华西医学

华西医学

肾嫌色细胞癌和嗜酸细胞瘤的鉴别诊断

查看全文

目的探讨肾嫌色细胞癌和嗜酸细胞瘤的临床特点、鉴别诊断及治疗。 方法纳入2009年12月-2013年5月经手术及病理检查证实41例肾嫌色细胞癌和22例肾嗜酸细胞瘤患者,并回顾性分析其临床特点、B型超声、CT的结果及免疫组织化学染色CK7、CD10、PAX-2、Ksp-cadherin抗体的表达情况。 结果肾嫌色细胞癌可伴有腰部疼痛或血尿,而肾嗜酸性细胞瘤一般无临床症状;B型超声及CT等影像学检查对于两者鉴别无特异性;免疫组织化学染色中,肾嫌色细胞癌中,66%(21/32)CK7表现为弥漫染色,22%(7/32)CD10弥漫染色,23%(3/13)PAX-2弥漫染色,93%(14/15)Ksp-cadherin弥漫染色。肾嗜酸细胞瘤中,7%(1/15)CK7表现为弥漫染色,7%(1/15)CD10弥漫染色,86%(13/15)PAX-2弥漫染色,31%(4/13)Ksp-cadherin弥漫染色。两者呈现的差异性表达有统计学意义(P<0.05),且两者免疫组织化学CK7(-)CD10(-)PAX-2(+)与CK7(-)CD10(-)Ksp-cadherin(-)组合均有差异。 结论CK7(-)CD10(-)PAX-2(+)与CK7(-)CD10(-)Ksp-cadherin(-)免疫组织化学组合在肾嫌色细胞癌和肾嗜酸性细胞瘤中的差异性表达对于两者的鉴别诊断具有一定的价值,结合影像学检查,能进一步提高疾病的鉴别诊断,值得深入研究。

ObjectiveTo investigate the clinical features, differential diagnosis and treatment for chromophobe cell renal carcinoma (CRCC) and renal oncocytoma. MethodsFrom December 2009 to May 2013, we selected 41 cases of CRCC and 22 cases of renal oncocytoma, retrospectively analyzed their clinical features, ultrasonography and CT findings and performed immunohistochemical staining for CK7, CD10, PAX-2, and Ksp-cadherin. ResultsCRCC could be associated with lower back pain or hematuria, and renal oncocytoma generally did not have clinical symptoms. Ultrasonography and CT examination were not specific for the differentiation between the two diseases. The expression rates of CK7, CD10, PAX-2, and Ksp-cadherin in CRCC were 66% (21/32), 22% (7/32), 23% (3/13) and 93% (14/15), respectively. In patients with oncocytoma, 7% (1/15) were positive for CK7, 7% (1/15) were positive for CD10, 86% (13/15) were positive for PAX-2, and 31% (4/13) were positive for Ksp-cadherin. Pearson chi-square analysis was performed with a significant P value set at <0.05. The results of CK7(-)CD10(-)PAX-2(+) and CK7(-)CD10(-)Ksp-cadherin(-) immunohistochemistry were integrated, which also showed the differences. ConclusionThe combination of CK7(-)CD10(-)PAX-2(+) and CK7(-)CD10(-)Ksp-cadherin(-) immunohistochemistry may be useful for differentiating between CRCC and oncocytoma. Combined with imaging examination, it can further improve the differential diagnosis of the two diseases.

关键词: 嫌色细胞癌; 嗜酸细胞瘤; 免疫组织化学染色; 鉴别诊断

Key words: Chromophobe cell carcinoma; Oncocytoma; Immunohistochemical staining; Differential diagnosis

引用本文: 陈力博, 王显丁, 胡蓉, 卢一平. 肾嫌色细胞癌和嗜酸细胞瘤的鉴别诊断. 华西医学, 2014, 29(3): 504-507. doi: 10.7507/1002-0179.20140151 复制

登录后 ,请手动点击刷新查看全文内容。 没有账号,
登录后 ,请手动点击刷新查看图表内容。 没有账号,
1. Thoenes W, Stsrkel S, Rumpeh HJ. Human chromophobe cell renal carcinoma[J]. Virchows Arch B Cell Pathol Incl Mol Pathol, 1985, 48(3):207-221.
2. Klein MJ, Valensi QJ. Proximal tubular adenomas of kidney with so-called oncocytic features. A clinicopathologic study of 13 cases of a rarely reported neoplasm[J]. Cancer, 1976, 38(2):906-914.
3. Eble J, Sauter G, Epstein JI, et al. WHO classification of tumors:pathology and genetics of tumours of the urinary system and male genital organs[M]. Lyon:IARC Press, 2004.
4. Rohan S, Tu JJ, Kao J, et al. Gene expression profiling separates chromophobe renal cell carcinoma from oncocytoma and identifies vesicular transport and cell junction proteins as differentially expressed genes[J]. Clin Cancer Res, 2006, 12(23):6937-6945.
5. Eble JN, Sauter G, Epstein JI, et al. Pathology and genetics of tumors of the urinary system and male genital organs[M]. Lyon:LARC Press, 2004:12-76.
6. Rosenkrantz AB, Hindman N, Fitzgerald EF, et al. MRI features of renal oncocytoma and chromophobe renal cell carcinoma[J]. AJR Am J Roentgenol, 2010, 195(6):W421-W427.
7. Regezi JA, Deegan MJ, Hayward JR. Lichen planus:immunologic and morphologic identification of the submucosal infiltrate[J]. Oral Surg Oral Med Oral Pathol, 1978, 46(1):44-52.
8. Leroy X, Moukassa D, Copin MC, et al. Utility of cytokeratin 7 for distinguishing chromophobe renal cell carcinoma from renaloncocytoma[J]. Eur Urol, 2000, 37(4):484-487.
9. Yasir S, Herrera L, Gomez-Fernandez C, et al. CD10+ and CK7/RON-immunophenotype distinguishes renal cell carcinoma, conventional type with eosinophilic morphology from its mimickers[J]. Appl Immunohistochem Mol Morphol, 2012, 20(5):454-461.
10. Khoubehi BI, Kessling AM, Adshead JM, et al. Expression of the developmental and oncogenic Pax2 gene in human prostate cancer[J]. J Urol, 2001, 165(6, Part 1):2115-2120.
11. Muratovska A, Zhou C, He S, et al. Paired-Box genes are frequently expressed in cancer and often required for cancer cell survival[J]. Oncogene, 2003, 22(39):7989-7997.
12. Carvalho JC, Wasco MJ, Kunju LP, et al. Cluster analysis of immunohistochemical profiles delineates CK7, vimentin, S100A1 and C-kit (CD117) as an optimal panel in the differential diagnosis of renal oncocytoma from its mimics[J]. Histopathology, 2011, 58(2):169-179.
13. Adley BP, Gupta A, Lin F, et al. Expression of kidney-specific cadherin in chromophobe renal cell carcinoma and renal oncocytoma[J]. Am J Clin Pathol, 2006, 126(1):79-85.
14. Gudbjartsson T, Hardarson S, Petursdottir V, et al. Renal oncocytoma:a clinicopathological analysis of 45 consecutive cases[J]. BJU Int, 2005, 96(9):1275-1279.