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"Granular" Renal Neoplasms?

stevenshen 离线

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楼主 发表于 2009-01-09 08:21|举报|关注(0)
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姓    名: ××× 性别:  Female 年龄:  50-70
标本名称: Kidney
简要病史: Kidney mass
肉眼检查:  

Four different (A, B, C, D) renal tumors with granular cells

What's your guess for each and why?

  • "Granular" Renal Neoplasms?图1
    图1
  • "Granular" Renal Neoplasms?图2
    图2
  • "Granular" Renal Neoplasms?图3
    图3
  • "Granular" Renal Neoplasms?图4
    图4
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stevenshen 离线

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1 楼    发表于2009-02-13 11:10:00举报|引用
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A few comments about the "granular" renal neoplasm. Obviously this is only one small high power field of a neoplasm. I hope that most people would agree the most important for a correct diagnosis of a difficult case is to look at all areas of the tumor and adequate sampling.  

  • A: difficult to diagnosis - eosinophilic cell, may be perinuclear halo, slight irregular nuclear contour, and prominent cytoplamic membrane, and linear vascular pattern
  • B: should be relatively easy - discohesive cells, round nuclei...
  • C and D: almost impossible to tell the difference...will need to search for areas of fat and abnormal vessels for the diagnosis of angiomyolipoma and look for low grade clear cells with chicken-wire pattern vascular network for clear cell RCC.

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Lili0321 离线

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2 楼    发表于2009-02-11 19:34:00举报|引用
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 Thanks, Dr.Shen.
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stevenshen 离线

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3 楼    发表于2009-02-07 23:44:00举报|引用
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Yes these pictures are from 4 different patients.  The answers are:

  • A. Chromophobe RCC, eosinophilic type
  • B. Oncocytoma
  • C. Angiomyolipoma (myoid rich)
  • D. Clear cell RCC
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天山望月 离线

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4 楼    发表于2009-01-12 21:48:00举报|引用
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 这里可以大胆的猜,试试看,还望老师多指导!

A:透明细胞肿瘤

B:嗜酸颗粒细胞肿瘤

C:血管平滑肌脂肪瘤,不排除脂肪肉瘤(粘液样,但没看到脂母细胞)

D:血管平滑肌脂肪瘤

C、D不好猜,也不知其它病史、肿瘤大小、边界、色泽等。

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广州金域病理

蔷薇 离线

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5 楼    发表于2009-01-12 21:18:00举报|引用
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 老师的意思是四个照片是四个病例。对吗?
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曲直 离线

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6 楼    发表于2009-01-12 14:38:00举报|引用
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 嫌色性肾细胞癌。

应该说比较典型,瘤组织呈实体性结构,瘤细胞周有明显空晕。

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蔷薇 离线

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7 楼    发表于2009-01-11 21:18:00举报|引用
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 A嫌色性肾细胞癌

B嗜酸细胞瘤

CD血管平滑肌脂肪瘤

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Lili0321 离线

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8 楼    发表于2009-01-11 19:06:00举报|引用
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 怪不得,我只看了50岁女性,没仔细看说明。1和2可能是肾细胞肿瘤,1可能是嫌色细胞癌或透明细胞癌,2可能是嗜酸细胞腺瘤或嫌色细胞癌,3和4更可能是血管平滑肌脂肪瘤。请沈老师解释。
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stevenshen 离线

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9 楼    发表于2009-01-10 23:07:00举报|引用
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以下是引用Lili0321在2009-1-9 21:33:00的发言:

 This is a difficult case. Polygonal and  round cells, with granular cytoplasm, sharp membrane, round to irregular nuclear, clear cell carcinoma or chromaphobe carcinoma should be considered. IHC stainings of vimentin, CD10(membrran, not cytoplasm expression) favor clear cell carcinoma(CK7-), while stainings of CK7, E-cadherin favor chromaphobe carcinoma(CD10 -, or cytoplasm staining). Finally, a combination of chromaphobe and oncytoma may suggest BDH syndrome. Thanks for the interesing case.   

Very good analysis! I am sorry that I did not make it very clear.  These 4 photos are from 4 different patients (tumors).  Try it again?
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thlcp 离线

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10 楼    发表于2009-01-09 22:35:00举报|引用
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 透明细胞癌
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Lili0321 离线

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11 楼    发表于2009-01-09 21:33:00举报|引用
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 This is a difficult case. Polygonal and  round cells, with granular cytoplasm, sharp membrane, round to irregular nuclear, clear cell carcinoma or chromaphobe carcinoma should be considered. IHC stainings of vimentin, CD10(membrran, not cytoplasm expression) favor clear cell carcinoma(CK7-), while stainings of CK7, E-cadherin favor chromaphobe carcinoma(CD10 -, or cytoplasm staining). Finally, a combination of chromaphobe and oncytoma may suggest BDH syndrome. Thanks for the interesing case.   
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