54 years old(one male and one female）respectively.One case was found by physicial examination and the other because of anemia.The cut surface of the tumor was solid with a yellow to gray in color with no cysts.Microscopical detection showed that the tumors were composed of variable proportions of tubular and spindle cell areas with prominent mucinous or myxoid stroma；some tumor cells were uniformly cuboidal with ovoid to round nuclei and eosinophilic or clear cytoplasm,cuboidal cells are arranged in tubules and cords;the other tumor cells showed spindle,which were arranged in the fascicular pattern,resembling smooth muscle tumors.One cases showed spindle cell predominance and the other showed tubular predominance.Immunostaining showed that tumors were positive for CK(AE1/AE3),EMA,vimentin，and one tumor focally express Syn,but negative for desmin, CgA,S－100,SMA,CD117,CD34,CD10,HMB45,p53,ER and PR.Both tumors had low proliferative index of less than 1%.Follow up in 2 patients（7 and 10 months）showed no recurrence. Conclusion MTSCC of kidney is a rarely low malignant renal cell carcinoma,it should be differentiated from other renal tumors.