后肾腺瘤临床病理及免疫组化观察分析孙慧勤1郭徳玉，章容，赵友光，闰晓初，于冬梅,柳凤轩(第三军医大学西南医院病理学研究所重庆400038)摘要：目的探讨后肾腺痫的临床病理、免疫组化特征及鉴别诊断。方法应用常规病理、免疫组化方法观察木所近年诊断的两例后肾腺斓手术切除标也结合相关临床资料(从病史屮摘収)及文献复习，分析后肾腺瘤的临床病理和免疫组化特点°结果两例犬体均为类岡形灰白色肿块，人小各约1、4CM,有薄层包膜，与周围组织分界消。组织学上具有独特的形态结构特点：瘤细胞较小，核大浆少，无界型性，呈规则的小管、小团状及肾小球样等结构排列。免疫纽化：vimentin阳性，WT1阳性或部分阳性，CK灶性阳性，CD57-例散在和小灶性阳性,另一例片状强阳性,EMA.CK7、CgA、CD10阴性。两例均发生于中老年女性,其中一例在同一肾脏的另一部位还有肾细胞癌。结论后肾腺瘤是WHO新确定的一类少见的良性肿瘤，在形态学上具有独特的组织结构特点,免疫表型为WT1、CD57、vimentin.CK多有表达,其中vimentin恒定出现,WT1.CD57、CK表达强度和范围各有不同,WEMA,CK7,CgA.CD10多无表达，要注意与Wlims瘤、肾乳头状细胞癌.后肾腺纤维瘤等进行鉴别。关键词：后肾腺瘤临床病理免疫组化表型特征中图法分类号：文献标识码：TheclinicopathologicandimmunohistochemicalfeaturesofmetanephricadenomaSunHuiqin,GuoDeyu,ZhangRong,ZhaoYouguang.YanXiaochu,YuDongmei,LiuFengxian(InstituteofPathology,SouthwestHospital,ThirdMilitaryMedicalUniversity,Chongqing400038,China)Abstract:Objectivetostudytheclinicopathologic,immunohistochemicalfeaturesanddifferentialdiagnosisofmetanephricadenoma(MA).Methods2casesofMArecentlydiagnosedinourinstitutewerebeenobservedandanalyzedinthegross,histologyandimmunohistochemicalfeature、clinicalinformationwasextractedfromthemedicalrecords,asthesametimereviewoftheliterature・ResultsBothtumorsshowedroundshapeandgraywhitemasswithacleardividingboundarylineinmacroscopicview.Theyalsohaddistinctstructureinhistologyassmallcellswithhighratiosofnucleustocytoplasm,nonuclearatypiaormitoticfigureswereseen.Thetumorexhibitedwell-organizedtubules,smallcellnests,^lomeruloidbodies*,andsharplydemarcatedfromtheadjacentrenalparenchyma.Immunohistochemicalphenotypeofexpressionprofileswereasdiffusedvimentin,diffusedorpartiallypositiveWT1,focalizedCK,spottyorsmallfocalofCD57inonecasewhilestrongpatchyexpressioninanothercase・TheexpressionofEMA,CK7,CgA,CD10werenegative・Bothcasesarcmiddletoold-agefemale,especiallyinonecasetherewasrenalcellcarcinomalocatedelsewhereinsamekidney.ConclusionMAisararenovelformofrenalncoplasmaintheWHOclassification,Inadditiontodistinctarchitectureintissuestructure,MAhascharacteristicphenotype,showedasfrequentexpressionofWTI,CD57,vimentinandCK,inamannerofconsistentvimentinexpression,variousexpressionofWT1,CD57andCKinbothstrengthandextent,butEMA,CK7,CgA,CD10arenegative.Sofar,it，sbelivedtoabenigntumorandshouldbedifferentiatedfromWilms'tumor,papillaryrenalcellcarcinoma(PRCC),metanephricadenofibromaandetc.Keywords:Metanephricadenoma;Clinicalpathology;immunophcnotypicfeature1作者简介：孙垃勤（1964）,久云南省昆明市人，博士，副教授，副主任医师，主耍从爭肿捕病理学及血管生成方面的研究•电话：（023）68765455,Emai1:huiqinsun02Cyahoo.com・cn_收稿日期:20082；修回日期:2008410后肾腺瘤（metanephricadenoma,MA）是一种少见的肾脏肿瘤,1992年EhBrisigotti命名'」，其后被归为一独立的腺瘤，2004年版WHO肾脏肿瘤分类中新增加了“后肾肿瘤”（metanephrictumors）大类，其屮包括了后肾腺瘤以及后肾腺纤维瘤、后肾间质肿瘤⑵。虽然口前国内外己有数十例病例报道，但対其临床病理、免疫表达、牛物学和基因变化特点...