Spectrum of epithelial neoplasms in end-stage renal disease - An experience from 66 tumor-bearing kidneys with emphasis on histologic patterns distinct from those in sporadic adult renal neoplasia
Spectrum of epithelial neoplasms in end-stage renal disease - An experience from 66 tumor-bearing kidneys with emphasis on histologic patterns distinct from those in sporadic adult renal neoplasia
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DOI：
10.1097/01.pas.0000185382.80844.b1
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发表时间：
2006-02-01
影响因子：
5.6
通讯作者：
Amin, MB
中科院分区：
文献类型：
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作者：
Tickoo, SK;dePeralta-Venturina, MN;Amin, MB
大多数（高达71%）发生在终末期肾病（ESRD）患者的肾细胞肿瘤，特别是获得性肾囊性疾病（ACDK），已被报道为乳头状肾细胞癌（RCC）。我们在这种情况下的肿瘤的初步经验表明，许多肿瘤在组织学上难以归类为已知的RCC亚型，或者具有与零星发生的RCC不同的特征。在本研究中，66例ESRD肾脏（其中52例有ACDK特征）因检测到肿瘤而切除，我们发现两大类RCC。总的来说，在这些肾脏中有261个粗略确定的肿瘤，在一些肾脏中有许多额外的肿瘤在显微镜下观察到。在两组主要的肾细胞癌中，一组由类似于散发性肾细胞癌的肿瘤组成（即透明细胞、乳头状和憎色肾细胞癌），这些肿瘤分别在66个肾脏中的12个（18%）、10个（15%）和5个（8%）中占主导地位。另一组由两种RCC亚型组成，这两种亚型似乎是ESRD所特有的。我们将更常见的肿瘤称为“获得性囊性疾病相关肾细胞癌”，在66例肾脏中有24例（36%）被认为是主要肿块，并且在较小的非主要肿块中也形成了最常见的肿瘤类型。其特点是典型的微囊性结构，嗜酸性细胞质伴Fuhrman 3级核，常伴有瘤内草酸盐晶体。此外，这些肿瘤经常（但通常是局部的）表现为乳头状结构和透明的细胞质。这些肿瘤仅发生在ACDK肾脏，而不发生在非囊性ESRD。另一类是“终末期肾脏的透明细胞乳头状肾细胞癌”，在66个肾脏中有15个（23%）为主要肿块，在ACDK和非囊性ESRD中均有发生。这些以囊性肿瘤为主的肿瘤表现为明显的乳头状结构和纯透明细胞细胞学。在组织学上与已知的散发性肾细胞癌亚型相似的肿瘤中，免疫组织化学研究显示，免疫图谱与报道的散发性肿瘤相似。ESRD特有的两种RCC亚型具有独特的免疫谱，支持其单独的形态学亚分类。只有2例获得性囊性疾病相关的RCC有淋巴结转移，2例有肉瘤样特征。后2例中有1例在肾切除术后34个月内死于广泛的转移性疾病。因此，ESRD中存在广泛的肾细胞肿瘤，其中只有一些类似于散发的rcc。获得性囊性疾病相关的肾细胞癌是ESRD中最常见的肿瘤亚型，在生物学上，它似乎比ESRD中其他肿瘤亚型更具侵袭性。
Most (up to 71%) of renal cell neoplasms occurring in patients with end-stage renal disease (ESRD), particularly with acquired cystic disease of the kidney (ACDK), have been reported to be papillary renal cell carcinoma (RCC). Our initial experience with tumors in such a setting indicated that many tumors were histologically difficult to classify into the known subtypes of RCC or had features that were different from those in sporadically occurring RCCs. In this study on 66 ESRD kidneys (52 of which showed features of ACDK) removed because tumors were detected in them, we found two major groups of RCC. Overall, there were 261 grossly identified tumors in these kidneys, and many additional tumors were observed on microscopic evaluation in some. Of the two major groups of RCCs, one consisted of tumors similar to those seen in sporadic settings (ie, clear-cell, papillary, and chromophobe RCC), and these formed the dominant mass in 12 (18%), 10 (15%), and 5 (8%) of the 66 kidneys, respectively. The other group consisted of two subtypes of RCC that appear quite unique to ESRD. The more common tumor that we have designated as "acquired cystic disease-associated RCC" was seen as the dominant mass in 24 (36%) of 66 of the kidneys, and it formed the most common tumor type among the smaller nondominant masses, as well. It was characterized by a typical microcystic architecture, eosinophilic cytoplasm with Fuhrman's grade 3 nuclei, and frequent association with intratumoral oxalate crystals. Additionally, these tumors frequently, but usually focally, exhibited papillary architecture, and clear cytoplasm. These tumors occurred only in kidneys with ACDK, and not in noncystic ESRD. The other category was "clear-cell papillary RCC of the endstage kidneys," present as the dominant mass in 15 (23%) of the 66 kidneys and occurring in both the ACDK and noncystic ESRD. These predominantly cystic tumors showed prominent papillary architecture with purely clear-cell cytology. Immunohistochemical studies in tumors with histology similar to the known subtypes of sporadic RCC showed immunoprofiles similar to that reported in sporadically occurring tumors. The two subtypes of RCC unique to ESRD had distinctive immunoprofiles supporting their separate morphologic subcategorization. Only the acquired cystic disease-associated RCC showed lymph node metastases in 2 cases and sarcomatoid features in 2 more cases. One of the latter 2 died with widespread metastatic disease within 34 months of nephrectomy. Thus, a broad spectrum of renal cell tumors exist in ESRD, only some of which resemble the sporadic RCCs. Acquired cystic disease-associated RCC is the commonest tumor subtype in ESRD, and biologically it appears to be more aggressive than the other tumor subtypes in ESRD.