Tsuji M, Murakami Y, Kanayama H, Sano T, Kagawa S
Department of Urology, School of Medicine, University of Tokushima, Japan.
Int J Urol. 1999 Apr;6(4):203-7. doi: 10.1046/j.1442-2042.1999.06448.x.
A unique case of metanephric adenoma of the left kidney is reported in a 61-year-old woman presenting with an incidental renal mass on ultrasonography.
METHODS/RESULTS: On radiographic examination, the presence of hypovascular renal cell carcinoma was suspected and left radical nephrectomy was performed. The resected tumor, measuring 4.9 x 4.7 x 4.5 cm, was well-circumscribed and solid and its cut surface was tan-pink with foci of focal hemorrhage and cystic change. Microscopically, the tumor was composed of uniformly small acini with hyperchromatic round nuclei. Some acini were dilated and occasionally contained glomeruloid-like bodies and psamoma bodies. Immunohistochemically, tumor cells showed positive immunoreaction for vimentin, cytokeratin and Leu 7. Cytogenetically, the tumor did not show numerical aberrations of chromosome 7 or 17 by fluorescence in situ hybridization.
The patient is alive without recurrence or metastasis 4 years after surgery. Metanephric adenoma must be differentiated from other renal tumors, particularly Wilms' tumor or low-grade renal cell carcinoma. Immunohistochemical and cytogenetic analysis may be helpful in difficult cases.
报道了一例61岁女性左肾后肾腺瘤的独特病例，该患者因超声检查偶然发现肾肿块。
方法/结果：影像学检查怀疑为乏血管性肾细胞癌，遂行左肾根治性切除术。切除的肿瘤大小为4.9×4.7×4.5 cm，边界清晰，质地坚实，切面呈棕粉色，有局灶性出血和囊性变区域。显微镜下，肿瘤由大小一致的小腺泡组成，细胞核深染呈圆形。部分腺泡扩张，偶见类肾小球样结构和砂粒体。免疫组化显示，肿瘤细胞波形蛋白、细胞角蛋白和Leu 7免疫反应阳性。细胞遗传学分析显示，荧光原位杂交检测肿瘤细胞未见7号或17号染色体数目异常。
患者术后4年无复发或转移，存活良好。后肾腺瘤必须与其他肾肿瘤相鉴别，尤其是肾母细胞瘤或低级别肾细胞癌。免疫组化和细胞遗传学分析对疑难病例可能有帮助。
