Thoenes W, Störkel S, Rumpelt H J, Moll R, Baum H P, Werner S
Institute of Pathology, Johannes Gutenberg University of Mainz, F.R.G.
J Pathol. 1988 Aug;155(4):277-87. doi: 10.1002/path.1711550402.
This paper reports on 32 chromophobe cell renal carcinomas observed in 697 renal cell cancers (RCC) of adults (peak in the sixth decade of life). The chromophobe cell-type differs from other types of RCC macroscopically, the cut-surface being predominantly of grey-beige colour. Histologically, there are two variants: one is the typical (light) variant (n = 22) and the other is eosinophilic (n = 10). Both variants have in common (a) reaction of the cytoplasm with Hale's acid iron colloid; (b) electron microscopic detection of cytoplasmic microvesicles (150-300 nm), frequently with 'inner vesicles', and (c) low glycogen content in comparison with the clear cell carcinoma. Immunocytochemical investigations on the intermediate filaments show a positive reaction for cytokeratins No. 18 (uniformly) and Nos. 7 and 19 (to varying extents) for both variants, whereas vimentin was not found in any of these carcinomas, in contrast to the clear-cell type. The cytomorphological grading revealed predominantly G II tumours. A lymph node metastasis was found in one patient. On the basis of the mortality curves determined, the prognosis for patients with chromophobe cell carcinomas is more favourable than that of the clear-cell type. In terms of differential diagnosis, on the one hand, the typical (light) variant of the chromophobe cell RCC must be delimited from the clear-cell RCC, and on the other hand, the eosinophilic variant must be distinguished from the chromophilic or 'granular' RCC. Microscopic, histological, histochemical, electron microscopic, and intermediate filament analysis results document that the chromophobe cell type of RCC is a distinct entity. The implications for the nomenclature of RCC, especially with regard to the 'granular' type, are discussed.
本文报告了在697例成人肾细胞癌（RCC）（发病高峰在60岁左右）中观察到的32例嫌色细胞肾细胞癌。嫌色细胞型在宏观上与其他类型的RCC不同，切面主要呈灰米色。组织学上有两种变体：一种是典型（浅色）变体（n = 22），另一种是嗜酸性变体（n = 10）。两种变体的共同特征有：（a）细胞质与黑尔酸性铁胶体发生反应；（b）电子显微镜下检测到细胞质微泡（150 - 300纳米），常伴有“内泡”；（c）与透明细胞癌相比，糖原含量较低。对中间丝的免疫细胞化学研究表明，两种变体对细胞角蛋白18（均呈阳性）以及细胞角蛋白7和19（程度不同）均呈阳性反应，而与透明细胞型不同，在这些癌中均未发现波形蛋白。细胞形态学分级显示主要为G II级肿瘤。1例患者发现有淋巴结转移。根据所确定的死亡率曲线，嫌色细胞癌患者的预后比透明细胞型更有利。在鉴别诊断方面，一方面，嫌色细胞RCC的典型（浅色）变体必须与透明细胞RCC区分开，另一方面，嗜酸性变体必须与嗜色性或“颗粒状”RCC区分开。微观、组织学、组织化学、电子显微镜和中间丝分析结果证明，RCC的嫌色细胞型是一个独特的实体。本文还讨论了对RCC命名法的影响，特别是关于“颗粒状”类型的影响。
