极性反转性乳头状肾肿瘤的临床病理特征及预后
Clinicopathological characteristics and prognosis of papillary renal neoplasm with reverse polarity
吴卓龙 1王早宇 2陈琼 1孔文 1黄吉炜 1张进 1陈勇辉 1黄翼然 1薛蔚1
作者信息
- 1. 上海交通大学医学院附属仁济医院泌尿科,上海 200127
- 2. 上海交通大学医学院附属仁济医院病理科,上海 200127
- 折叠
摘要
目的 总结极性反转性乳头状肾肿瘤(PRNRP)的临床病理特点、治疗方法和预后.方法 回顾性分析2022年8月至2023年8月上海交通大学医学院附属仁济医院收治的6例病理确诊PRNRP患者的临床病理资料.男3例,女3例;年龄(55.3±10.5)岁.6例均为体检发现.术前CT增强检查肿瘤皮质期表现为不均匀强化、乏血供、边界欠清的肿块,CT值为(85.6±18.7)HU;皮髓质期CT值轻度升高,CT值为(94.3±4.7)HU;延迟期肿瘤边界清晰,强化程度明显低于周围肾皮质、肾髓质,瘤体CT值为(86.3±11.9)HU.肿瘤假包膜于增强CT扫描时显示不清晰.6例均接受肾部分切除术,其中2例行机器人辅助腹腔镜肾部分切除术,4例行腹腔镜肾部分切除术.结果 术后病理示肿瘤最大径为(11.0±3.5)mm(范围6～15 mm),6例均为pT1aN0M0期.肿瘤镜下表现为具有嗜酸性细胞质的分支乳头状结构,肿瘤细胞的特征为低级别的细胞核远离基底膜而位于胞质顶部,形成"极性反转".免疫组化染色检查结果示GATA3、CK7弥漫性强阳性,CA-Ⅸ呈阴性表达,Ki-67阳性率≤2％.术后中位随访时间为10(9,13)个月,未见肿瘤复发或转移.结论 PRNRP是一种罕见的、恶性程度低的乳头状肾肿瘤,增强CT扫描显示为乏血供肿瘤;病理检查肿瘤形态学特征为低级别的细胞核远离基底膜而位于胞质顶部,形成"极性反转",免疫组化染色检查示特异性表达GATA3和CK7.肾部分切除术是其推荐的治疗术式,术后预后良好.
Abstract
Objective To summarize the clinical and pathological characteristics,treatment methods,and prognosis of papillary renal neoplasm with reverse polarity(PRNRP).Methods The clinical and pathological data of six pathologically confirmed PRNRP patients admitted to Renji Hospital affiliated with Shanghai Jiaotong University School of Medicine from August 2022 to August 2023 were retrospectively analyzed.Among them,three were male and three were female,with an average age of(55.3±10.5)years old.All six cases were incidentally discovered during health examinations.Preoperative contrast-enhanced CT scans showed tumors with cortical phase manifestations of uneven enhancement,avascularity,and indistinct borders,with CT values of(85.6±18.7)HU.In the corticomedullary phase,the CT values showed mild elevation,with an average of(94.3±4.7)HU.In the delayed phase,the tumor boundaries were clear,and the enhancement degree was significantly lower than that of the surrounding renal cortex and medulla,with a tumor CT value of(86.3±11.9)HU.The pseudocapsule of the tumor was not clearly displayed on contrast-enhanced CT scans.All cases underwent partial nephrectomy,including two cases of robot-assisted laparoscopic partial nephrectomy and four cases of laparoscopic partial nephrectomy.Results Postoperative pathological measurements revealed a maximum tumor diameter ranging from 6 to 15 mm,with an average diameter of(11.0±3.5)mm.All six cases were classified as pT1aN0M0 stage.Microscopically,the tumors exhibited branching papillary structures with eosinophilic cytoplasm,and the tumor cells displayed low-grade nuclei located at the top of the cytoplasm and away from the basal membrane.Immunohistochemical analysis showed diffuse strong positivity for GATA3 and CK7,while CA-Ⅸexpression was negative.The median follow-up time after surgery was 10(9,13)months,and no tumor recurrence or metastasis was observed.Conclusions PRNRP is a rare,low-grade malignant papillary renal tumor.Contrast-enhanced CT scan has characteristic features of avascularity.Pathological morphological features are low-grade nuclei located at the top of the cytoplasm and far away from the basal membrane,forming a"reverse polarity".The immunophenotype shows positive expression of GATA3 and CK7.Partial nephrectomy is the recommended treatment approach,and the postoperative prognosis is favorable.
关键词
肾肿瘤/极性反转/临床病理特征/预后Key words
Kidney neoplasms/Reverse polarity/Clinicopathological characteristics/Prognosis引用本文复制引用
出版年
2024
NETL
NSTL
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