晚期肾癌索拉非尼治疗后形态学改变二例报告

目的 探讨晚期肾癌患者索拉非尼治疗后形态学及肾癌相关蛋白表达改变的特点.方法 晚期肾癌索拉非尼治疗后的组织2例,行HE染色病理学检查,应用国内常用组织学分级系统评价治疗反应,免疫组织化学方法检测原发性肿瘤组织与复发或转移灶索拉非尼治疗后的免疫表型改变. 结果 2例患者标本病理类型与治疗前无改变,均出现不同程度的治疗反应,表现为肿瘤细胞轻度退行性改变,肿瘤组织可见明显坏死及间质纤维化.免疫组织化学分析结果显示索拉非尼治疗前后肾癌相关抗原Vimentin、AE1/AE3、CK7、CK8、CK18及CD10蛋白表达无明显变化,索拉非尼治疗后肾癌组织中血管内皮生长因子(VEGF)、VEGF受体-2(VEGFR2)、p53及Ki-67蛋白表达增强,而Bcl-2蛋白表达降低. 结论 索拉非尼治疗后可引起转移癌或复发肿瘤与原发肿瘤之间的形态学差异,以瘤细胞退行性改变及间质纤维化为主要表现,但转移性肾癌病理组织学类型无改变.VEGF、VEGFR2等表达的变化可能与索拉非尼疗效相关.

Morphologic change of metastatic renal cell carcinoma treated with sorafenib:report of 2 cases

Objective To investigate the characters of morphology change and protein expres-sion in progressed renal cell carcinoma after the treatment of sorafinib. Methods Clinical data of 2 cases with progressed renal cell carcinoma treated with sorafenib were collected. The HE slices were reviewed. Immunochemistry was used to detect the expression of Vimentin, AE1/AE3, CK7, CK8, CK18, CD10, VEGF, VEGFR2, p53 and Ki-67 levels. Results There was no difference in patho-logic type between before and after the therapy of sorafenib. Both of the 2 cases were showed degener-ation in tumor cell in different degree with fibrosis and necrosis. The expression of renal cell carcinoma related antigens (Vimentin, AE1/AE3, CK7, CK8, CK18 and CD10) had no difference before and af-ter the treatment of sorafinib. The expressions of VEGF, VEGFR2, p53 and Ki-67 were increased, and the expression of Bcl-2 was decreased after the therapy of sorafinib. Conclusions There may be some morphologie differences between the metastatic tumor or the recurrent tumor and primary tumor because of the treatment of sorafenib. However the pathologic type is the same before and after the treatment of sorafenib. The main differences are the degeneration of the tumor cell and fibrosis after the treatment of sorafenib. The expression changes of VEGF and VEGFR2 may be related to the sor-afenib application.