肾脏乳头状腺瘤和其他小的上皮性肿瘤尸检研究

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   --本文经《美国外科病理学杂志》授权发布,其他媒体转载或引用须经《美国外科病理学杂志》同意,否则追究法律责任。
  摘要:本文的目的是研究肾小管上皮源性的小肿瘤;对来自402例未经筛选的尸体解剖肾脏标本每间隔1至2mm进行切片。对所有病变进行组织学检查。在76例患者(19%)中共发现232个乳头状腺瘤,范围为1~35个腺瘤/患者(平均:3,中位数:2)。乳头状腺瘤患者年龄较大(范围:27~90岁)(P<0.0001),更常见于吸烟者(P=0.01),并且更常伴有肾小球硬化症(P=0.0001)。乳头状腺瘤大小为0.5~5mm(平均:1.4,中位数:1),形态上分为4种亚型。A型腺瘤由乳头和/或小管组成,肿瘤细胞胞浆少,通常伴有砂砾体,是最常见的亚型(149个腺瘤)。B型有30例,乳头宽,轴心内有淋巴细胞浸润。C型共30例,呈囊性,被覆柱状细胞,并含有巨噬细胞和砂砾体。D型16例,由大的嗜酸性细胞组成,核呈假复层,偶尔靠近胞浆顶端。有4例不能归类。仅观察到1例混合型(1例患者中有3个腺瘤,每个均为B和D型混合)。其他上皮性病变包括31个肾上腺残余、5个嗜酸细胞腺瘤、2个透明细胞乳头状肾细胞癌、2个管状囊性肾细胞癌和2个获得性囊性疾病相关的肾细胞癌。总之,乳头状腺瘤是最常见的小上皮性肿瘤。第1种亚型(A型)的乳头状腺瘤与1型乳头状肾细胞癌非常类似,第4种亚型(D型)与2型乳头状肾细胞癌类似。未发现其他类型的肾细胞肿瘤(包括透明细胞肾细胞癌和嫌色性肾细胞癌)。没有发现肾源性残余。血管平滑肌脂肪瘤和肾髓质间质细肿瘤也有被发现,这些之前也有文章报道过。
  关键词:乳头状腺瘤,肾脏,尸检
  (Am J Surg Pathol 2019;43:277-287)
  美国外科病理学杂志中文版2019年第三期摘要NO.12
  ( 葛 莉 翻译 卢朝辉 审校 )










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