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目的分析肾球旁细胞瘤的临床病理特征,探讨其生物学行为及预后因素。方法采用光镜和免疫组化方法,结合临床资料对比研究2例肾球旁细胞瘤的临床病理特点。结果 2例肾球旁细胞瘤患者均为男性,年龄分别为46岁和9岁,有高血压症状;均行肾部分切除术,术后随访1～6个月,无复发或转移。肿瘤位于肾皮质,直径2 cm,界清。例1具有典型的良性肾球旁细胞瘤特征,即瘤组织实性、片状分布,细胞呈圆形,大小较一致,胞质淡染或弱嗜酸性,胞核呈圆形或椭圆形,染色质细腻,缺乏核分裂;间质毛细血管和血窦丰富,透明变性的厚壁血管呈簇状分布。例2则由椭圆形、多角形、梭形及带状细胞构成,核异型性明显,核分裂8～10个/10HPF,可见病理性核分裂;部分区域呈席纹状或旋涡状生长。免疫组化示肿瘤细胞vimentin和CD34弥漫强(+),SMA不同程度(+);例1和例2的Ki-67指数分别为<1%和20%。结论肾球旁细胞瘤是一种良性肿瘤,少部分病例为恶性潜能未定。提示恶性潜能的临床病理指标包括血管或包膜浸润、肿瘤体积大、高核分裂象及年长或年幼患者。明显核异型对预后的影响尚不确定。
OBJECTIVE: To analyze the clinicopathological features of glomerular tumors and to investigate their biological behavior and prognostic factors. Methods The clinical and pathological features of 2 cases of glomerular mesothelioma were studied by light microscopy and immunohistochemistry combined with clinical data. Results Two cases of patients with glomerular mesothelioma were male, aged 46 years and 9 years old, with symptoms of hypertension. All patients underwent partial nephrectomy and were followed up for 1 to 6 months without recurrence or metastasis. The tumor is located in the renal cortex, diameter 2 cm, clear boundary. Example 1 has the typical characteristics of benign renal ball cell tumor, that is, the solid tumor tissue, flaky distribution, the cells were round, the size of the same, pale or weakly eosinophilic cytoplasm, the nucleus was round or oval, Chromatin delicate, lack of nuclear fission; interstitial capillary and sinusoid rich, transparent degeneration of thick-walled blood vessels were clustered distribution. Example 2 is composed of oval, polygonal, fusiform and ribbon-shaped cells, nuclear atypia obvious, mitotic 8 ~ 10 / 10HPF, visible pathological mitosis; some areas were striated or spiral-shaped growth. Immunohistochemistry showed that vimentin and CD34 were diffusely (+) and SMA to varying degrees (+); Ki-67 index of cases 1 and 2 were <1% and 20%, respectively. Conclusion Renal para-tumor is a benign tumor. In a small number of cases, malignant potential is undetermined. The clinicopathological parameters that suggest malignant potential include vascular or envelope infiltration, large tumor size, high-mitotic figures, and elderly or young patients. The obvious impact of nuclear atypia on the prognosis is uncertain.