肾集合管癌:罕见病例报告

Julpa Nurul Aini, Noza Hilbertina, Pamelia Mayorita
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摘要

背景:集合管癌(CDC)是肾细胞癌的罕见病理亚型之一,恶性程度高,预后差。病理检查是确诊 CDC 的金标准。CDC 被描述为一种具有管状乳头状结构并沿腺管形成滚刀型的肿瘤。病例介绍:一名 56 岁女性,入院前主诉右腹部肿块 1 个半月。胃部肿块越来越大,主诉伴有间歇性疼痛、恶心、呕吐、全身乏力、食欲减退。随后,患者接受了腹部 CT 扫描检查,结果发现右肾旁有积液/积水,肝脏右叶第 6 段出现低密度病变。大块组织的组织病理学检查显示,肾脏组织碎片外有结缔组织囊,内含肾小球和肾小管,肾小球和肾小管之间有立方体上皮衬里,结缔组织基质中有肿瘤细胞浸润性增生,结缔组织基质部分为去瘤细胞和脂肪组织。肿瘤细胞排列成肾小管乳头状结构和肾小管囊状结构。这些细胞核呈多形性,有的呈高色素性,有的呈水泡状,染色质粗糙,核清晰,有不典型有丝分裂,可见肿瘤细胞栓塞血管和侵入神经周围。可见淋巴细胞和浆细胞的斑点和集群,以及出血和坏死区域。结论患者被诊断为集合管癌(CDC)。
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Collecting Duct Carcinoma in the Kidneys: A Rare Case Report
Background: Collecting duct carcinoma (CDC) is one of the rare pathological subtypes of renal cell carcinoma, with high malignancy and poor prognosis. Pathological examination is the gold standard in confirming the diagnosis of CDC. CDC is described as a tumor that has a tubulopapillary architecture and forms a hobnail pattern along the glandular tube. Case presentation: A 56-year-old woman with the main complaint of a lump in the right abdomen for 1.5 months before entering the hospital. The lump in the stomach is getting bigger, complaints are accompanied by intermittent pain, nausea, vomiting, body feeling weak, and decreased appetite. The patient then underwent a CT-Scan examination of the abdomen and concluded that fluid/water was found next to the right kidney, and a hypodense lesion appeared in segment 6 of the right lobe of the liver. Histopathological examination of large tissue shows pieces of kidney tissue with a connective tissue capsule on the outside containing glomeruli and tubules lined by cuboidal epithelium as well as a proliferation of tumor cells that grow infiltratively in the connective tissue stroma which is partly desmoplastic and fatty tissue between the glomeruli and tubules. Tumor cells are arranged to form tubulopapillary and tubulocystic structures. These cells with pleomorphic nuclei, some hyperchromatic, some vesicular, coarse chromatin, clear nuclei, and atypical mitoses can be found and tumor cell embolism in the blood vessels and perineural invasion can be seen. There were spots and clusters of lymphocytes and plasma cells as well as areas of bleeding and necrosis. Conclusion: The patient was diagnosed with collecting duct carcinoma (CDC).
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