任春毅　廖鸿力　陈丽雅　俞海波

[摘要] 目的 探討多房性囊性肾细胞癌的病理特点、鉴别诊断及预后。 方法 选取2007～2010年在我院治疗的多房性囊性肾细胞癌的患者6例进行回顾行分析，均于体格检查时发现有包块而到院就诊，对所有患者进行影像学检查，行手术切除后进行病理检测和免疫组化检测，记录结果。患者出院后，对所有患者进行为期5年的随访，记录预后情况。 结果 6例多房性囊性肾细胞癌患者中男性患者和女性患者各有3例，病理巨检发现病变部位与正常部位的界限清楚，表面有包膜，无血管浸润，无淋巴转移，肿块直径平均（3.52±0.48）cm，切面可见大小不等互不相通的囊腔，腔内可见血性或浆液性液体，镜检可见囊腔内衬单层透明细胞，部分可见乳头状结构，纤维组织构成的间隔内有炎细胞浸润，肿瘤细胞包浆透亮，染色质深染，Fuhrman核分级有5例Ⅰ级，1例Ⅱ级。免疫组化检测Vim，EMA呈强阳性，CD68、CD10为阴性。6例患者5年内均无复发，5年生存率为100%，预后良好。结论 多房性肾细胞癌病理特点独特，应注意与其他肾囊性疾病等相鉴别，预后情况好。

[关键词] 多房囊性肾细胞癌；病理特点；鉴别诊断；预后

[中图分类号] R737.11 [文献标识码] B [文章编号] 1673-9701（2015）35-0103-03

[Abstract] Objective To investigate the pathological features， distinguishment and diagnosis and prognosis of multiple cystic renal cell carcinoma. Methods Six patients with multilocular cystic renal cell carcinoma in our hospital from 2007 to 2010 were chosen and reviewed for analysis. All patients who were found to have mass after physical examination， came to our hospital， and image examination was conducted， and pathological detection and immunohistochemical detection were conducted after surgical resection. All the results were recorded. After hospitalization， all patients were followed up for a period of five years， and prognosis was recorded. Results Among 6 cases of multilocular cystic renal cell carcinoma patients， there were three cases of male patients and three cases of female patients. Pathological examination revealed the apparent limits of diseased region and normal part， the surface coating， no vascular invasion， and no metastasis. The average tumor diameter was （3.52±0.48） cm， and different cysts of varying sizes were visible in section， with visible bloody or serous liquid in cavities. Microscopic examination showed clear cell of monolayers lining in cysts， partially with papillary structures， and there were inflammatory cells in interval composed of fibrous tissue. Tumor cells included translucent pulp and stained chromatin. According to fuhrman nuclear grade， 5 patients were grade Ⅰ， and 1 patients was gradeⅡ. Immunohistochemical detections such as Vim and EMA were strongly positive， and CD68 and CD10 were negative. Six patients had no recurrence within 5 years， and 5-year survival rate was 100%， with good prognosis. It should be noted that multi-cystic renal cell carcinoma and other renal cystic diseases should be identified. Conclusion Pathological features of multi-cystic renal cell carcinoma are unique， and we should pay attention to identification of multi-cystic renal cell carcinoma and other renal cystic diseases. The prognosis of multi-cystic renal cell carcinoma is good.

[Key words] Multi-cystic renal cell carcinoma； Pathological features； Distinguishment and diagnosis； Prognosis

多房性囊性肾细胞癌在临床上比较少见，单纯依靠临床常用的影像学检查或生化检查等手段只能帮助判断是否有患本病的可能而并不能进行确诊，本病的病理特征非常独特[1，2]，因此，对高度怀疑患有本病的患者病理切片检查是确诊的重要途径。……