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目的:探讨肾黏液样小管状和梭形细胞癌(MTSCC)的临床病理学特点、诊断、鉴别诊断、治疗方法及预后。方法:对3例MTSCC进行HE和免疫组化、特殊染色,并复习相关文献,分析患者的临床、病理特点。结果:3例中女2例,男1例,发病年龄48~62岁,平均年龄56.3岁,均伴临床症状。肿瘤边界清楚,可见局部坏死,1例合并肾盂输尿管重复畸形。镜下肿瘤由紧密排列的小管构成,细胞异型性小,小管间为淡染黏液样间质,并见梭形细胞区。黏液样基质Alcian blue染色+。上皮样细胞EMA+,AE1/AE3+,Vimentin+,CK7+,CK19+,EMA+,AMACR+,CD10-,S-100-,SMA-,HMB45-,Ki-67<5%。行肾癌根治术,术后恢复良好,未行辅助治疗,随访2~7年未见肿瘤复发和转移。结论:MTSCC是一类低度恶性的肾上皮性肿瘤,组织形态温和,合并发育畸形者罕见。肿瘤边界清楚,可有假包膜,可发生坏死。预后较好,可长期存活。少数病例发生局部复发或淋巴结转移。正确诊断和避免过度诊断、过度治疗非常重要,早期手术是其首选的治疗方法。
Objective: To investigate the clinicopathological characteristics, diagnosis, differential diagnosis, treatment and prognosis of renal mucinous tubulointerstitial and spindle cell carcinoma (MTSCC). Methods: Three cases of MTSCC were subjected to HE and immunohistochemistry, special staining, and review of relevant literature, analysis of the clinical and pathological features of patients. Results: There were 2 males and 1 females in 3 cases. The age of onset was 48-62 years with a mean age of 56.3 years, with clinical symptoms. Clear tumor border, visible local necrosis, 1 case of pelvis and ureter duplication deformity. Microscopic tumor consists of closely arranged tubules, cell atypia, small tube between the lightly myxoid interstitial, and see the spindle cell area. Mucinous matrix Alcian blue staining +. Epithelial cells EMA +, AE1 / AE3 +, Vimentin +, CK7 +, CK19 +, EMA +, AMACR +, CD10-, S-100-, SMA-, HMB45-, Ki-67 <5%. Renal cancer radical surgery, postoperative recovery was good, without adjuvant therapy, no follow-up of 2 to 7 years of tumor recurrence and metastasis. Conclusions: MTSCC is a kind of low-grade neoplasm with mild histomorphosis and rare combined deformity. Clear tumor border may have a pseudocapsule, necrosis may occur. Good prognosis, long-term survival. A few cases of local recurrence or lymph node metastasis. Correct diagnosis and avoid over diagnosis, over-treatment is very important, early surgery is the preferred treatment.