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lfl001200546 离线
Sorry. I cannot type in Chinese. I hope you can understand it.
This is multilocular cystic renal cell carcinoma.
Morphologically you can see the cysts lined by clear cels. There are clear cells forming nest in the stroma or septa. Normally the clear cells have small dark nuclei.
In kidney the differentials of cystic lesions mainly include cystic nephroma, mixed epithelial and stromal tumor (MEST), simple cyst, atypical renal cyst, renal cell carcinoma with cyst (cystic, necrotic RCC or multilocular cystic RCC), polycystic kidney disease.
Basically cystic nephroma and MEST are the same kind of benign tumor. They predominantly occur in female patient. The epithelial lining is benign and stroma cells are spindle, similar to the ovarian stromal cells. The stromal cells are positive for estrogen receptor and progesterone receptor. They can be misdiagnosed on core biopsy since the epithelial cells may have reactive or degenerative atypica. The best clue is the blue spindle stromal cells under the epithelial area.
Atypical renal cysts have clear cell lining. There is not papillary projection or nest of clear cells in the septa. You need to inform the urologist that the patient should be followed closely.
Multilocular cystic RCC: like current case. There are nests of clear cells and papillary projection. For diagnosing cystic RCC you will not see large solid area of clear cells. Generally cystic RCC has excellent prognosis. In some case there are small nest RCC cells you can call multicystic RCC low malignant potential.
Cystic, necrotic RCC: often has papillary structure or solid clear cells. There are florid necrosis and cyst formation.
ZQH19811029 离线