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谢谢
大体我有点吃不准,HE就比较明确了
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Oncocytoma.Thank you so much!
朱正龙
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1: CK7
2: Colloid iron
3: EMA
4: EM, lower power
5: EM, Higher power
Oncocytoma
The Key Features
· Central scar, central loose hypocellular fibrous stroma;
· Uniform granular eosinophilic cytoplasm;
· CK7 scattered +, CD117+; Vim-, CD10-, RCC-;
· EM: numerous mitochondria.
Clinical Futures
· Most common benign solid renal tumor;
· Originate from the intercalated cells of the collecting duct;
· 3-7% of all renal tumor, 2-12% multifocal, and 4-14% bilateral;
· M:F= 2-3:1;
· Mean patient age is 62-68
· 10% of cases, oncocytoma and chromophobe RCC may coexist.
Gross Findings
· Spherical and are large (average size, 7 cm) with a pseudocapsule or no capsule;
· Cut sections, homogeneously tan-pale yellow, mahogany color;
· Characteristic fleshy/stellate central scar (33-54%);
· Necrosis, hemorrhage and calcification may be present.
Microscopic Findings
· Large cells, granular eosinophilic cytoplasm;
· Well-defined small nests, no sheet-like arrangement;
· Nuclei: round/oval/smooth and round, minimal atypia, large nucleoli
· Some areas, the nests are separated by a loose hypocellular fibrous stroma.
Differential Diagnosis
Chromophobe RCC
Gross
Mahogany brown +/- central scar
Pale tan-brown, +/- central necrosis
Architecture
Closely packed nests (periphery) and nests in loose hypocellular stroma; no trabeculae/sheets
Closely packed nests; +/-broad trabeculae/sheets
Cell
Uniform, limited atypia
Classic and eosinophic cells, more atypia
Cytoplasm
Granular, acidophilic
Granular, acidophilic with perinuclear halos
Nuclei
Uniform, round, degenerative pleomorphism
More pleomorphism, "raisinoid"
Mitoses
None or rare
Occasional
Colloidal iron
Focal positivity, in the lumen.
Strongly diffuse positivity
CK
Positive,CK7-scattered strong positive
Positive,CK7-diffusely strong positive
Vimentin
Negative
Ultrastructure
Numerous mitochondria with lamellar cristae;
no microvesicles
Numerous mitochondria with tubulovesicular cristae; interspersed microvesicles
Immunohistochemistry Staining
· Cathepsin H +, EMA+, CK7-scattered strong positive, CD117+
· RCC-, Vimentin-, CD10-
· Colloid iron staining: focal positive
Election Microscopy
· Abundant abnormal mitochondria
Cytogenetics
· Losses of chromosome 1 and X chromosomes, deletion of chromosome 14 and a balanced translocation involving 11q13.
Treatment and Prognosis
· Benign tumors, and the prognosis after total or partial nephrectomy is excellent.
Reference
· http://emedicine.com/radio/topic484.htm
· AFIP, 4th series
· Essential of Anatomic Pathology. Liang Cheng. 2nd Edition.
Discussion: Zenggang Pan, MD, PhD. www.enjoypath.com
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