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目的 探讨各型肾腺瘤的形态特点及其诊断标准。方法 各型肾腺瘤共 19例 ,进行光镜、电镜观察 ,组织化学、免疫组织化学LSAB法检测及随访观察。结果 乳头状腺瘤 3例 ,呈乳头、管乳头状排列 ;由嗜碱性细胞或嗜酸性细胞组成 ;上皮膜抗原 (EMA)及细胞角蛋白 (CK) 7双表达。嗜酸细胞腺瘤 13例 ,呈巢状排列 ,也见管状、乳头结构或单个细胞散在 ;以嗜酸细胞为主 ,尚见“嗜酸母细胞”及透亮细胞等 ;波形蛋白、CK7均阴性 ,Hale胶体铁染色阴性 ;电镜示胞质内多量大线粒体。后肾腺瘤 3例 ,均匀一致的小细胞构成小管 ,亦见实性、肾小球样、分支长管结构 ,间质水肿状 ;EMA阴性、CK7阴性或局灶阳性。各型肾腺瘤均随访 3～ 5年 ,1例嗜酸细胞腺瘤 5年后死亡 ,余均健在。结论 肾腺瘤有 3种 ,乳头状腺瘤、嗜酸细胞腺瘤、后肾腺瘤 ,各有其临床病理特点 ,后两者以形态学为诊断依据 ,前者仍需参考肿瘤大小。组织化学、免疫组织化学检测有助于鉴别诊断
Objective To investigate the morphological characteristics and diagnostic criteria of various types of renal adenomas. Methods A total of 19 cases of various types of renal adenomas were observed by light microscopy, electron microscopy, histochemistry, immunohistochemistry LSAB method and follow-up observation. Results Three cases of papillary adenoma showed papillary and papillary arrangement, basophilic cells or eosinophils, and both of epithelial membrane antigen (EMA) and cytokeratin (CK) Eosinophilic adenoma in 13 cases, were arranged in nests, also see tubular, papillary structures or single cells scattered; to eosinophil, see also “eosinophil” and translucent cells; vimentin, CK7 were negative , Hale colloidal iron staining negative; electron microscopy showed a large number of cytoplasmic large mitochondria. 3 cases of adenocarcinoma of the kidney, small tubules of uniform small cells forming tubules, also see the real, glomerular, branched long tube structure, interstitial edema; EMA negative, CK7 negative or focal positive. All types of renal adenomas were followed up for 3 to 5 years, 1 case of eosinophilic adenoma died after 5 years, I still alive. Conclusion There are three types of renal adenoma, papillary adenoma, eosinophilic adenoma, and adenocarcinoma of the rear. Each has its own clinicopathological features. The latter two are based on morphology and the former still need to refer to tumor size. Histochemistry, immunohistochemistry test can help differential diagnosis