肾脏外科病理集锦.doc
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肾脏非肿瘤性疾病系列(Miscellaneous Non-Neoplastic Lesions in Kidney)
多囊性肾疾病(Kidney - Multilocular Cyst )
低倍镜下见大小不等的囊肿被菲薄的纤维性隔膜分割开。囊腔内膜光滑，与肾盂不相通。
This low-power scan of the glass slide nicely illustrates the small and large cysts separated by thin fibrous septa. The cysts have smooth inner surface and do not communicate with the renal pelvis.
多囊性肾疾病
囊腔内衬以扁平样上皮。囊壁内不含有实质性肿物和肾单位。囊性肾瘤应与囊性肾癌和囊性Wilms瘤相鉴别。
The cysts are lined by flattened epithelium. Solid areas and nephronic elements are absent from cyst walls. Cystic nephroma should be distinguished from cystic renal cell carcinoma and cystic Wilms tumor.
肾脏鹿角样结石(Kidney - Staghorn Calculus)
图中可见巨大的鹿角样结石嵌顿于肾盂肾盏系统。肾下极可见出血坏死区域，伴有肾皮质萎缩。
A large staghorn calculus is seen obstructing the renal pelvi-calyceal system. The lower pole of the kidney shows areas of hemorrhage and necrosis with collapse of cortical areas.
黄色肉芽肿性肾盂肾炎(Xanthogranulomatous pyelonephritis)
下图肉眼可见，因长期化脓性炎症而出现肾实质广泛性破坏。肾下极凹陷区域是由于鹿角样结石压迫所致，结石已经取出。
This gross photograph shows extensive destruction of renal parenchyma due to long-standing suppurative inflammation. The depressions seen in the lower half of the specimen were caused by a staghorn calculus which has been removed.
黄色肉芽肿性肾盂肾炎
病例1：25岁，女性，因肾脏肿物行根治性肾切除术，病理排除癌症。病理证实为黄色肉芽肿性肾盂肾炎伴发肾周脓肿。肾内可见一直径6.0cm的腔隙性病灶，腔内表层粗糙，伴有出血。
This 25 y/o female presented with a renal mass and underwent radical nephrectomy to rule out carcinoma. The specimen revealed xanthogranulomatous pyelonephritis with a large perinephric abscess. There is a 6.0 cm cavitary lesion in the center of the kidney lined by shaggy hemorrhagic surface. It communicates with the perinephric abscess on the central lateral aspect of the specimen. Case contributed by: Liang Cheng, MD, Dept. of Pathology, Indiana University School of Medicine, Indianapolis
黄色肉芽肿性肾盂肾炎
病例2：70%的肾组织受到破坏。可见大量囊性扩张合并黄褐色的结石形成。中心坏死区域被致密的纤维组织所包绕。
Another case of XGP showing destruction of approximately 70% of the kidney. Numerous dilated calyces with yellow-brown calculi are seen. The central necrotic areas are surrounded by dense fibrosis. Case contributed by: Liang Cheng, MD, Dept. of Pathology, Indiana University School of Medicine, Indianapolis.
肾脏嗜酸细胞腺瘤
下图见瘤细胞巢被丰富的粘液样间质所分隔。
The tumor cell nests are separated from each other by abundant myxoid stroma.
肾脏嗜酸细胞腺瘤
瘤细胞有时也可单层或多层排列构成管状或形成小的囊腔，周围有少量基质。
The tubulocystic pattern depicted here consists of cystically dilated tubular structures separated by scant stroma.
肾脏嗜酸细胞腺瘤
下图为嗜酸性细胞瘤的典型组织学表现，肿瘤细胞呈巢状或类器官样排列，周围充满较丰富的粘液样或玻璃样间质。
The classic histologic pattern of oncocytoma consists of nested or organoid arrangement of tumor cells surrounded by moderate to abundant quantity of myxoid or hyalinized stroma
肾脏嗜酸细胞腺瘤-脂肪浸润(Oncocytoma : Fat Infiltration)
肾脏嗜酸细胞腺瘤的组织学特征中有很多非典型性表现，其中外周脂肪浸润可见于11%的病例。
A number of atypical features have been described in the histologic spectrum of renal oncocytomas. Infiltration of perinephric fat was seen in 11% of cases in one study (Amin MB et al. Am J Surg Pathol 1997 Jan; 21(1):1-12.)
