肾脏肿瘤—病例2 - 华夏病理网论坛

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肾脏肿瘤—病例2

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姓名：	×××	性别：	female	年龄：	86 year-old
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简要病史：	86 year-old white female was in good heath. Two days before admission to ER, she had an increased abdominal pain in the left lower quadrant without bowel movement, and she had three times of vomiting with possible blood. On admission, she was found to have severe extensive abdominal pain (10/10) with movement, urinary tract infection, dehydration,hypercalcemia (13.9), elevated alkaline phosphatase (414), and white cell count (32K). One day later, she had decreased air entry bilaterally with minimal atelectasis, acute renal failure with metabolic and respiratory acidosis (Potassium 6.2, pH 7.11, BUN 84, Cr 2.7, AST 960, ALT 428, CK 2441, Myoglobin >1000). CT scan showed distended small bowel and colon with distal colon obstruction and abdominal aortic atherosclerosis. The patients expired two days later.
肉眼检查：	A cortical tumor is identified in the middle of the left kidney that measures 2.5 x 2.0 x 1.5 cm, and the tumor is well circumscribed with a homogenously pale brown cut surface.

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1 楼发表于2008-03-15 13:10:00举报|引用
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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

Oncocytoma

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.

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

Oncocytoma

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.

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panzenggang 离线: 帖子：189; 粉蓝豆：480; 经验：246; 注册时间：2008-01-09; 加关注 | 发消息

2 楼发表于2008-03-15 13:09:00举报|引用
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