Sarsik Banu, Sımşır Adnan, Karaarslan Serap, Sen Sait
Department of Pathology, Ege University, Faculty of Medicine, İzmir, Turkey.
Turk Patoloji Derg. 2011 May;27(2):116-26. doi: 10.5146/tjpath.2011.01059.
Mucinous tubular and spindle cell carcinomas (MTSCC's) are recently described rare type of renal cell carcinoma (RCC). MTSCC's are characterized by small, elongated tubules lined by cuboidal cells and/or cords of spindled cells separated by pale mucinous stroma. They have morphological similarities to papillary RCC (papRCC). We evaluated the importance of the immunohistochemical features in the differential diagnosis of MTSCC and papRCC.
We re-evaluated 9 cases of MTSCC diagnosed between 2004 and 2010 and compared 10 cases of papRCC. All tumors were stained with alpha-methylacyl-CoA racemase (AMACR), cytokeratin 7 (CK7), CK19, renal cell carcinoma marker (RCC Ma), CD10 and kidney specific cadherin (KspCad).
A total of 6/9 cases were considered classical. Two of 9 MTSCC's were classified as "mucin-poor". Foamy macrophages were identified in 4 cases. The immunoreactivity in MTSCC was AMACR 100%, CK7 100%, CK19 100%, RCC Ma 50%, CD10 11%, and KspCad 38% while the values for papRCC were AMACR 100%, CK7 90%, CK19 100%, RCC Ma 100%, CD10 80%, and KspCad 0%.
MTSCCs may include little mucin and show a marked predominance of either of its principal morphological components. They may mimic other forms of RCC. Pathologists should be aware of the histological spectrum of MTSCCs to ensure an accurate diagnosis. Careful attention to the presence of a spindle cell population may be helpful in the differential diagnosis in tumors with predominant compact tubular growth. Immunohistochemical stains for papRCC are also expressed in MTSCC, but strong CD10 expression may not favor MTSCC.
黏液性小管状和梭形细胞癌（MTSCC）是最近被描述的一种罕见的肾细胞癌（RCC）类型。MTSCC的特征是由立方体细胞衬里的小的细长小管和/或由淡染的黏液性间质分隔的梭形细胞索。它们在形态上与乳头状肾细胞癌（papRCC）相似。我们评估了免疫组化特征在MTSCC和papRCC鉴别诊断中的重要性。
我们重新评估了2004年至2010年间诊断的9例MTSCC，并与10例papRCC进行了比较。所有肿瘤均用α-甲基酰基辅酶A消旋酶（AMACR）、细胞角蛋白7（CK7）、CK19、肾细胞癌标志物（RCC Ma）、CD10和肾特异性钙黏蛋白（KspCad）进行染色。
9例中有6例被认为是典型的。9例MTSCC中有2例被归类为“黏液缺乏型”。4例中发现了泡沫状巨噬细胞。MTSCC中的免疫反应性为AMACR 100%、CK7 100%、CK19 100%、RCC Ma 50%、CD10 11%和KspCad 38%，而papRCC的值为AMACR 100%、CK7 90%、CK19 100%、RCC Ma 100%、CD10 80%和KspCad 0%。
MTSCC可能含有少量黏液，并显示其主要形态成分之一明显占优势。它们可能模仿其他形式的RCC。病理学家应了解MTSCC的组织学谱以确保准确诊断。仔细注意梭形细胞群体的存在可能有助于在以紧密小管生长为主的肿瘤的鉴别诊断中。papRCC的免疫组化染色在MTSCC中也有表达，但强CD10表达可能不支持MTSCC。
