Hong S M, Yu E, Ahn H, Kim O J
Department of Diagnostic Pathology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
J Korean Med Sci. 1998 Jun;13(3):321-4. doi: 10.3346/jkms.1998.13.3.321.
We report a case of alpha-fetoprotein (AFP) producing renal cell carcinoma. A 53-year-old man with fever was found to have a left renal mass on computed tomography. No mass was detected in the liver. Serum AFP was 1,460 ng/ml. Radical nephrectomy showed a 10 cm mass in the upper half. A half of the tumor was whitish yellow and firm whereas another half was soft and bright yellow with hemorrhagic and necrotic areas. Histologically, the two areas were different. The lower part consisted of the clear cell renal cell carcinoma and the upper part consisted of granular cells. On immunohistochemistry, the granular tumor cells only were positive for AFP. Serum AFP level dropped abruptly to 383 ng/ml on the 6th postoperative day and gradually returned to normal during the 6 months. Multiple metastatic nodules were found in the lungs, liver and bone in 9th postoperative month and the AFP was less than 1 ng/ml. This suggest metastatic lesions are non-AFP producing clear cell type. It can be concluded that serum AFP elevation was due to synthesis by the renal cell carcinoma in the absence of liver neoplasm. Although AFP producing renal cell carcinoma is a rare entity, serum AFP can be a useful marker for the detection of the tumor.
我们报告一例产生甲胎蛋白（AFP）的肾细胞癌病例。一名53岁发热男性经计算机断层扫描发现左肾有一肿块。肝脏未检测到肿块。血清AFP为1460 ng/ml。根治性肾切除术显示上半部分有一个10厘米的肿块。肿瘤一半为灰白色且质地硬，另一半柔软、亮黄色，伴有出血和坏死区域。组织学上，这两个区域不同。下部由透明细胞肾细胞癌组成，上部由颗粒细胞组成。免疫组化显示仅颗粒状肿瘤细胞AFP呈阳性。术后第6天血清AFP水平骤降至383 ng/ml，并在6个月内逐渐恢复正常。术后第9个月在肺、肝和骨发现多个转移结节，AFP小于1 ng/ml。这表明转移灶为不产生AFP的透明细胞类型。可以得出结论，血清AFP升高是由于肾细胞癌在无肝脏肿瘤情况下的合成所致。虽然产生AFP的肾细胞癌是一种罕见实体，但血清AFP可作为检测该肿瘤的有用标志物。
