Kim Y I, Yoon D H, Lee S W, Lee C
Department of Pathology, College of Medicine, Seoul National University, Korea.
Cancer. 1988 Dec 1;62(11):2402-7. doi: 10.1002/1097-0142(19881201)62:11<2402::aid-cncr2820621126>3.0.co;2-n.
A case of multicentric papillary adenocarcinoma arising in the renal pelvis and proximal ureteral mucosa of a 35-year-old man is presented. The left nephrectomy specimen demonstrated multiple, fungating, papillary tumors. The largest tumor measured 10 X 9 X 6 cm and invaded the renal parenchyma. Smaller tumors with long stalks were found. Microscopically, the papillary fronds of each neoplasm were lined by a single layer of cuboidal to low columnar epithelium admixed with a few areas of invasive tubular adenocarcinoma. The adjacent pelvic mucosa was the site of cuboidal epithelial metaplasia. The ultrastructure of both the papillary tumor and the pelvic mucosa suggested that they originated from the nonmucigenic metaplastic epithelium with a partial similarity to the lining of the proximal convoluted tubule. The growth pattern and the multicentric development of this unusual neoplasm suggest that this is a case of the malignant counterpart of the nephrogenic adenoma in the kidney and ureter, and reflect a biologic behavior corresponding to ordinary urothelial papillary tumors.
本文报告一例35岁男性肾盂和近端输尿管黏膜发生的多中心乳头状腺癌。左肾切除标本显示多个呈息肉状的乳头状肿瘤。最大的肿瘤大小为10×9×6 cm，侵犯肾实质。还发现了带长蒂的较小肿瘤。显微镜下，每个肿瘤的乳头状叶由单层立方上皮至低柱状上皮衬覆，并混有一些浸润性管状腺癌区域。相邻的盆腔黏膜为立方上皮化生部位。乳头状肿瘤和盆腔黏膜的超微结构提示它们起源于与近端曲管内衬部分相似的非黏液生成性化生上皮。这种不寻常肿瘤的生长方式和多中心发展提示这是一例肾和输尿管中肾源性腺瘤的恶性对应物，反映了与普通尿路上皮乳头状肿瘤相应的生物学行为。
