Renal lymphatics, and lymphatic involvement in sinus vein invasive (pT3b) clear cell renal cell carcinoma: a study of 40 cases
Renal lymphatics, and lymphatic involvement in sinus vein invasive (pT3b) clear cell renal cell carcinoma: a study of 40 cases
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DOI：
10.1038/modpathol.3800589
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发表时间：
2006-05-01
期刊：
影响因子：
7.5
通讯作者：
Bonsib, SM
中科院分区：
文献类型：
--
作者：
Bonsib, SM
虽然肾窦静脉侵犯是肾透明细胞癌（CC）最常见的肾外侵犯部位，但CC也可通过淋巴细胞扩散。由于皮质神经纤维流入鼻窦，一些受累的鼻窦结构可能是神经纤维，而不是静脉。在40例伴有窦静脉侵犯的CC中，用podoplanin（一种特异性淋巴管内皮标记物）研究了这种可能性。10块未受累肾脏（作为对照）显示中皮质小叶内动脉外膜内有血管化。随着向骨髓的进展，淋巴管变得越来越多和扩大。肾小球或髓质内无炎症，除非与炎症相关。最大的出血发生在窦内，也见于骨盆肌层和大静脉中膜。观察淋巴管内肿瘤并分为两组。第1组（4例）涉及肿瘤浸润性边缘内无假包膜的淋巴结。肿瘤细胞较小（0.045 - 0.19 mm），形状不规则，通常不完整，包含单个细胞或小的肿瘤细胞簇。第2组（4例）涉及与肿瘤分离的窦淋巴管。各有1例还涉及小叶内动脉、肾盂肌层和肌静脉中膜的外膜血管。第2组淋巴管内肿瘤常表现为松散，无内皮细胞浸润，且比第1组大（0.4 - 0.5 mm）。相反，在肌肉静脉内的肿瘤是粘性的，包含毛细血管丛，并被内皮细胞包裹。结论：淋巴管内肿瘤可在CC中显示。淋巴管受累比静脉受累少，且累及较小的结构。淋巴道转移的可能性在受累的淋巴管中可能不相等。小的瘤周胶质细胞可能注定被肿瘤生长破坏。然而，窦内和肾盂相关的受累淋巴管可能是淋巴扩散和淋巴结转移的来源。
Although renal sinus vein invasion is the most common site of extrarenal involvement in clear cell renal cell carcinoma ( CC), CC also spreads by lymphatics. As cortical lymphatics drain into the sinus, some involved sinus structures may be lymphatics, not veins. This possibility was investigated with podoplanin, a specific lymphatic endothelial marker, in 40 CC with sinus vein invasion. Ten blocks of uninvolved kidney, serving as controls, showed lymphatics within the adventitia of midcortical intralobular arteries. Lymphatics became more numerous and enlarged with progression towards the medulla. No lymphatics were among glomeruli or within the medulla unless associated with inflammation. The largest lymphatics occurred within the sinus, and were also noted within pelvic muscularis, and media of large veins. Intralymphatic tumor was observed and divided into two Groups. Group 1 ( four cases) involved lymphatics within the invasive edge of tumors lacking a pseudocapsule. The lymphatics were small ( 0.045 - 0.19 mm), irregularly shaped, often incomplete, and contained single cells or small clusters of tumor cells. Group 2 ( four cases) involved sinus lymphatics separate from tumor. One case each also involved adventitial lymphatics of an intralobular artery, the muscularis of the renal pelvis, and media of a muscular vein. The intralymphatic tumor in Group 2 often appeared discohesive, not endothelial cell invested, and larger than in Group 1 (0.4 - 0.5 mm). Conversely, tumor within muscular veins was cohesive, contained a capillary plexis, and was endothelial cell invested. In conclusion, intralymphatic tumor can be demonstrated in CC. Lymphatic involvement is less frequent than venous involvement and involves smaller structures. The potential for lymphatic spread may not be equal among involved lymphatics. Small peritumoral lymphatics may be destined for destruction by tumor growth. However, involved lymphatics within sinus and associated with renal pelvis, are likely sources for lymphatic spread and lymph node metastases.