胰腺转移性透明细胞性肾细胞癌6例并文献复习

发布时间：2018-04-08 09:09

本文选题：肾肿瘤　切入点：透明细胞性肾细胞癌　出处：《临床与实验病理学杂志》2017年07期

【摘要】：目的探讨胰腺转移性透明细胞性肾细胞癌(clear cell renal cell carcinoma,CCRCC)的临床病理学特征、诊断、鉴别诊断。方法分析6例胰腺转移性CCRCC的临床病理特征并复习相关文献。结果 6例胰腺转移性CCRCC中男性2例,女性4例;发病年龄61~79岁,中位年龄68.8岁;肿瘤位于胰头1例,胰体尾5例;转移病变距肾癌切除术后时间1~10年不等,平均6.2年。术前患者均表现为胰腺占位,无特异性临床表现。术前影像学示3例胰腺单发占位,3例胰腺多发占位,其中1例伴肝转移。6例患者均行胰腺肿瘤根治切除手术,常规病理检查示肿瘤边界清楚,直径1.3~4 cm不等。形态学观察大部分肿瘤组织呈巢状、腺泡状、乳头状排列,肿瘤细胞圆形、卵圆形,核偏小居中,核仁隐约可见;胞质丰富,胞质透明,部分嗜酸性,间质血窦丰富。免疫表型:ABC、CD10、Pax-8、CA9、CAM5.2、CK8/18、EMA、vimentin均阳性,CA-199、CgA、TFE-3均阴性,Ki-67增殖指数2%~50%。结合既往肾癌病史,均诊断为胰腺转移性CCRCC。3例患者分别于胰腺肿瘤根治切除后1、6、17个月死亡;其余3例术后随访9、15、23个月均存活,未见肿瘤复发和转移。结论胰腺转移性CCRCC临床表现无特异性,术前诊断困难。既往病史对诊断有提示作用,最终确诊仍依赖术后病理诊断,手术完整切除为最佳治疗方案。
[Abstract]:Objective to investigate the clinicopathological features, diagnosis and differential diagnosis of clear cell renal cell carcinoma of the pancreas.Methods the clinicopathological features of 6 cases of metastatic CCRCC of pancreas were analyzed and the related literatures were reviewed.Results there were 2 males and 4 females in 6 cases of metastatic CCRCC of pancreas, the age of onset was 61-79 years, the median age was 68.8 years, the tumor was located in 1 case of pancreatic head and 5 cases of pancreatic body and tail, and the time of metastasis varied from 1 to 10 years after nephrectomy, with an average of 6.2 years.Preoperatively, all the patients presented as pancreatic space occupying, and no specific clinical manifestations were found.Preoperative imaging showed that 3 cases had solitary pancreatic space occupying and 3 cases had multiple pancreatic mass. Among them, 1 case with hepatic metastasis underwent radical resection of pancreatic tumor. Routine pathological examination showed that the margin of the tumor was clear and the diameter varied from 1.3 cm to 4 cm.Morphological observation showed that most of the tumor tissues were nesting, acinar, papillary, round, oval, nucleus small and middle, nucleolus was vague, cytoplasm was abundant, cytoplasmic transparency, partial eosinophilic, and interstitial sinuses were abundant.Pax-8 + CAM5.2CK8 / 18EMAvimentin + CA-199CgAfTFE-3 were negative for Ki-67 proliferative index (Ki 67).According to the previous history of renal cell carcinoma, all the patients diagnosed as metastatic pancreatic CCRCC.3 died 1, 6 and 17 months after radical resection of pancreatic tumor, and the other 3 cases were followed up for 9 days, 15 months and 23 months, without recurrence or metastasis.Conclusion the clinical manifestation of pancreatic metastatic CCRCC is not specific and it is difficult to diagnose before operation.The diagnosis depends on postoperative pathological diagnosis. Complete resection is the best treatment.
【作者单位】：第二军医大学第一附属医院长海医院病理科;
【基金】：上海市卫计委薄弱学科建设计划(2015ZB0202)
【分类号】：R737.11

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