目的 探讨骨转移性透明细胞性肾细胞癌(clear cell renal cell carcinoma bone metastasis，CCRCC-BM)患者的临床病理学特征，提高对CCRCC-BM的认识。方法 回顾性分析2011 年 1 月—2023 年 7 月福州市第二总医院病理科收集的 33例CCRCC-BM患者的临床病理资料及随访结果，并复习相关文献。结果 33 例患者中，男性27例，女性6例，发病年龄42～94岁，中位年龄65岁。影像学均表现为膨胀性、溶骨性骨质破坏，骨转移病灶共43处，常见的骨转移部位为股骨(15处)及肱骨(12处);单发骨转移23例，伴一处或以上其他部位转移占10例。33例均因骨相关事件(skeletal related event，SREs)为首发症状就诊后经病理诊断为CCRCC-BM，18例出现肿瘤性坏死，3例伴有肉瘤样分化。Fuhrman细胞核分级:Ⅰ级16例、Ⅱ级14例，Ⅲ级1例，Ⅳ级2例。免疫表型:肿瘤细胞表达成对盒基因8(paired box protein 8，Pax-8)(32/33)、白细胞分化抗原 10(cluster of differentiation 10，CD10)(33/33)、波形蛋白(vimentin)、碳酸酐酶Ⅸ(carbonic anhydrase Ⅸ，CA Ⅸ)(30/33)、上皮细胞膜抗原(epithelial membrane antigen，EMA)(32/33)、广谱细胞角蛋白(pan cytokeratin，CKpan)(31/33)。33例均经手术切除病灶，术后随访2～108个月，死亡21例，生存12例。结论 CCRCC-BM好发于中老年男性患者，股骨、肱骨是最常见的转移部位，预后不佳。对于临床上不明原因出现的病理性骨折、脊髓压迫、骨痛等症状的患者，应考虑肾细胞癌骨转移的可能，结合既往史、病理形态学及免疫组织化学染色等有助于诊断及鉴别诊断。
Clinicopathological Analysis of 33 Cases of Bone Metastatic Clear Cell Renal Cell Carcinoma
Objective To investigate the clinicopathological features,diagnosis and differential diagnosis of clear cell renal cell carcinoma with bone metastasis(CCRCC-BM)in order to improve the understanding of CCRCC-BM.Methods The clinicopathological data and follow-up results of 33 patients with CCRCC-BM collected from the department of pathology,Fuzhou Second General Hospital from January 2011 to July 2023 were retrospectively analyzed,and the relevant literature was reviewed.Results There were 33 cases of CCRCC-BM in this study,including 27 males and 6 females.The age of onset ranged from 42 to 94 years old,and the median age was 65 years old.The imaging findings showed swelling and lytic bone destruction.There were 43 bone metastases lesions,and the most common bone metastases sites were femur(15 sites)and humerus(12 sites).There were 23 cases with single bone metastasis and 10 cases with one or more other sites metastasis.All 33 cases were pathologically diagnosed as CCRCC-BM with skeletal related events(SREs)as the first symptom,of which 18 cases showed neoplastic necrosis and 3 cases were accompanied by sarcomatoid differentiation.Fuhrman nuclear classification of tumor cells:16 cases of grade Ⅰ,14 cases of grade Ⅱ,1 case of grade Ⅲ and 2 cases of grade Ⅳ.Immunohistochemical staining revealed all of the tumor cells expressed Paired box protein 8(Pax-8)(32/33)and white blood cell differentiation antigen 10(cluster)Of differentiation 10,CD10(33/33),vimentin,carbonic acidAnhydride IX(CA IX)(30/33),epithelial membrane antigen(EMA)(32/33),and broad-spectrum cytokeratin(CKpan)(31/33).All cases of the lesions surgical resection were made.In the series of 33 cases were postoperative follow-up by 2 to 108 months:21 patients died and 12 patients survived.Conclusion CCRCC-BM occurs frequently in middle-aged and elderly male patients,and the femur and humerus are the most common metastatic sites,with a poor prognosis.For patients with pathological fractures,spinal cord compression,bone pain and other symptoms of clinically unknown reasons,the possibility of renal cell carcinoma bone metastasis should be considered,and the combination of past history,pathological morphology and immunohistochemical staining is helpful for diagnosis and differential diagnosis.
万方数据
维普
