Weir M, Pitman M B
Department of Pathology, Massachusetts General Hospital, Boston 02114, USA.
Cancer. 1997 Feb 25;81(1):45-50.
The morphologic similarities between renal cell carcinoma (RCC) and hepatocellular carcinoma (HCC) can cause diagnostic difficulty in fine-needle aspiration biopsy (FNAB) specimens. In the authors' prior study of liver FNAB, peripherally wrapping endothelium (PE) and arborizing transgressing endothelium (TE) were 100% specific for HCC relative to metastatic tumors, which included only three RCCs. In this study, the vascular patterns of RCC in FNAB were reviewed for comparison with HCC, to determine their usefulness in the differential diagnosis of HCC and RCC.
FNAB of 49 RCCs (26 primary and 23 metastatic) from 46 patients were reviewed. Four vascular patterns were assessed: PE, TE, papillary endothelium (PAP) in fibrovascular cores of papillary fragments, and short nonbranching endothelium (SE) in small cell clusters. Each pattern was given a semiquantitative score: absent (0), focal (1), or extensive (2). Cellularity was categorized as low (< 20 groups), moderate (20-50 groups), or high (> 50 groups).
Vessels were present in 19 of 26 (73%) primary and 9 of 23 (39%) secondary RCC. PE was not identified. TE was observed in 11 primary (42%) and 7 metastatic (30%) RCC. SE was present in 5 primary (19%) and 1 metastatic (4%) RCC. The TE and SE patterns were distributed among the clear cell, granular cell, and chromophobe RCC. PAP was observed in all four papillary RCC. The majority of the TE and all of the PAP were present in moderately to highly cellular FNABs, whereas SE was usually observed in FNABs with low cellularity.
FNAB specimens of RCC commonly contain TE, as in HCC, but lack PE. TE was less frequent in metastatic than primary RCC. Other vascular patterns (SE, PAP), absent in HCC, were observed infrequently. Vascular patterns, especially PE, are useful in distinguishing HCC from RCC.
肾细胞癌（RCC）与肝细胞癌（HCC）在形态学上的相似性可能会给细针穿刺活检（FNAB）标本的诊断带来困难。在作者之前对肝脏FNAB的研究中，相对于转移性肿瘤，外周包裹内皮（PE）和树枝状侵袭性内皮（TE）对HCC具有100%的特异性，其中转移性肿瘤仅包括3例RCC。在本研究中，对FNAB中RCC的血管模式进行了回顾，以与HCC进行比较，确定它们在HCC和RCC鉴别诊断中的作用。
回顾了46例患者的49例RCC（26例原发性和23例转移性）的FNAB。评估了四种血管模式：PE、TE、乳头状碎片纤维血管核心中的乳头状内皮（PAP）以及小细胞簇中的短非分支内皮（SE）。每种模式都给予一个半定量评分：无（0）、局灶性（1）或广泛性（2）。细胞密度分为低（<20组）、中（20 - 50组）或高（> >50组）。
26例原发性RCC中有19例（73%）和23例继发性RCC中有9例（39%）存在血管。未发现PE。在11例原发性（42%）和7例转移性（30%）RCC中观察到TE。5例原发性（19%）和1例转移性（4%）RCC中存在SE。TE和SE模式分布于透明细胞、颗粒细胞和嫌色性RCC中。在所有4例乳头状RCC中均观察到PAP。大多数TE和所有PAP存在于细胞密度中等至高的FNAB中，而SE通常在细胞密度低的FNAB中观察到。
RCC的FNAB标本通常像HCC一样含有TE，但缺乏PE。TE在转移性RCC中比原发性RCC中少见。在HCC中不存在的其他血管模式（SE、PAP）很少观察到。血管模式，尤其是PE，有助于区分HCC和RCC。