肾脏嗜酸细胞腺瘤-骨化生(Oncocytoma : Osseous metaplasia)
肾脏嗜酸细胞腺瘤的间质中可见到弥漫性的钙化、钙球、骨化生(如图)和骨髓样化生等表现。
The stroma in oncocytomas can show diffuse calcification, calcospherites, osseous metaplasia (shown here), and myeloid metaplasia (Ref: Perez-Ordonez et al. Renal Oncocytoma: A Clinicopathologic Study of 70 cases. Am J Surg Pathol
后肾腺瘤(针刺活检)
后肾腺瘤尽管体积较大，但却为胚胎发育过程中后肾来源的良性肿瘤，较少见。可伴发红细胞增多症。女性多发。针刺活检可见瘤组织形成腺管及小囊，含少量间质。因肿瘤为良性，老年病人为保存肾功能可不做肾切除。
Metanephric adenoma is a unique renal tumor with benign biologic behavior in spite of their large size. It may be associated with polycythemia. There is female predominance. This needle core biopsy shows tightly packed small tubules with little intervening stroma. Given the benign nature of the tumor, this elderly patient with compromised renal function opted not to undergo nephrectomy.
后肾腺瘤
大部分后肾腺瘤的边界清晰，但通常没有包膜，只有一层薄薄的非连续性的假性包膜。肿瘤如向肾外突出，可借助肾包膜与肾周组织分隔开来。
The majority of the tumors are well-circumscribed as seen in the previous and this image. They are usually not encapsulated but may have a thin and discontinuous pseudocapsule. The areas that bulge above the kidney are separated from the perirenal tissue by renal capsule.
后肾腺瘤
肿瘤的胞核小而圆，大小一致，形成管状结构，与周围少量的间质分隔开。瘤细胞大小均匀，核深染，胞浆少。
The tumor is composed of small, uniform, round acini and tubular structures separated by scant stroma. The lining epithelial cells are uniform with hyperchromatic nuclei and have scant cytoplasm.
后肾腺瘤：肾小球样结构(Metanephric Adenoma : Glomeruloid structures)
50%以上的病例可见到乳头状结构，瘤组织形成小囊，其内腔有瘤细胞陷入并形成小乳头状，外观似肾小球样结构，在这些乳头状结构内通常没有血管。
More than 50% of cases contain papillary structures, consisting of minute cysts into which small blunt papillary structures protrude. Many such structures resemble immature glomeruli. Usually there are no blood vessels in these papillary structures.
后肾腺瘤：砂粒体(Metanephric Adenoma : Psammoma bodies)
瘤组织经常会有钙化，形成砂粒体。
Psammoma bodies are commonly seen in Metanephric Adenomas. References: 1) Am J Surg Pathol 19: 615-626, 1995. 2) Am J Surg Pathol 19(10): 1101-1114, 1995.
肾透明细胞癌系列(Clear Cell Renal Cell Carcinoma)
肾细胞癌(Renal Cell Carcinoma )：大体形态
本例肾部分切除标本清楚显示肾细胞癌典型的黄褐色外观。但是，仅凭肉眼所见要想与血管平滑肌脂肪瘤和黄色肉芽肿性肾盂肾炎相鉴别是不可能的。
This partial nephrectomy specimen shows the typical yellow-orange gross appearance commonly seen in renal cell carcinoma. However, on gross features alone, its distinction from angiomyolipoma and xanthogranulomatous pyelonephritis may be impossible. (Photo courtesy of: Dr. Kyle Molberg, UT Southwestern Med. Ctr, Dallas)
肾细胞癌：大体形态
本例肾细胞癌瘤体巨大，伴发小囊肿形成、局灶性出血和坏死。
This large renal cell carcinoma shows cyst formation and foci of hemorrhage and necrosis
囊性肾细胞癌(Cystic Renal Cell Carcinoma)
本例可见癌组织中出现大小不等的多发性囊肿，故而也称为多房囊性肾细胞癌。但从肉眼所见无法与多房性肾囊肿相鉴别。
Note the cystic nature of this tumor. On gross appearance alone, it is impossible to distinguish this example of cystic RCC from other cystic lesions such as Multilocular cyst. (Photo courtesy of: Dr. Kyle Molberg, UT Southwestern Med. Ctr., Dallas)
囊性肾细胞癌
肿瘤大部分由多发性小囊肿组成，囊壁衬以透明癌细胞。
Some cases of renal cell carcinoma are composed largely of multilocular cysts separated by thin septa containing tumor cells. The cystic nature of this tumor is illustrated in this low-power scan
肾脏非肿瘤性疾病系列(Miscellaneous Non-Neoplastic Lesions in Kidney)
多囊性肾疾病(Kidney - Multilocular Cyst )
低倍镜下见大小不等的囊肿被菲薄的纤维性隔膜分割开。囊腔内膜光滑，与肾盂不相通。
This low-power scan of the glass slide nicely illustrates the small and large cysts separated by thin fibrous septa. The cysts have smooth inner surface and do not communicate with the renal pelvis.
