Low‐grade renal cell carcinoma arising from the lower nephron: A case report with immunohistochemical, histochemical and ultrastructural studies
Low‐grade renal cell carcinoma arising from the lower nephron: A case report with immunohistochemical, histochemical and ultrastructural studies
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源自下肾单位的低度肾细胞癌：免疫组织化学、组织化学和超微结构研究的病例报告
DOI：
10.1046/j.1440-1827.2001.01297.x
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发表时间：
2001
影响因子：
2.2
通讯作者：
Y. Nagashima
中科院分区：
文献类型：
--
作者：
M. Otani;Tohru Shimizu;H. Serizawa;Y. Ebihara;Y. Nagashima
大多数肾细胞癌（RCC）由具有血窦样脉管系统的透明细胞组成，起源于近端小管。另一方面，集合管癌（CDC）和嫌色肾细胞癌被认为起源于下肾单位。在本研究中，我们介绍了一个不寻常的 RCC 病例。患者是一名 68 岁的日本女性，出现全身疲劳并伴有血尿。计算机断层扫描显示左肾肿瘤提示肉瘤。切除的肿瘤位于肾实质，大小12×10×8cm。在组织学上，肿瘤主要由形成平行或放射状阵列的立方形细胞组成，与纺锤形细胞连续。肿瘤大部分呈出血性坏死。免疫组织化学显示，肿瘤细胞高分子量细胞角蛋白、纽蛋白、波形蛋白、CD15和上皮膜抗原呈阳性，并与某些种类的凝集素表现出亲和力。 N-和E-钙粘蛋白以及β-连环蛋白在肿瘤细胞中呈弥漫性阳性。 Ki-67 和 p53 蛋白的核阳性率分别约为 2.0% 和 1.7%。考虑到其形态和组织化学性质，该肿瘤被认为起源于下肾单位，这是低度恶性肿瘤所特有的。
Most renal cell carcinomas (RCC) are composed of clear cells with sinusoid‐like vasculatures and originate from the proximal tubule. On the other hand, collecting duct carcinoma (CDC) and chromophobe RCC are thought to originate from the lower nephron. In the present study, we present a case of unusual RCC. The patient was a 68‐year‐old Japanese woman who had developed general fatigue with hematuria. Computed tomography revealed a left renal tumor suggesting sarcoma. The resected tumor was located in the renal parenchyma, measuring 12 × 10 × 8 cm in size. Histologically, the tumor consisted principally of cuboidal cells forming parallel or radiating arrays, continuous with the spindle‐shaped cells. Most parts of the tumor showed hemorrhagic necrosis. Immunohistochemically, tumor cells were positive for high molecular weight cytokeratins, vinculin, vimentin, CD15 and epithelial membrane antigen, and showed affinities with some kinds of lectins. N‐ and E‐cadherins and β‐catenin were diffusely positive in tumor cells. Nuclear positivity for Ki‐67 and p53 protein were approximately 2.0 and 1.7%, respectively. Considering its morphological and histochemical natures, this tumor is considered to have originated from the lower nephron, which is unique for a tumor of low‐grade malignancy.