Ono Y, Ito T, Tsujino S, Aizawa S, Suzuki M
Department of Urology, Tokyo Medical College.
Nihon Hinyokika Gakkai Zasshi. 1997 Jun;88(6):587-95. doi: 10.5980/jpnjurol1989.88.587.
Papillary renal cell carcinomas (PRCCs) are genotypically distinct from nonpapillary renal cell carcinomas.
We studied the clinical, pathomorphological, immunohistochemical features in 34 PRCCs and 7 papillary renal adenomas. Immunohistochemical studies were performed using lectins and antibodies against cytokeratins, epithelial membrane antigen and Tamm-Horsfall protein.
PRCCs were divided into two types based on the features of tumor cells and vascular stalks. Fifteen PRCCs displayed small cuboidal cells with basophilic cytoplasm and thin, short vascular stalks (type 1, micropapillary). Nineteen PRCCs displayed large columnar cells with eosinophilic cytoplasm and edematous or fibrous thick stalks (type 2, macropapillary). Infiltration of foam cells was more common in type 1. Co-existence of papillary renal adenomas was recognized in three cases among type 1, but in only case among type 2. In type 1, a male to female predominance was evident (13:2), and the majority of tumors in type 1 were in lower nuclear grade and lower stage. The 5-year survival rates of patients in type 1 and 2 were 87% and 46%, respectively. Immunohistochemically, 15 (100%) cases in type 1 were diffusely positive for cytokeratin 7 (CK7), 15 (100%) were positive for cytokeratin 19 (Progen 19) and 11 (73%) were positive for dolichos biflorus agglutinin (DBA). In type 2, only 4 (19%) cases focally stained for CK7, 10 (53%) were stained for Progen 19 and only 2 (10%) were positive for DBA. The staining pattern in papillary renal adenoma was similar to that of type 1, all cases were positive for CK7, four of five cases (80%) were positive for Progen 19 and five of seven cases (71%) were positive for DBA.
The pathomorphologic and immunohistochemical features suggested that it is possible to divide PRCCs into 2 types and that PRCCs in type 1 confer an favorable prognosis. Furthermore, our results supported the possibility of adenoma-carcinoma sequence.
乳头状肾细胞癌（PRCC）在基因型上与非乳头状肾细胞癌不同。
我们研究了34例PRCC和7例乳头状肾腺瘤的临床、病理形态学及免疫组化特征。使用凝集素以及针对细胞角蛋白、上皮膜抗原和Tamm-Horsfall蛋白的抗体进行免疫组化研究。
根据肿瘤细胞和血管蒂的特征，PRCC分为两型。15例PRCC显示小立方形细胞，胞质嗜碱性，血管蒂细短（1型，微乳头型）。19例PRCC显示大柱状细胞，胞质嗜酸性，血管蒂水肿或纤维性增厚（2型，大乳头型）。泡沫细胞浸润在1型中更常见。1型中有3例同时存在乳头状肾腺瘤，而2型中仅1例。在1型中，男性明显多于女性（13:2），且1型中的大多数肿瘤核分级较低、分期较早。1型和2型患者的5年生存率分别为87%和46%。免疫组化方面，1型中的15例（100%）细胞角蛋白7（CK7）弥漫阳性，15例（100%）细胞角蛋白19（Progen 19）阳性，11例（73%）双花扁豆凝集素（DBA）阳性。在2型中，仅4例（19%）CK7局灶染色阳性, 10例（53%）Progen 19染色阳性，仅2例（10%）DBA阳性。乳头状肾腺瘤的染色模式与1型相似，所有病例CK7均阳性，5例中的4例（80%）Progen 19阳性，7例中的5例（71%）DBA阳性。
病理形态学和免疫组化特征提示，PRCC有可能分为2型，且1型PRCC预后良好。此外，我们的结果支持腺瘤-癌序列的可能性。
