Dlhodobá dialyzačná liečba chronickej obličkovej nedostatočnosti sprevádzaná získanou cystickou chorobou obličiek a súčasnými prednádorovými zmenami a mnohopočetnými nádormi ľavej obličky
Authors:
A. Böör; I. Jurkovič; Z. Havierová; P. Kočan
Authors‘ workplace:
Department of Pathology, Faculty of Medicine, P. J. Šafárik University in Košice, Slovak Republic
Published in:
Čes.-slov. Patol., 46, 2010, No. 4, p. 105-110
Category:
Original Article
Overview
Cieľ práce:
opis a imunohistochemická analýza prednádorových zmien a nádora obličky u pacienta s chronickou obličkovou nedostatočnosťou liečenou dlhodobou hemodialýzou.
Metódy:
Nefrektomický bioptický materiál (ľavá oblička), bol vyšetrený mikroskopicky a polaroskopicky. Ďalej boli na analýzu použité tieto protilátky: CK1/CK3, CK5/6, CK8, CK20, EMA, „Renal cells“, CD10, Ki-67, PCNA, p53 a E-cadherin.
Hlavné nálezy:
Operačný preparát pochádzal z pacienta, liečeného pre renálnu insuficienciu 11 rokov hemodialýzou pre diabetickú nefropátiu a chronickú tubulointersticiálnu nefritídu. Indikáciou pre urgentnú nefrektómiu bola bolesť a masívne intrarenálne krvácanie. Spolu s nálezom vyššie uvedených obličkových ochorení zistili sme rozvinutý nález získanej cystózy vznikajúcej počas dlhodobej dialýzy, viaceré malé papilárne adenómy a multifokálne karcinómy z buniek obličky vykazujúce konvenčný, ďalej papilárny a sarkomatoidný charakter. Prítomné boli tiež známky ťažkej vaskulárnej nefrosklerózy a uremickej oxalózy. Horný pól orgánu bol masívne prekrvácaný.
Závery:
Nami popísaný nález obsahuje súčasnú prítomnosť mikroskopických zmien vysvetľujúcich stav chronickej obličkovej nedostatočnosti s prítomnou uremickou oxalózou, kombinovaných so získanou cystózou vznikajúcou v dôsledku dlhodobej hemodialýzy. V takto zmenenom orgáne sa nachádzali dysplastické mikrotubulárne a intracystické zmeny, smerujúce ku vzniku viacerých papilárnych adenómov a multifokálnych karcinómov z buniek obličky, vyznačujúcich sa rôznorodou diferenciáciou.
Kľúčové slová:
chronická renálna insuficiencia – získaná cystická choroba obliček – prekarcenózne zmeny – nádory obličky
Sources
1. Aita, K., Tanimoto, A., Fujimoto, Y. et al.: Sarcomatoid collecting duct carcinoma arising in the hemodialysis-associated acquired cystic kidney: an autopsy report. Pathol. Int. 53, 2003, p. 463–7.
2. Bisceglia, M., Galliani, C.A., Senger, C. et al.: Renal cystic diseases: a review. Adv. Anat. Pathol. 13, 2006, p. 26–56.
3. Cheuk, W.,Lo, E.S.F., Chan, A.K.C. et al.: Atypical epithelial proliferations in acquired renal cystic disease harbor cytogenetic aberrations. Hum. Pathol. 33, 2002, p. 761–5.
4. Cossu-Rocca, P., Eble, J.N., Zhang, S. et al.: Acquired cystic disease-associated renal tumors: an immunohistochemical and fluorescence in situ hybridization study. Mod. Path. 19, 2006, p. 780–7.
5. Denton, M.D., Magee, C.C., Ovuworie, C. et al.: Prevalence of renal cell carcinoma in patients with ESRD pre-transplantation: A pathologic analysis. Kidney Int. 61, 2002, p. 2201–2209.
