肉瘤样癌

 The staining of HMB45 is a special mark for AML, which is never positive  in RCCs. I think the case could be a variant of AML- epithelioid AML, which is a seprated entity in WHO book and potential for malignancy. 

 平滑肌脂肪瘤

 梭形细胞癌也要考虑，看看免疫组化结果吧。

 Large atypical cell with area of cell necrosis strongly suggestive of malignant neoplasm.  At least focally, the neoplastic cells appear to form nest, therefor, I would first consider renal cell caricnoma or urothelial carcinoma with sarcomatoid changes.  Looking forward to hearing the final anwser.  Thanks.

 谢谢大家关注,因为我考虑是肉瘤样肾细胞癌,因为科室只有我一个人,没得商量,不敢出,已经让病人拿出去会诊了,有结果再说

 会诊结果,血管平滑肌脂肪瘤,免疫组化HMB45(+)

 做随访。时间是检验真理的唯一标准。

 Thanks for the follow-up with immunstain result.  I have seen quite a few angiomyolipoma (AML) including some atypica ones, such as myoid rich, epithelioid, pigmented, cystic etc.  Some can have significant cytologic atypia.  But combinations of cytologic atypia + hypercelluarity + necrosis are rare.  I still worry about sarcomatoid carcinoma.  Immunostain with other markers including pan-cytokeratin, AE1/3, SMA are also necessary to confirm the diagnosis of a atypical angiomyolipoma.  Also a symptomatic 3.0 cm AML will be pretty rare.  Opinions from 曲直 ﹢指环王 ﹢pathdoc will certainly help.  Thanks.

 形态学首选肉瘤样癌，与Stevenshen有同感。

 其它的免疫表型如何？