Tsuzuki Toyonori, Iwata Hidehiro, Murase Yota, Takahara Taishi, Ohashi Akiko
Department of Surgical Pathology, Aichi Medical University Hospital, Nagakute, Aichi, Japan.
Department of Pathology, Japanese Red Cross Nagoya Daini Hospital, Nagoya, Aichi, Japan.
Int J Urol. 2018 Sep;25(9):780-786. doi: 10.1111/iju.13759. Epub 2018 Jul 31.
The incidence of end-stage renal disease has increased owing to the greater prevalence of patients with chronic kidney disease and diabetes mellitus. End-stage renal disease is usually accompanied by acquired cystic disease and is a risk factor for renal cell carcinoma. The present review discusses the etiology of renal cell carcinoma in end-stage renal disease patients, focusing on two unique renal cell carcinoma histological subtypes: acquired cystic disease-associated renal cell carcinoma and clear cell papillary renal cell carcinoma. Acquired cystic disease-associated renal cell carcinoma occurs almost exclusively in patients who underwent hemodialysis, especially long-term (>10 years) hemodialysis. Its histology is distinctive: a cribriform or sieve-like architecture with intra- or intracystic lumina; tumor cells containing abundant eosinophilic cytoplasm and large nuclei with prominent nucleoli; and most notably, calcium oxalate crystal deposition. Recognition of the crystals is critical for diagnosing acquired cystic disease-associated renal cell carcinoma. Acquired cystic disease-associated renal cell carcinoma typically has an indolent clinical course, except in cases with sarcomatoid components. Clear cell papillary renal cell carcinoma also has an indolent course (no cases involving metastasis have been reported to date), and its features resemble those of both clear cell renal cell carcinoma and papillary renal cell carcinoma. Unlike acquired cystic disease-associated renal cell carcinoma, which occurs only in end-stage renal disease patients, clear cell papillary renal cell carcinoma occurs in non-end-stage renal disease patients as well. Additional renal tumors in end-stage renal disease patients include anastomosing hemangiomas. Long-term hemodialysis worsens the prognosis of end-stage renal disease patients with renal cell carcinoma, regardless of its original histological subtype, presumably by inducing oxidative stress and sarcomatoid transformation.
由于慢性肾脏病和糖尿病患者的患病率增加，终末期肾病的发病率也随之上升。终末期肾病通常伴有获得性囊性疾病，并且是肾细胞癌的一个危险因素。本综述讨论了终末期肾病患者肾细胞癌的病因，重点关注两种独特的肾细胞癌组织学亚型：获得性囊性疾病相关性肾细胞癌和透明细胞乳头状肾细胞癌。获得性囊性疾病相关性肾细胞癌几乎仅发生于接受血液透析的患者，尤其是长期（>10年）血液透析患者。其组织学特征独特：呈筛状或筛孔状结构，伴有囊内或囊间腔隙；肿瘤细胞含有丰富的嗜酸性细胞质、大细胞核及明显的核仁；最显著的是，有草酸钙晶体沉积。识别这些晶体对于诊断获得性囊性疾病相关性肾细胞癌至关重要。获得性囊性疾病相关性肾细胞癌通常临床病程进展缓慢，除了伴有肉瘤样成分的病例。透明细胞乳头状肾细胞癌临床病程也进展缓慢（迄今尚无转移病例报道），其特征类似于透明细胞肾细胞癌和乳头状肾细胞癌。与仅发生于终末期肾病患者的获得性囊性疾病相关性肾细胞癌不同，透明细胞乳头状肾细胞癌也可发生于非终末期肾病患者。终末期肾病患者的其他肾脏肿瘤包括吻合性血管瘤。长期血液透析会使患有肾细胞癌的终末期肾病患者的预后恶化，无论其原发组织学亚型如何，推测其原因是诱导氧化应激和肉瘤样转化。
