| 图片： | |
|---|---|
| 名称： | |
| 描述： | |
- 肾肿瘤（2008-9-1）
-
lantian0508 离线
- 帖子：1250
- 粉蓝豆：42
- 经验：1495
- 注册时间：2007-08-01
- 加关注 | 发消息
唐平老师关于嫌色细胞癌的文章：
瘤体较大，常单个，境界明显，坏死出血少见，包膜完整很少突破肾包膜。光镜下肿瘤细胞呈腺泡状排列，细胞大，胞浆丰富，常见两种类型细胞，胞浆淡染呈细网状甚至透明的气球样的I型细胞及胞浆嗜酸性呈细颗粒状的Ⅱ型细胞。这两种类型的肿瘤细胞的PAS和苏丹Ⅳ染色均显示其胞浆内缺乏糖原和脂滴。Hale胶体铁染色，胞浆阳性，呈亮蓝色，说明肿瘤细胞含有酸性粘液物质。免疫组织化学染色Vimentin阴性，CK8、CK7、CK19阳性，CK20阴性。电镜下见胞浆内大量的小空泡，二型细胞均可见。小空泡的存在是嫌色细胞癌区别于其它肾肿瘤的独特之处，亦是光镜下其独特细网状胞浆的结构基础。
肾嫌色细胞癌起源于肾集合小管上皮，组织学上可分为透明细胞型和嗜酸细胞型。透明细胞型肿瘤细胞胞体界限清楚，胞浆内可见细网状结构，CK8阳性，Vimentin阴性以及Hale胶体铁染色阳性，可与肾透明细胞癌(CK8阴性Vimentin阳性以及Hale胶体铁染色阴性)相区别。嗜酸细胞型则与肾嗜酸细胞瘤区别要点 ：①两者行细胞质Hale胶体铁染色均阳性，但细胞癌着色较为弥散，而嗜酸细胞瘤较为集中；② 嫌色细胞癌电镜下细胞质内有大量密集小空泡；③ 嗜酸细胞瘤瘤体较大时，许多肿瘤可见中央瘢痕，而嫌色细胞癌无瘢痕。
- 超越自我，自由飞翔！
-
lantian0508 离线
- 帖子：1250
- 粉蓝豆：42
- 经验：1495
- 注册时间：2007-08-01
- 加关注 | 发消息
-
lantian0508 离线
- 帖子：1250
- 粉蓝豆：42
- 经验：1495
- 注册时间：2007-08-01
- 加关注 | 发消息
-
stevenshen 离线
- 帖子：343
- 粉蓝豆：2
- 经验：343
- 注册时间：2008-06-03
- 加关注 | 发消息
-
I do not disagree with the final diagnosis. I think this tumor has features of both oncocytoma and eosinophilic type chromophobe renal cell carcinoma (linear vascular pattern, focal prominent plasma membrane, nuclear wrinkling etc). These two neoplasms share many overlapping features include cytogenetic changes. Unfortunately there are no reliable immunohistochemical markers to distinguish them. Thanks.
-
stevenshen 离线
- 帖子：343
- 粉蓝豆：2
- 经验：343
- 注册时间：2008-06-03
- 加关注 | 发消息
There are a number of ways to issue the repot. If you agree and SURE that a tumor indeed has features of oncocytoma and chromophobe RCC. My suggestion would be either "Chromophobe RCC (eosinophilic) with focal oncocytoma feature" or "unclassified oncocytic RCC" and write a note or comment at the end of your report. If you are not an expert and don't have too much experience with renal tumor, it is a good idea to get a consultation. Oncocytoma is a benign tumor; fortunately eosinophilic chromophobe RCC is a low grade tumor; the treatment is the same. The risk for underdiagnosis of a true carcinoma is that you will be embrassed or in trouble if patient develop recurrence or metastasis in the future. I hope this is helpful. 回复仅供参考
