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目的探讨肾脏黏液样小管状和梭形细胞癌(mucinous tubular and spindle cell carcinoma,MTSCCa)的临床病理特征和鉴别诊断要点及生物学行为。方法对4例MTSCCa标本进行组织病理学和免疫组化染色观察,并复习临床资料及相关文献。结果该肿瘤好发于女性,发病年龄17~82岁(平均53岁),临床症状不明显。组织学:肿瘤与周围肾组织分界清楚,切面实性、灰白色,肿瘤细胞形态呈双相(小管状和梭形细胞)或三相(小管状、梭形和脊索瘤样或黏液样)。其他组织学表现:泡沫样巨噬细胞聚集、典型的透明细胞和乳头状或乳头结构。免疫组化显示复合性免疫表型。结论MTSCCa是一种罕见的低级别多形性肿瘤,组织学谱系在不断扩大,免疫组化表型及组织学形态与乳头状肾细胞癌(PRCCa)有重叠。
Objective To investigate the clinicopathological characteristics, differential diagnosis and biological behavior of mucinous tubular and spindle cell carcinoma (MTSCCa) in the kidney. Methods Four cases of MTSCCa specimens were histopathologically and immunohistochemically stained, and clinical data and related literatures were reviewed. Results The tumor occurred in women, the age of onset of 17 to 82 years (mean 53 years), clinical symptoms were not obvious. Histology: The tumor is clearly demarcated from the surrounding renal tissue. The section is solid, gray and white. The tumor cells are biphasic (tubules and spindle cells) or three phases (tubules, fusiform and chordoma-like or myxoid). Other histological findings: Foam-like macrophages aggregate, typically clear cells and papillary or papillary structures. Immunohistochemistry showed a complex immunophenotype. Conclusions MTSCCa is a rare low-grade pleomorphic tumor with an expanding histological lineage and an overlap of immunohistochemical and histological features with papillary renal cell carcinoma (PRCCa).