Naik Madhavi A, Pai Sanjay A
1 Pathocon Diagnostics, Bengaluru, Karnataka, India.
2 Columbia Asia Referral Hospital, Bengaluru, Karnataka, India.
Int J Surg Pathol. 2017 May;25(3):206-215. doi: 10.1177/1066896916678926. Epub 2016 Nov 16.
We report the presence of epididymis-like tubules in unilateral renal hypodysplasia in 3 adult men. Microscopy showed dilated tubules lined by ciliated columnar epithelium and smaller basal cells, morphologically resembling epididymal tubules. Small tubules lined by cuboidal epithelium were also present in all cases, with glomeruli in 2 cases. The epididymis-like tubules expressed CD10, CK7, PAX8, and AR in the luminal epithelium, while the basal cells were positive for p63, CK7, and focally for CD10. The smooth muscle bundles around the epididymis-like tubules were focally AR and WT1 (cytoplasmic) positive. The epididymis-like tubules were negative for ER, PR, and WT1. CK7 and PAX8 stained all the collecting ducts, with AR staining some. Bowman's capsule, parietal and visceral epithelial cells expressed CD10; WT1 stained the visceral and parietal epithelial cells. Glomerular parietal cells expressed PAX8 and focally, CK7. Proximal tubules were positive for CD10 (luminal membranous and weak cytoplasmic). Distal tubules expressed CK7, PAX8 and AR. An occasional small tubule was ER positive. Scattered stromal cells expressed ER, PR, and AR. The urothelium of the renal pelvis/upper ureter expressed CK7 in all layers, CD10 in the superficial layers, PAX8 in the basal layers and p63 in all layers except the umbrella layer. The epididymis-like tubules replicate the pattern of the mesonephros-derived normal epididymis in expressing CK7, PAX8, CD10, and AR. This supports a mesonephric rather than metanephric origin for these tubules. The aberrant expression of some markers may be a manifestation of the dysplastic nature of the kidneys.
我们报告了3名成年男性单侧肾发育不全中存在附睾样小管。显微镜检查显示，小管扩张，内衬纤毛柱状上皮和较小的基底细胞，形态上类似于附睾小管。所有病例中还存在内衬立方上皮的小导管，2例中有肾小球。附睾样小管的腔上皮表达CD10、CK7、PAX8和AR，而基底细胞p63、CK7阳性，局灶性表达CD10。附睾样小管周围的平滑肌束局灶性AR和WT1（细胞质）阳性。附睾样小管ER、PR和WT1阴性。CK7和PAX8染色所有集合管，AR染色部分集合管。鲍曼囊、壁层和脏层上皮细胞表达CD10；WT1染色脏层和壁层上皮细胞。肾小球壁层细胞表达PAX8，局灶性表达CK7。近端小管CD10阳性（腔膜和弱细胞质）。远端小管表达CK7、PAX8和AR。偶尔有小导管ER阳性。散在的基质细胞表达ER、PR和AR。肾盂/上输尿管的尿路上皮各层均表达CK7，表层表达CD10，基底层表达PAX8，除伞状层外各层均表达p63。附睾样小管在表达CK7、PAX8、CD10和AR方面复制了中肾来源的正常附睾模式。这支持了这些小管的中肾而非后肾起源。一些标志物的异常表达可能是肾脏发育异常性质的表现。
