Department of Pathology and Laboratory Medicine, Indiana University School of Medicine, Indianapolis, IN 46202; Department of Pathology and Laboratory Medicine, Henry Ford Health System, Detroit, MI 48202.
Department of Pathology and Laboratory Medicine, Indiana University School of Medicine, Indianapolis, IN 46202.
Hum Pathol. 2014 Apr;45(4):735-44. doi: 10.1016/j.humpath.2013.10.033. Epub 2013 Nov 15.
A component of syncytial-type multinucleated tumor giant cells is uncommon in clear cell renal cell carcinoma, and the histogenesis, incidence, and clinical implications of this finding are not well understood. We retrieved 13 such tumors from our pathology archives in patients with a median age of 60years, comprising 1.5% of clear cell renal cell carcinomas. Stage was typically pT4 or pT3 (each 38%). Microscopically, all tumors included a component of low-grade clear cell renal cell carcinoma with usual features. Syncytial-type giant tumor cells possessed voluminous cytoplasm, usually granular and eosinophilic, and numerous nuclei similar to those of the mononuclear tumor cells. Transition between areas of mononuclear and multinucleated cells was sometimes abrupt. Other findings included necrosis (77%), hyaline globules (46%), emperipolesis (46%), and intranuclear cytoplasmic invaginations (23%). Immunohistochemical staining typically revealed both mononuclear and multinucleated cells to be positive for carbonic anhydrase IX, CD10, epithelial membrane antigen, vimentin, and cytokeratin AE1/AE3 and negative for β human chorionic gonadotropin, TFE3, cathepsin K, cytokeratin 7, cytokeratin 20, HMB45, CD68, smooth muscle actin, and S100. Most patients with available information (7/9) were alive with metastatic disease at the most recent follow-up. Syncytial-type giant cells are an uncommon finding associated with aggressive clear cell renal cell carcinomas. Despite the unusual appearance of this tumor component, its immunoprofile supports an epithelial lineage and argues against trophoblastic, osteoclast-like, or histiocytic differentiation. Reactivity for typical clear cell renal cell carcinoma antigens facilitates discrimination from giant cells of epithelioid angiomyolipoma or other tumors, particularly in a biopsy specimen or a metastatic tumor.
横纹肌样型多核巨细胞瘤成分在透明细胞肾细胞癌中并不常见，其组织发生、发生率和临床意义尚不清楚。我们从病理档案中检索了 13 例此类肿瘤，患者中位年龄为 60 岁，占透明细胞肾细胞癌的 1.5%。分期通常为 pT4 或 pT3（各 38%）。显微镜下，所有肿瘤均包括具有通常特征的低级别透明细胞肾细胞癌成分。横纹肌样型巨细胞瘤细胞具有丰富的细胞质，通常呈颗粒状和嗜酸性，并且有许多类似于单核肿瘤细胞的核。单核和多核细胞区域之间的过渡有时很突然。其他发现包括坏死（77%）、透明小体（46%）、胞质内包涵体（46%）和核内细胞质内陷（23%）。免疫组织化学染色通常显示单核和多核细胞均为碳酸酐酶 IX、CD10、上皮膜抗原、波形蛋白和细胞角蛋白 AE1/AE3 阳性，β 人绒毛膜促性腺激素、TFE3、组织蛋白酶 K、细胞角蛋白 7、细胞角蛋白 20、HMB45、CD68、平滑肌肌动蛋白和 S100 阴性。有可获得信息的大多数患者（7/9）在最近的随访中仍患有转移性疾病。横纹肌样型巨细胞是一种罕见的与侵袭性透明细胞肾细胞癌相关的发现。尽管这种肿瘤成分的外观不寻常，但它的免疫表型支持上皮谱系，并排除滋养层、破骨样或组织细胞分化。典型的透明细胞肾细胞癌抗原的反应性有助于将其与上皮样血管平滑肌脂肪瘤或其他肿瘤的巨细胞区分开来，尤其是在活检标本或转移瘤中。