多囊性肾疾病
囊腔内衬以扁平样上皮。囊壁内不含有实质性肿物和肾单位。囊性肾瘤应与囊性肾癌和囊性Wilms瘤相鉴别。
The cysts are lined by flattened epithelium. Solid areas and nephronic elements are absent from cyst walls. Cystic nephroma should be distinguished from cystic renal cell carcinoma and cystic Wilms tumor.
肾脏鹿角样结石(Kidney - Staghorn Calculus)
图中可见巨大的鹿角样结石嵌顿于肾盂肾盏系统。肾下极可见出血坏死区域，伴有肾皮质萎缩。
A large staghorn calculus is seen obstructing the renal pelvi-calyceal system. The lower pole of the kidney shows areas of hemorrhage and necrosis with collapse of cortical areas.
黄色肉芽肿性肾盂肾炎(Xanthogranulomatous pyelonephritis)
下图肉眼可见，因长期化脓性炎症而出现肾实质广泛性破坏。肾下极凹陷区域是由于鹿角样结石压迫所致，结石已经取出。
This gross photograph shows extensive destruction of renal parenchyma due to long-standing suppurative inflammation. The depressions seen in the lower half of the specimen were caused by a staghorn calculus which has been removed.
黄色肉芽肿性肾盂肾炎
病例1：25岁，女性，因肾脏肿物行根治性肾切除术，病理排除癌症。病理证实为黄色肉芽肿性肾盂肾炎伴发肾周脓肿。肾内可见一直径6.0cm的腔隙性病灶，腔内表层粗糙，伴有出血。
This 25 y/o female presented with a renal mass and underwent radical nephrectomy to rule out carcinoma. The specimen revealed xanthogranulomatous pyelonephritis with a large perinephric abscess. There is a 6.0 cm cavitary lesion in the center of the kidney lined by shaggy hemorrhagic surface. It communicates with the perinephric abscess on the central lateral aspect of the specimen. Case contributed by: Liang Cheng, MD, Dept. of Pathology, Indiana University School of Medicine, Indianapolis
黄色肉芽肿性肾盂肾炎
病例2：70%的肾组织受到破坏。可见大量囊性扩张合并黄褐色的结石形成。中心坏死区域被致密的纤维组织所包绕。
Another case of XGP showing destruction of approximately 70% of the kidney. Numerous dilated calyces with yellow-brown calculi are seen. The central necrotic areas are surrounded by dense fibrosis. Case contributed by: Liang Cheng, MD, Dept. of Pathology, Indiana University School of Medicine, Indianapolis.
肾脏嗜酸细胞腺瘤
下图见瘤细胞巢被丰富的粘液样间质所分隔。
The tumor cell nests are separated from each other by abundant myxoid stroma.
肾脏嗜酸细胞腺瘤
瘤细胞有时也可单层或多层排列构成管状或形成小的囊腔，周围有少量基质。
The tubulocystic pattern depicted here consists of cystically dilated tubular structures separated by scant stroma.
肾脏嗜酸细胞腺瘤
下图为嗜酸性细胞瘤的典型组织学表现，肿瘤细胞呈巢状或类器官样排列，周围充满较丰富的粘液样或玻璃样间质。
The classic histologic pattern of oncocytoma consists of nested or organoid arrangement of tumor cells surrounded by moderate to abundant quantity of myxoid or hyalinized stroma
肾脏嗜酸细胞腺瘤-脂肪浸润(Oncocytoma : Fat Infiltration)
肾脏嗜酸细胞腺瘤的组织学特征中有很多非典型性表现，其中外周脂肪浸润可见于11%的病例。
A number of atypical features have been described in the histologic spectrum of renal oncocytomas. Infiltration of perinephric fat was seen in 11% of cases in one study (Amin MB et al. Am J Surg Pathol 1997 Jan; 21(1):1-12.)
