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目的探讨肾小细胞型嗜酸细胞瘤(RO)的临床病理学特征、免疫表型及鉴别诊断。方法报道3例罕见的小细胞型RO,结合文献分析其临床、形态学及免疫表型特点。结果 3例患者均为女性,年龄38~53岁,均体检发现。巨检:肿瘤境界清楚,直径3~9 cm;切面1例囊实性,2例实性,灰白、灰黄色,其中1例中央可见纤维瘢痕。镜检:3例瘤组织均主要由巢团状或实性片状排列、形态一致的小圆形瘤细胞组成,瘤细胞淡嗜酸,核深染、核仁不明显,核分裂象罕见或无;部分区域可见密集的小腺泡、假菊形团及散在的管囊状结构。2例局部可见典型嗜酸细胞瘤区域,1例仅见很少量散在的嗜酸性瘤细胞。瘤组织间质稀少,2例局部有疏松水肿的结缔组织。免疫组化:3例肿瘤小细胞免疫表型与典型嗜酸细胞基本一致,AE1/AE3、EMA、E-cad、CD117、MOC31和mitochondria均强(+),CK7、pax-8、ksp-cad和p504s灶状或弱(+);vimentin、CD10、CAⅨ、RCC、S-100A1、CD56、Cg A、Syn、TFEB、HMB45、melan A、CD99、WT-1、CD34和SMA均(-);Ki-67阳性指数均≤5%。患者随访12~30个月,均未见肿瘤复发和转移。结论肾小细胞型RO是一种非常罕见的RO亚型,组织学形态以一致的小细胞呈片、团状排列并伴有多量假菊形团结构为特征,免疫表型与典型RO基本一致;免疫组化染色有助于与肾原发性或转移性小细胞肿瘤鉴别。
Objective To investigate the clinicopathological, immunophenotypic and differential diagnosis of renal cell type oncocytoma (RO). Methods Three cases of rare small cell type RO were reported and their clinical, morphological and immunophenotypic characteristics were analyzed in combination with the literature. Results All 3 patients were female, aged from 38 to 53 years old. Giant examination: clear tumor, diameter 3 ~ 9 cm; section of 1 case of cystic solidity, 2 cases of solid, gray, gray, of which 1 case of central visible fiber scar. Microscopic examination: 3 cases of tumor tissue are mainly composed of nest clusters or solid flake arranged in the same form of small round tumor cells, neutrophilic tumor cells, deep stained nucleoli, nucleoli are not obvious, mitotic figures rare or not ; Part of the area can be seen dense acini, false daisy clusters and scattered tube capsule structure. In 2 cases, the typical area of eosinophilia was partially seen. Only a few eosinophilic tumor cells were scattered in one case. Smear interstitial sparse, 2 cases of local loose connective tissue edema. Immunohistochemistry: The immunophenotypes of three small cell tumors were basically the same as those of typical eosinophils. AE1 / AE3, EMA, E-cad, CD117, MOC31 and mitochondria were all strongly (+), CK7, pax-8 and ksp-cad (+); Vimentin, CD10, CAIX, RCC, S-100A1, CD56, CgA, Syn, TFEB, HMB45, melan A, CD99, WT- 1, CD34 and SMA; Ki-67 positive index is less than or equal to 5%. Patients were followed up for 12 to 30 months, no tumor recurrence and metastasis. Conclusions Renal cell type RO is a very rare subtype of RO. The histological morphology is characterized by uniform small cells in the form of lumps arranged in clusters with a large number of pseudo-daisy-shaped structures. The immunophenotype is basically the same as that of the typical RO Immunohistochemical staining can be used to identify primary or metastatic small cell tumor of kidney.