6. Dunnill, M.S., Millard, P.R., Oliver, D.: Acquired cystic diseae of the kidneys: A hazard of long-term intermittent maintainance hemodialysis. J. Clin. Patol. 30, 1977, p. 868–877.
7. Fujimoto, K., Anai, S., Okajima, E. et al.: Chromophobe cell renal carcinoma with acquired cystic disease of the kidney in a long-term hemodialysis patient. Int. J. Urol. 10, 2003, p. 99–102.
8. Hammerschmied, C.G., Walter, B., Hartmann, A.: Nierenzellkarzinom 2008. Pathologe 29, 2008, p. 354–63.
9. Hashimoto, T., Togo, Y., Yasuda, K. et al.: Oncocytoma associated with acquired cystic disease of kidney (ACKD): a case report. Hinyokika Kiyo 51, 2005, p. 747–9.
10. Hora, M., Hes, O., Reischig, T. et al.: Tumors in end-stage kidney. Transplant. Proc. 40, 2008, p. 3354–8.
11. Huang, X., Wang, X., Zhu, J. et al.: Chemical-induced polycyst with renal tumor and expression of 8-OHdG in kidney tissue. Thonghua Wai Ke Za Zhi 38, 2000, p. 226–8.
12. Ikeda, R., Tanaka, T., Moriwama, M.T. et al.: Proliferative activity of renal cell carcinoma associated with acquired cystic disease of the kidney: a comparison with typical renal cell carcinoma. Hum. Pathol. 33, 2002, p. 230–5.
13. Ishikawa, I., Saito, A., Chikazawa, Y. et al.: Cystic renal cell cell carcinoma, suspected because of lack of regression of renal cysts after renal transplantatioon in a dialysis patient witrh acquired renal cystic disease. Cli. Exp. Nephrol. 7, 2003, p. 81–4.
14. Kato, T., Takahasi, Y., Nakane, K. et al.: Bilateral renal cell carcinoma associated with polycystic kidney disaese: case report and literature review. Hinyokika Kiyo 53, 2007, p. 117–119.
15. Kojima, Y., Takahara, S., Mivake, O. et al.: Renal cell carcinoma in dialysis patients: a single center experience. Int. J. Urol. 13, 2006, p. 1045–8.
16. Konda, R., Sato, H., Hatafuku, F. et al., T.: Expression of hepatocyte growth factor and its receptor C-met in acquired renal cystic disease associated with renal cell carcinoma. J. Urol. 171, 2004, p. 2166–70.
17. Konda, R., Sugimura, J., Sohma, F. et al.: Over expression of hypoxia-inducible protein 2, hypoxia-inducible factor-1alpha and nuclear factor kappa B is putatively involved in acquired renal cyst formation and subsequent tumor transformation in patients with end stage renal failure. J. Urol. 180, 2008, p. 481–5.
18. Kovacs, G.: Molecular cytogenetics or renal cell tumors. Adv. Cancer. Res. 62, 1993, p. 89–124.
19. Kovacs, G.: High frequency of papillary renal-cell tumours in end-stage kidneys – is there a molecular genetic explanation?. Nephrol. Dial. Transplant. 10, 1995, p. 595–6.
20. Kuroda, N., Tamura, M., Taguchi, T. et al: Sarcomatoid acquired cystic disease-associated renal cell carcinoma. Histol. Histopathol. 23, 2008, p. 1327–31.
21. Lu, T.C., Lim, P.S., Hsu, W.M. et al.: Renal oncocytoma in acquired renal cystic disease. J. Formos. Med. Assoc. 100, 2001, p. 488–91.
22. Matsui, F., Kobori, Y., Amano, T. et al.: Renal cell carcinoma in acquired cystic disease of the kidney manifested by spontaneous renal supture. Hinyokika Kiyo 49, 2003, p. 239–41.
23. Mazzucchelli, R., Cheng, L., Lopez-Beltran, A. et al.: Renal oncocytosis and multiple papillary adenomas with oncocytoma as dominant nodule coexisting with papillary carcinoma in a patient with diabetic glomerulosclerosis, acquired renal cystic disease and B cell lymphoma. APMIS 116, 2008, p. 934–8.