肾脏嗜酸细胞腺瘤-骨化生(Oncocytoma : Osseous metaplasia)
肾脏嗜酸细胞腺瘤的间质中可见到弥漫性的钙化、钙球、骨化生(如图)和骨髓样化生等表现。
The stroma in oncocytomas can show diffuse calcification, calcospherites, osseous metaplasia (shown here), and myeloid metaplasia (Ref: Perez-Ordonez et al. Renal Oncocytoma: A Clinicopathologic Study of 70 cases. Am J Surg Pathol
后肾腺瘤(针刺活检)
后肾腺瘤尽管体积较大，但却为胚胎发育过程中后肾来源的良性肿瘤，较少见。可伴发红细胞增多症。女性多发。针刺活检可见瘤组织形成腺管及小囊，含少量间质。因肿瘤为良性，老年病人为保存肾功能可不做肾切除。
Metanephric adenoma is a unique renal tumor with benign biologic behavior in spite of their large size. It may be associated with polycythemia. There is female predominance. This needle core biopsy shows tightly packed small tubules with little intervening stroma. Given the benign nature of the tumor, this elderly patient with compromised renal function opted not to undergo nephrectomy.
后肾腺瘤
大部分后肾腺瘤的边界清晰，但通常没有包膜，只有一层薄薄的非连续性的假性包膜。肿瘤如向肾外突出，可借助肾包膜与肾周组织分隔开来。
The majority of the tumors are well-circumscribed as seen in the previous and this image. They are usually not encapsulated but may have a thin and discontinuous pseudocapsule. The areas that bulge above the kidney are separated from the perirenal tissue by renal capsule.
后肾腺瘤
肿瘤的胞核小而圆，大小一致，形成管状结构，与周围少量的间质分隔开。瘤细胞大小均匀，核深染，胞浆少。
The tumor is composed of small, uniform, round acini and tubular structures separated by scant stroma. The lining epithelial cells are uniform with hyperchromatic nuclei and have scant cytoplasm.
后肾腺瘤：肾小球样结构(Metanephric Adenoma : Glomeruloid structures)
50%以上的病例可见到乳头状结构，瘤组织形成小囊，其内腔有瘤细胞陷入并形成小乳头状，外观似肾小球样结构，在这些乳头状结构内通常没有血管。
More than 50% of cases contain papillary structures, consisting of minute cysts into which small blunt papillary structures protrude. Many such structures resemble immature glomeruli. Usually there are no blood vessels in these papillary structures.
后肾腺瘤：砂粒体(Metanephric Adenoma : Psammoma bodies)
瘤组织经常会有钙化，形成砂粒体。
Psammoma bodies are commonly seen in Metanephric Adenomas. References: 1) Am J Surg Pathol 19: 615-626, 1995. 2) Am J Surg Pathol 19(10): 1101-1114, 1995.
肾透明细胞癌系列(Clear Cell Renal Cell Carcinoma)
肾细胞癌(Renal Cell Carcinoma )：大体形态
本例肾部分切除标本清楚显示肾细胞癌典型的黄褐色外观。但是，仅凭肉眼所见要想与血管平滑肌脂肪瘤和黄色肉芽肿性肾盂肾炎相鉴别是不可能的。
This partial nephrectomy specimen shows the typical yellow-orange gross appearance commonly seen in renal cell carcinoma. However, on gross features alone, its distinction from angiomyolipoma and xanthogranulomatous pyelonephritis may be impossible. (Photo courtesy of: Dr. Kyle Molberg, UT Southwestern Med. Ctr, Dallas)
肾细胞癌：大体形态
本例肾细胞癌瘤体巨大，伴发小囊肿形成、局灶性出血和坏死。
This large renal cell carcinoma shows cyst formation and foci of hemorrhage and necrosis
囊性肾细胞癌(Cystic Renal Cell Carcinoma)
本例可见癌组织中出现大小不等的多发性囊肿，故而也称为多房囊性肾细胞癌。但从肉眼所见无法与多房性肾囊肿相鉴别。
Note the cystic nature of this tumor. On gross appearance alone, it is impossible to distinguish this example of cystic RCC from other cystic lesions such as Multilocular cyst. (Photo courtesy of: Dr. Kyle Molberg, UT Southwestern Med. Ctr., Dallas)
囊性肾细胞癌
肿瘤大部分由多发性小囊肿组成，囊壁衬以透明癌细胞。
Some cases of renal cell carcinoma are composed largely of multilocular cysts separated by thin septa containing tumor cells. The cystic nature of this tumor is illustrated in this low-power scan
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