右肾下级肿块（6） - 华夏病理网论坛

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楼主发表于 2010-02-28 15:14|举报|关注(0)
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姓名：	×××	性别：	女	年龄：	60
标本名称：	右肾
简要病史：	体检发现右肾下极肿块
肉眼检查：	肿块4x4x4cm，切面实性，棕黄色，边界清，似有包膜。

欢迎大家讨论，谢谢！

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本帖最后由于 2010-02-28 15:18:00 编辑

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: 广州金域病理

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1 楼发表于2010-03-23 06:02:00举报|引用
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判断IHC标记结果和鉴别诊断价值，不尽要参考文献，更重要是本病理科实验室标记结果是否与文献报道相同。由于IHC标准化问题，抗体的选择、标本的固定时间、石蜡包埋的材质、染色用的试剂、抗原修复方法、抗体的稀释度、技术员的经验、是否设定阳性和阴性对照，都会影像到IHC标记结果和判断。因此，用IHC进行鉴别诊断时一定要根据自己实验室的经验，而不要人云亦云。

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: xljin8

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2 楼发表于2010-03-22 23:44:00举报|引用
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感谢金主任提供相关文献！各文献报道不一，因此诊断基于HE形态学。

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: 广州金域病理

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3 楼发表于2010-03-19 06:36:00举报|引用
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本帖最后由于 2010-03-19 06:36:00 编辑
非常好的问题。 CD117 在肾脏肿瘤中的表达和鉴别诊断意义文献报道不一。请看此文献：

名称：图1
描述：图1

名称：图2
描述：图2

名称：图3
描述：图3

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: xljin8

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4 楼发表于2010-03-17 22:25:00举报|引用
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谢谢Dr.jin ！多数文献认为CD117在肾嫌色细胞癌和嗜酸细胞腺瘤均阳性，胶体铁是鉴别两者的非常有用的方法。而上面这篇文献显示CD117在所有的肾细胞癌均阴性，而在嗜酸性腺瘤阳性，不知理解的对否？请赐教，谢谢！

此例胶体铁为（—），产生阴性的原因可能与组织固定、染色过程等有关。

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: 广州金域病理

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5 楼发表于2010-03-17 19:17:00举报|引用
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哦！CD117还有这功能，谢谢了！

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: 嫁人就嫁灰太狼，学习要上华夏网。

XLJin8 离线: 帖子：2275; 粉蓝豆：1536; 经验：2417; 注册时间：2009-03-04; 加关注 | 发消息

6 楼发表于2010-03-14 20:40:00举报|引用
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12楼文献报道：
1）胶体铁染色：嫌色细胞癌和嗜酸性腺瘤均为阳性；
2）仅嗜酸性腺瘤阳性表达CD117。

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: xljin8

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7 楼发表于2010-03-14 08:30:00举报|引用
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本帖最后由于 2010-03-14 20:37:00 编辑

以下是引用xljin8在2010-3-14 8:29:00的发言：

Rekha PR, Rajendiran S, Rao S, Shroff S, Joseph LD, Prathiba D.

Histological reclassification, histochemical characterization and c-kit immunoexpression in renal cell carcinoma. Indian J Urol. 2008;24:343-7.

OBJECTIVES: Renal cell carcinoma is the most lethal of all urologic malignancies. Several parameters such as histological subtype, nuclear grade and TNM staging help in determining the prognosis and treatment options. A newer therapeutic modality has been suggested based on expression of c-kit antigen by the tumor cells. This study was designed to evaluate various histological parameters and correlate them with c-kit expression. MATERIALS AND METHODS: The study was done on 40 consecutive cases of renal epithelial tumors. Histological sections were reviewed and reclassified according to WHO (2004) classification and nuclear grade assessed. Hale's colloidal iron stain was done to identify the chromophobe variant. Immunostaining with c-kit was done and its expression was studied. The results were correlated and statistical significance was assessed. RESULTS: The age range was 31-81 years, with a male to female ratio of 2:1. Seventy per cent of the cases were clear cell RCC (ClRCC), 17.5% were chromophobe type, 7.5% were papillary RCCs and 5% cases were oncocytomas. Fuhrman nuclear grading revealed 60.5% cases to be of low grade and 39.5% high grade.

Hale's colloidal iron staining was positive in chromophobe RCC and oncocytomas, while it was negative in ClRCC. Immunostaining with c-kit was positive only in oncocytomas. CONCLUSIONS: Clear cell RCC was the most common histological subtype of RCC. Clear cell RCC known to have a poor prognosis, showed a statistically significant higher nuclear grade than chromophobe and papillary RCCs which have a better prognosis. Hale's colloidal iron staining was extremely useful in distinguishing chromophobe RCC and oncocytoma from the granular cell variant of clear RCC. Our study revealed c-kit negativity in all RCC. As Imatinib could be ineffective in such tumors, its clinical activity has to be carefully assessed in such tumors through further studies.

胶体铁染色：嫌色细胞癌和嗜酸性腺瘤均为阳性；CD117 仅嗜酸性腺瘤阳性。

以下是引用xljin8在2010-3-14 8:29:00的发言：

Rekha PR, Rajendiran S, Rao S, Shroff S, Joseph LD, Prathiba D.

Histological reclassification, histochemical characterization and c-kit immunoexpression in renal cell carcinoma. Indian J Urol. 2008;24:343-7.

OBJECTIVES: Renal cell carcinoma is the most lethal of all urologic malignancies. Several parameters such as histological subtype, nuclear grade and TNM staging help in determining the prognosis and treatment options. A newer therapeutic modality has been suggested based on expression of c-kit antigen by the tumor cells. This study was designed to evaluate various histological parameters and correlate them with c-kit expression. MATERIALS AND METHODS: The study was done on 40 consecutive cases of renal epithelial tumors. Histological sections were reviewed and reclassified according to WHO (2004) classification and nuclear grade assessed. Hale's colloidal iron stain was done to identify the chromophobe variant. Immunostaining with c-kit was done and its expression was studied. The results were correlated and statistical significance was assessed. RESULTS: The age range was 31-81 years, with a male to female ratio of 2:1. Seventy per cent of the cases were clear cell RCC (ClRCC), 17.5% were chromophobe type, 7.5% were papillary RCCs and 5% cases were oncocytomas. Fuhrman nuclear grading revealed 60.5% cases to be of low grade and 39.5% high grade.

Hale's colloidal iron staining was positive in chromophobe RCC and oncocytomas, while it was negative in ClRCC. Immunostaining with c-kit was positive only in oncocytomas. CONCLUSIONS: Clear cell RCC was the most common histological subtype of RCC. Clear cell RCC known to have a poor prognosis, showed a statistically significant higher nuclear grade than chromophobe and papillary RCCs which have a better prognosis. Hale's colloidal iron staining was extremely useful in distinguishing chromophobe RCC and oncocytoma from the granular cell variant of clear RCC. Our study revealed c-kit negativity in all RCC. As Imatinib could be ineffective in such tumors, its clinical activity has to be carefully assessed in such tumors through further studies.