Sakatani Toru, Okumura Yoshinaga, Kuroda Naoto, Magaribuchi Toshihiro, Nakano Yorika, Shirahase Toshiaki, Watanabe Jun, Taki Yoji, Okigaki Mitsuhiko, Ikehara Susumu, Adachi Yasushi
Department of Urology, Toyooka Hospital, Toyooka, Hyogo 668-8501, Japan.
Department of Diagnostic Pathology, Kochi Red Cross Hospital, Kochi 780-8562, Japan.
Mol Clin Oncol. 2017 Dec;7(6):976-980. doi: 10.3892/mco.2017.1430. Epub 2017 Sep 29.
Mucinous tubular and spindle cell carcinoma (MTSCC) is rare in renal cell carcinoma (RCC) and usually demonstrates a low nuclear grade and a better prognosis compared with other RCCs. The authors present a case report of MTSCC containing an area of Fuhrman nuclear grade 3, in addition to an area with a micropapillary pattern. An 82-year-old man consulted a hospital due to macrohematuria, and a tumor in the right kidney was detected. The tumor was resected and histologically examined. The tumor consisted of various growth patterns: Elongated tubular structure, a papillary structure containing a micropapillary pattern and solid pattern with spindle cells. The tumor cells demonstrated Fuhrman nuclear grades 2 and 3. Invasion into the lymph vessel and metastasis into the regional lymph node were observed. Thus, the tumor was diagnosed as a high grade MTSCC. Five months following resection, a computed tomography scan suggested metastasis of the tumor into the para-aortic lymph nodes and liver, and the patient succumbed to brain metastasis. When MTSCC of kidney is observed, careful histological observation is important to avoid missing a high nuclear grade area.
黏液性小管状和梭形细胞癌（MTSCC）在肾细胞癌（RCC）中较为罕见，与其他肾细胞癌相比，通常核分级较低，预后较好。作者报告了1例黏液性小管状和梭形细胞癌病例，该病例除了具有微乳头结构区域外，还包含1个福尔曼核分级为3级的区域。1名82岁男性因肉眼血尿到医院就诊，检查发现右肾有肿瘤。肿瘤切除后进行了组织学检查。肿瘤由多种生长模式组成：细长的管状结构、含有微乳头结构的乳头状结构以及梭形细胞实性结构。肿瘤细胞显示福尔曼核分级为2级和3级。观察到肿瘤侵犯淋巴管并转移至区域淋巴结。因此，该肿瘤被诊断为高级别黏液性小管状和梭形细胞癌。切除术后5个月，计算机断层扫描显示肿瘤转移至主动脉旁淋巴结和肝脏，患者最终死于脑转移。当观察到肾黏液性小管状和梭形细胞癌时，仔细的组织学观察对于避免遗漏高核分级区域很重要。
