19例肾腺瘤的组织病理学观察

目的 探讨各型肾腺瘤的形态特点及其诊断标准。方法 各型肾腺瘤共19例,进行光镜,电镜观察,组织化学,免疫组织化学LSAB法检测及随访观察。结果 乳头状腺瘤3例,呈乳头,管乳头状排列;由嗜碱性细胞或嗜酸性细胞组成;上皮膜抗原（EMA）及细胞角蛋白（CK）7双表达。嗜酸细胞腺瘤13例,呈巢状排列,也见管状,乳头结构或单个细胞散在;以嗜酸细胞为主,尚见“嗜酸母细胞”及透亮细胞等;波形蛋白,CK7均阴性,Hale胶体铁染爸阴性;电镜示胞质内多量大线粒体。后肾腺瘤3例,均匀一致的小细胞构成小管,亦见实性,肾小球样,分支长管结构,间质未肿状;EMA阴性,CK7阴性或局灶阳性。各型肾腺瘤均随访3－5年,1例嗜酸细胞腺瘤5年后死亡,余均健在。结论 肾腺瘤有3种,乳头状腺瘤,嗜酸细胞腺瘤,后肾腺瘤,各有其临床病理特点,后两者以形态学为诊断依据,前者仍需参考肿瘤大小。组织化学,免疫组织化学检测有助于鉴别诊断。

Clinicopathological observation of renal adenomas

Objective To investigate the morphologic features and diagnostic criteria of various types pf renal adenomas of the kidney. Methods In addition to light microscopy,electron microscopy, histochemical and immunohistochemical assays were applied. All 19 cases of adenomas were followed up. Results Three (3) cases of papillary adenoma were featured as papillary or tubulopapillary growth in patterns consisting of tumor cells with basophilic or acidophilic cytoplasm and were positive for both epithelial membrane antigen (EMA) and cytokeratin (CK7). Thirteen (13) cases of oncocytoma were characterized by the diversity of the structures including to be nest,tubular and papillary in pattern; a mixture of cell types including the classic oncocytes,oncoblasts and clear cells which were negative for vimentin and CK7 but positive for EMA. Enormous large mitochondria were obtained in 4 cases of oncocytoma by electronic microscopy. Three (3) cases of metanephric adenoma consisted of closely packed, round tubules lined by small bland cells with solid,glomeruloid constructure. Branching, elongated tubules and polypoid fronds were also detected. Tumor cells were negative for EMA,negative or only focally positive for CK7. Eighteen (18) patients were alive except one oncocytoma patient died 5 years after the diagnosis convinced. All the cases reported in this article had been followed up of 3 5 years. Conclusions There are 3 kinds of renal adenomas, namely, the papillary adenoma, oncocytoma, and metanephric adenoma and each kind has its own clincopathological features. The latter two can be recognized by their distinctive morphology, and the former can only be diagnosed according to the size of the tumor as the reference. Histochemical and immohistochemical assays are helpful in differential diagnosis.