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Two Cases of Renal Cell Carcinoma Harboring a Novel STRN-ALK Fusion Gene.

两例具有STRN-ALK融合基因的肾细胞癌

Kusano H,Togashi Y,Akiba J,Moriya F,Baba K,Matsuzaki N,Yuba Y,Shiraishi Y,Kanamaru H,Kuroda N,Sakata S,Takeuchi K,Yano H

Abstract

Anaplastic lymphoma kinase (ALK) translocation renal cell carcinomas (RCCs) have been reported by several independent groups in recent times. The clinical behavior and histopathologic characteristics of these carcinomas are not fully understood because of the paucity of cases reported. Here, we describe 2 cases of RCC harboring a novel striatin (STRN)-ALK fusion. The first case was a 33-year-old woman with no sickle cell trait who underwent nephrectomy for right renal mass and had late recurrence in para-aortic lymph nodes twice 10 and 12 years after initial surgery. After the second recurrence, she was carefully observed without any treatment. Twenty-six years after the initial nephrectomy, the second para-aortic lymphadenectomy was performed, and gastrectomy was performed for newly developed primary gastric cancer. The resected para-aortic lymph nodes were largely replaced by metastatic carcinoma. The second case was a 38-year-old man with no sickle cell trait who underwent cytoreductive nephrectomy followed by sunitinib therapy for metastatic RCC. In both cases, the tumor showed solid, papillary, tubular, and mucinous cribriform structures. Psammoma bodies were occasionally seen in the stroma. Tumor cells had a large nucleus and prominent nucleoli with predominantly eosinophilic cytoplasm. Rhabdoid cells and signet-ring cells were also observed. Intracytoplasmic mucin deposition and background mucinous stroma were confirmed. In the second case, tumor necrosis was seen in some areas. Tumor cells exhibited diffuse positive staining for ALK in both cases. ALK translocation was confirmed by fluorescent in situ hybridization, and further gene analysis revealed a STRN-ALK fusion. These cases provide great insights into ALK translocation RCCs.

摘要

近年来,间变性淋巴瘤激酶(ALK)异位导致的肾细胞癌(RCCs)已经有几个独立的团体报道。但由于有关这种肿瘤的报道数量较少,其临床表现和组织病理形态学特点至今尚未完全明了。

本文中,我们描述了两例具有独特的striatin(STRN)-ALK融合的肾细胞癌(RCCs)

第一例为33岁女性,没有发现镰状细胞特性,曾因右肾肿块行肾切除术,分别于第一次手术10年和12年后,发现肿瘤复发于腹主动脉旁淋巴结。第二次肿瘤复发后,我们对她进行严密观察、没有进行任何治疗。第一次肾切除术26年后,进行了第二次腹主动脉旁淋巴结切除术并因原发胃癌进行胃切除术。切除后的淋巴结被大量转移的肿瘤所取代。

第二个病例是38岁、没有镰状细胞特征的男性患者,因转移性肾细胞癌进行减瘤性肾切除术后,还进行了舒尼替尼治疗。

两个案例中,肿瘤呈现实性、乳头状、管状、黏液性筛状结构。基质中偶可见砂粒体。肿瘤细胞核大,核仁明显,胞质明显嗜酸性,杆状细胞和印戒细胞可见。胞浆内有黏蛋白沉积,背景中有粘液性间质。第二个病例中,有些区域可见肿瘤坏死。两例中都可见肿瘤细胞呈现ALK弥漫性阳性。荧光原位杂交技术确认ALK基因发生异位,随后的基因分析发现STRN-ALK融合。

这些案例为深入了解ALK异位导致的肾细胞癌提供了新视角。

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