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目的探讨肾微乳头型尿路上皮癌(MPC)的临床病理特征、诊断及鉴别诊断。方法应用常规病理、免疫组化方法对1例肾MPC进行观察、随访并复习相关文献。结果患者男性,67岁。因间歇性、无痛性肉眼血尿2年余,加重1个月入院。CT示肾盂肿物。巨检:肾盂及肾实质内见一灰白色不规则结节状肿瘤,2.5 cm×2 cm大小,切面灰白色、质软。镜检:肿瘤实体细胞排列成簇状、索条状或假腺样漂浮在干净的类似淋巴管的空腔中,管腔壁无内皮细胞被覆,乃属于收缩的纤维间质空隙。肿瘤细胞呈多角形、立方形、长柱状,部分细胞表面可见纤毛;胞质嗜酸性、丰富,部分胞质内见空泡形成,胞核呈圆形、椭圆形,中等异型性,核仁不明显,核分裂象不多见。在肾门淋巴结内及肾周脂肪囊内均发现转移灶。免疫组化:肿瘤细胞CK7、CK20和CEA弥漫(+),EMA部分(+),c-erbB2弱(+),Ki-67阳性率为30%;CD10、vimentin和p53(-)。术后4个月死亡。结论肾微乳头型尿路上皮癌是一种罕见的、高度恶性且预后较差的尿路上皮癌,早期诊断对临床治疗具有重大的指导价值。
Objective To investigate the clinicopathological characteristics, diagnosis and differential diagnosis of renal micro-papillary urothelial carcinoma (MPC). Methods One case of renal MPC was observed by routine pathology and immunohistochemistry. Follow-up and review of relevant literature. Results The patient was male, 67 years old. Due to intermittent, painless gross hematuria more than 2 years, increased 1 month admission. CT showed renal pelvis mass. Giant check: renal parenchyma and renal parenchyma see an irregular white nodular tumor, 2.5 cm × 2 cm size, gray and white section, soft. Microscopic examination: Tumor solid cells arranged in clusters, cable-like or pseudo-gland-like floating in a clean lymphatic cavity similar to the lumen wall without endothelial cell covering, but belong to the contraction of interstitial interstitial fibrosis. Tumor cells were polygonal, cuboidal, long columnar, part of the cell surface visible cilia; eosinophilic cytoplasm, rich in some cytoplasm to see the formation of vacuoles, the nucleus was round, oval, medium atypia, the nucleolus is not Obviously, mitotic figures are rare. Metastatic lesions were found in the hilar lymph nodes and in the perirenal fat capsule. Immunohistochemistry: The positive rates of CK7, CK20 and CEA in tumor cells (+), EMA fraction (+), c-erbB2 weakly (+) and Ki-67 positive rate were 30%; CD10, vimentin and p53 (-). 4 months after the death. Conclusion Renal micro-papillary urothelial carcinoma is a rare, highly malignant and poor prognosis of urothelial carcinoma. Early diagnosis has great guiding value for clinical treatment.