Xiao J C, Walz-Mattmüller R, Ruck P, Horny H P, Kaiserling E
Institute of Pathology, University of Tübingen, Germany.
Gen Diagn Pathol. 1997 Feb;142(3-4):147-53.
A considerable proportion of cases of myeloproliferative and lymphoproliferative disorders exhibit renal involvement. However, it is unclear whether the cytologic features, immunophenotype or grade of malignancy of the cells infiltrating the kidney differ from those of the primary tumor. This study was performed on 120 autopsy cases with the following diagnoses: acute myelogenous leukemia (AML, n = 22; subtypes M1 + M2, n = 12, subtype M4, n = 10), chronic myelogenous leukemia (CML, n = 7), agnogenic myeloid metaplasia/myelofibrosis (AMM/MF, n = 6), acute lymphocytic leukemia (ALL, n = 6), chronic lymphocytic leukemia (CLL, n = 9), other low-grade non-Hodgkin's lymphomas (low-grade NHL, n = 24), high-grade NHL (n = 21) and multiple myeloma (MM, n = 25). Renal involvement was investigated by light microscopy and immunohistochemistry. It was found in 34% of the cases, and was most common in ALL (83%) and low-grade NHL (50%) and least common in high-grade NHL (10%) and MM (12%). Dense infiltration of almost the entire kidney was most commonly seen in AML, low-grade NHL and ALL. Infiltration was bilateral and involved both the cortex and medulla in the majority of cases. When involvement of other organs was compared with that of the kidney, the lung was found to be involved in approximately the same number of cases, but liver involvement was more common and heart involvement less common. Reactive lymphocytic infiltration of the kidney was found in 18 of the 120 cases (15%), and was distinguished from scanty tumorous infiltration by immunohistochemical staining. No major phenotypical differences were found between the tumor cells infiltrating the kidney and those of the primary tumors in the bone marrow or lymph nodes. However, in one case of CML, the cells infiltrating the kidney were negative for KP1 and chloroacetate esterase, but could be identified by reactivity for CD34. The grade of malignancy in NHL was similar in both the nodal and renal manifestations.
相当一部分骨髓增殖性疾病和淋巴增殖性疾病病例存在肾脏受累情况。然而，浸润肾脏的细胞的细胞学特征、免疫表型或恶性程度是否与原发性肿瘤不同尚不清楚。本研究对120例尸检病例进行，诊断如下：急性髓系白血病（AML，n = 22；M1 + M2亚型，n = 12，M4亚型，n = 10）、慢性髓系白血病（CML，n = 7）、原发性骨髓化生/骨髓纤维化（AMM/MF，n = 6）、急性淋巴细胞白血病（ALL，n = 6）、慢性淋巴细胞白血病（CLL，n = 9）、其他低级别非霍奇金淋巴瘤（低级别NHL，n = 24）、高级别NHL（n = 21）和多发性骨髓瘤（MM，n = 25）。通过光学显微镜和免疫组织化学研究肾脏受累情况。在34%的病例中发现肾脏受累，在ALL（83%）和低级别NHL（50%）中最为常见，在高级别NHL（10%）和MM（12%）中最不常见。几乎整个肾脏的密集浸润最常见于AML、低级别NHL和ALL。在大多数病例中，浸润是双侧性的，累及皮质和髓质。当将其他器官的受累情况与肾脏的受累情况进行比较时，发现肺部受累的病例数大致相同，但肝脏受累更常见，心脏受累较少见。在120例病例中有18例（15%）发现肾脏有反应性淋巴细胞浸润，通过免疫组织化学染色可将其与少量肿瘤浸润区分开来。浸润肾脏的肿瘤细胞与骨髓或淋巴结中的原发性肿瘤细胞之间未发现主要的表型差异。然而，在1例CML病例中，浸润肾脏的细胞KP1和氯乙酸酯酶呈阴性，但可通过对CD34的反应性进行识别。NHL在淋巴结和肾脏表现中的恶性程度相似。
