Rotterova Pavla, Martinek Petr, Alaghehbandan Reza, Prochazkova Kristyna, Damjanov Ivan, Rogala Joanna, Suster Saul, Perez-Montiel Delia, Alvarado-Cabrero Isabel, Sperga Maris, Svajdler Marian, Michalova Kvetoslava, Pivovarcikova Kristyna, Daum Ondrej, Hora Milan, Dusek Martin, Ondic Ondrej, Stehlikova Adela, Michal Michal, Hes Ondrej
Department of Pathology, Charles University, Medical Faculty and Charles University Hospital Plzen, Czech Republic.
Biopticka laborator Plzen, Czech Republic.
Histol Histopathol. 2018 Mar;33(3):277-287. doi: 10.14670/HH-11-925. Epub 2017 Sep 1.
Emperipolesis has recently been described as a constant feature of "biphasic squamoid" papillary renal cell carcinoma (BPRCC). We also noticed this in some high-grade (HG) RCC, which promoted the present study to estimate the incidence of emperipolesis in RCCs and to describe them in further detail. 14 cases of HGRCC showing emperipolesis were retrieved from our registry. Microscopic examination of filed slides was supplemented with immunohistochemical and molecular-genetic analyses using paraffin embedded tissue. 12 of 14 patients were males with a mean age of 58.6 years (range 41-72 years). Tumor size ranged from 6-16.5 cm (mean of 8.8 cm). Follow up data were available for 8/14 patients (range 0.5-10 years). Metastases were documented in 6 cases. All tumors showed solid-alveolar growth patterns with focal pseudopapillary features, and were composed of large cells with bizarre nuclei and eosinophilic rhabdoid-like cytoplasm. Emperipolesis was a constant and prominent feature in large bizarre cells. All cases were positive for OSCAR, CANH 9, vimentin, cyclin D1, INI-1, and myoD1, while negative for melanocytic markers, CK 7, myoglobin, cathepsin K, and TFE3. VHL gene abnormalities were found in 6/9 analyzable cases, of which 2 demonstrated polysomy of chromosomes 7, 17. Emperipolesis is a rare histomorphologic feature which can be seen not only in BPRCCs but also in highgrade CCRCCs. All RCC cases with prominent emperipolesis fulfilled both morphologic and immunohistochemical diagnostic criteria of high-grade CCRCC. The majority of patients with available follow up information developed metastases.
近年来，噬血细胞现象已被描述为“双相鳞状”乳头状肾细胞癌（BPRCC）的一个恒定特征。我们在一些高级别（HG）肾细胞癌中也注意到了这一现象，这促使本研究去评估肾细胞癌中噬血细胞现象的发生率，并更详细地描述它们。从我们的登记册中检索出14例显示噬血细胞现象的高级别肾细胞癌病例。对存档切片进行显微镜检查，并使用石蜡包埋组织进行免疫组织化学和分子遗传学分析。14例患者中有12例为男性，平均年龄58.6岁（范围41 - 72岁）。肿瘤大小在6 - 16.5厘米之间（平均8.8厘米）。14例患者中有8例有随访数据（范围0.5 - 10年）。6例有转移记录。所有肿瘤均表现为实性-肺泡样生长模式，伴有局灶性假乳头特征，由具有奇异核和嗜酸性横纹肌样细胞质的大细胞组成。噬血细胞现象在大的奇异细胞中是一个恒定且突出的特征。所有病例OSCAR、CANH 9、波形蛋白、细胞周期蛋白D1、INI - 1和肌分化抗原1均为阳性，而黑素细胞标志物、细胞角蛋白7、肌红蛋白、组织蛋白酶K和TFE3均为阴性。9例可分析病例中有6例发现VHL基因异常，其中2例显示7号、17号染色体多体性。噬血细胞现象是一种罕见的组织形态学特征，不仅可见于BPRCC，也可见于高级别透明细胞肾细胞癌（CCRCC）。所有具有显著噬血细胞现象的肾细胞癌病例均符合高级别CCRCC的形态学和免疫组织化学诊断标准。大多数有随访信息的患者发生了转移。