24. Menéndez, C.L., Pobes, A., Corte Torres, M.G. et al.: A case of acquired renal cystic disease ACKD) with oncocytosis, a dominant nodule (oncocytoma), mutliple adenomas and a microscopic papillary renal cell carcinoma associated with crescentic glomerulonephritis. Virchows. Arch. 450, 2007, p. 365–7.
25. Nagashima, A., Ikemoto, I., Furuta, N. et al.: A case of pheochromocytoma associated with incidental multiple renal cell carcinoma originating from acquired cystic disease of the kidney in hemodialysis. Hinyokika Kiyo 52, 2006, p. 557–60.
26. Ova, M., Mikami, S., Mizuno, E. et al.: C-jun activation in acquired kidney disease and renal cell carcinoma. J.Urol. 174, 2005, p. 726.
27. Peces, R., Martinez-Ara, J., Miguel, J.L.: Renal cell carcinoma co-existent with other renal disease: clinico-pathological features in pre-dialysis patients and those receiving dialysis or renal transplantation. Nephrol. Dial. Transplant. 19, 2004, p. 2789–96.
28. Rifkin, S.I.: Thirty-seven uninterrupted years of hemodialysis: a case report. Medscape J. Med. 10, 2008, p. 231–5.
29. Rioux-Leclercq, N.C., Epstein, J.I.: Renal cell carcinoma with intratumoral calcium oxalate crystal depositions in patients with acquired cystic disease of the kidney. Arch. Pathol. Lab. Med. 127, 2003, p. 89–92.
30. Rivera, M., Tickoo, S.K., Saqi, A. et al.: Cytologic findings of acquired cystic disease-associate renal cell carcinoma: a report of two cases. Diagn. Cytopathol. 36, 2008, p. 344–7.
31. Scandling, J.D.: Acquired cystic kidney disease and renal cell cancer after transplantation: time to rethink screening?. Clin. J. Am. Soc. Nephrol. 2, 2007, p. 750–6.
32. Schwarz, A., Vatandaslar, S., Merkel, S. et al.: Renal cell carcinoma in transplant recipients with acquired cystic kidney disease. Clin. J. Am. Soc. Nephrol. 2, 2007, p. 621–2.
33. Sule, N., Yakupoglu, U., Shen, S.S. et al.: Calcium oxalate deposition in renal cell carcinoma associated with acquired cystic kidney disease: a comprehensive study. Am. J. Surg. Pathol. 29, 2005, p. 443–451.
34. Ticoo, S.K., de Peralta-Venturina, M.N., Salama, M. et al.: Spectrum of epithelial tumors in end stage renal disease (ESRD): emphasis on histologic patterns distinct from those in sporadic adult renal neoplasia. Lab. Invest. 83, 2003, .... 173A.
35. Truong, L.D., Choi, Y.J., Shen, S.S. et al.: Renal cystic neoplasms and real neoplasms associated with cystic renal diseases: pathogenetic and molecular links. Adv. Anat. Pathol. 10, 2003, p. 135–159.
36. Vaseemuddin, M., Kraus, M.A.: Quiz page. Acquired kidney disease (ACKD) with associated bilateral renal cell carcinoma. Am. J. Kidney Dis. 46, 2005, p. 47–9.
Labels
Anatomical pathology Forensic medical examiner ToxicologyArticle was published in
Czecho-Slovak Pathology
2010 Issue 4
Most read in this issue
- Muir-Torre syndrom – fenotypická varianta Lynchova syndromu
- Lymfatický systém: novinky v morfologii a patologii
- Systémová sklerozující choroba spojená s imunoglobuliny IgG4 – současné poznatky
- Dlhodobá dialyzačná liečba chronickej obličkovej nedostatočnosti sprevádzaná získanou cystickou chorobou obličiek a súčasnými prednádorovými zmenami a mnohopočetnými nádormi ľavej obličky