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目的探讨中肾管附件肿瘤的临床病理特征、免疫组化、鉴别诊断、治疗与预后,以提高对中肾管附件肿瘤的认识,减少误诊及漏诊。方法对1例中肾管附件肿瘤进行临床和病理学观察、免疫组化研究并复习相关文献。结果巨检:卵巢附壁及输卵管系膜处见一大小12 cm×12 cm×12 cm肿块,切面灰白色、质中,局部有黏液感,包膜完整。镜检:肿瘤有纤维包膜,肿瘤组织中见实性片状、小管及小梁状结构,局部区域呈囊性结构,小管周围有基底膜。瘤细胞为低柱状或立方状,部分细胞胞质透明,细胞排列密集,细胞核圆形或卵圆形,无明显异型性,核分裂象罕见。免疫组化示肿瘤细胞vimentin、AE1/AE3、CAM5.2、CK7、WT1和CD99均(+),Ki-67(5%)、CA125、α-inhibin、calretinin、desmin、α-SMA、ER、PR、CD10和EMA均(-)。结论中肾管附件肿瘤是一种少见的具有低度恶性潜能的肿瘤,肿瘤全切加全子宫和双附件切除术以及术后长时间的密切随访是主要的治疗方式。
Objective To investigate the clinicopathological characteristics, immunohistochemistry, differential diagnosis, treatment and prognosis of the accessory tumor of the middle and nephroureteral tube in order to improve the understanding of the tumors of the accessory renal tubules and to reduce the misdiagnosis and missed diagnosis. Methods One case of renal accessory tumor was observed clinically and pathologically. Immunohistochemical study and review of relevant literature. The results of the macroscopic examination: ovarian attachment and fallopian tube mesangial see a size of 12 cm × 12 cm × 12 cm mass, section of gray, qualitative, local mucus, capsule integrity. Microscopic examination: the tumor has a fibrous capsule, see solid tumor tissue flake, tubular and trabecular structure, cystic structure of the local area, the basement membrane around the tubule. Tumor cells are low columnar or cubic, some cells are cytoplasm transparent, dense arrangement of cells, the nucleus is round or oval, no atypia, mitotic rare. Immunohistochemistry showed that the expressions of vimentin, AE1 / AE3, CAM5.2, CK7, WT1 and CD99 in tumor cells were significantly increased (P < PR, CD10 and EMA are both (-). Conclusions The renal accessory tumor is a rare tumor with low malignant potential. Tumor resection plus total hysterectomy and double attachment resection and close follow-up after a long period of time are the main treatment modalities.