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中华临床医师杂志(电子版) ›› 2024, Vol. 18 ›› Issue (05) : 512 -515. doi: 10.3877/cma.j.issn.1674-0785.2024.05.012

病例报告

肾脏混合性上皮和间质肿瘤一例
孙双权1, 孙玮玮2, 王勇1, 方道成1, 温晖1,()   
  1. 1. 201600 上海,上海交通大学医学院附属松江医院泌尿外科
    2. 201600 上海,上海交通大学医学院附属松江医院病理科
  • 收稿日期:2024-01-29 出版日期:2024-05-15
  • 通信作者: 温晖

Mixed epithelial and stromal tumor of the kidney: a case report and review of the literature

Shuangquan Sun, Weiwei Sun, Yong Wang   

  • Received:2024-01-29 Published:2024-05-15
引用本文:

孙双权, 孙玮玮, 王勇, 方道成, 温晖. 肾脏混合性上皮和间质肿瘤一例[J/OL]. 中华临床医师杂志(电子版), 2024, 18(05): 512-515.

Shuangquan Sun, Weiwei Sun, Yong Wang. Mixed epithelial and stromal tumor of the kidney: a case report and review of the literature[J/OL]. Chinese Journal of Clinicians(Electronic Edition), 2024, 18(05): 512-515.

回顾性分析上海交通大学医学院附属松江医院收治的1例肾脏混合性上皮和间质肿瘤的临床资料,并结合文献进行分析、讨论。患者,女,46岁,因“检查发现左肾占位10余天”收住院。术前影像学检查考虑左肾占位,Bosniak IV级。排除手术禁忌后行腹腔镜下左肾部分切除术,病检结果提示混合性上皮和间质肿瘤。MESTK是一种极其罕见的肾脏肿瘤,临床和影像学表现均不典型,组织病理学在诊断中起着非常重要的作用,治疗上以手术切除为主,良性MESTK预后良好。

图1 MESTK典型的CT影像学特征。图a为平扫:左肾实质中后部分类圆形灶,呈略低密度灶,边界不清;图b为皮质期:增强扫描边界清楚,大小约23×22 mm,囊实性改变,实性成分强化不明显;图c为髓质期:病灶实性成分伴斑片及条隔状强化;图d为髓质期冠状位:可见本病例肿瘤大部分位于肾上极,外突不明显
图2 肿瘤大体观。图a为术中见左肾背侧肿块,有明显包膜;图b为切除病灶,为结节状囊实性肿物,大小3.2×2.1×1.8 cm
图3 MESTK典型的组织学特征(HE染色,×200)。图a为镜下见肿瘤呈囊状,局部上皮间质成分向囊内突起;图b为镜下见纤维性间质,间质细胞较稀疏,靠近囊腔周围间质密度较高,围绕囊腔呈袖套样分布
图4 MESTK典型的免疫组织学特征(免疫组化×200)。图a为上皮细胞PAX-8阳性表达;图b为间质中雌激素受体(ER)阳性表达;图c为孕激素受体(PR)阳性表达;图d为平滑肌肌动蛋白(SMA)阳性表达
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