| Objective To observe the invasion signs of pseudocapsule and beyond it of the specimens that were collected after radical nephrectomy, and to test the expression of E-candherin and Bcl-2 in renal carcinoma and peritumoral tissues, that provide a basis for the safety excision margins in nephron sparing surgery in the patients with early renal cell carcinoma.Methods The specimens were cut along the coronal of the renal hilum,the maximal diameter of the tumors were measured and recorded.The specimens were step sectioned continuously at 2 mm intervals and examined for completeness of pseudocapsule and penetration beyond it.The tissues that were penetration and suspected beyond pseudocapsule were derived and the distance between the tissues and the pseudocapsule were measured.Then the tissues were observed under the microscope after conventional HE staining;In addition,tumor tissues (group a)and normal renal cortex tissues of different distances to the tumor:0.5 cm(group b),1.0 cm(group c),2.0 cm(group d) were derived as the standard with the size of each about 2 cm×1 cm×0.2 cm.Use the type of non-biotin immunohistochemical Elivision method to study the different expression about E-candherin and Bcl-2 in different organizations.Results Pathologic results of the 45 specimens are all renal clear cell carcinoma.The mean of the greatest dimensions of the tumors was (4.6±1.5)cm(range: 2.0~7.0 cm).In 31 RCC tumors(68.9%) the pseudocapsule was intact and free from invasion (PS-)while in 14 tumors (31.1%) there were signs of infiltration within its layers,with or without invasion beyond it.Of these,9 tumors(9/14) had PS penetration(PS+),and 5 tumors(5/14) had penetration and invasion beyond it(PSK+).The mean diameter of 31 tumors was (4.3±1.5)cm,14 tumors was (5.4±1.3)cm(P<0.05).The chance of invasion with and beyond pseudocapsule is significantly associated with the grade of tumor (P<0.05).The invasion beyond pseudocapsule was more limited within 0.5cm,the stage ,grade and invasion distance beyond pseudocapsule of five tumors were 0.1cm(pT1b,G1),0.2cm(pT1a,G2),0.2 cm(pT1b,G2),0.5cm(pT1b,G3),0.7cm(pT1b,G3) respectively.The expression of E-candherin in renal carcinoma was 11.1%,Bcl-2 was 80.0%. The positive expression of E-candherin and Bcl-2 were statistically significantly different between group a and group b,c and d(P<0.01), but the difference between group b,c and d were no statistically significant(P>0.05).Conclusions1. The probability of pseudocapsule and beyond it with invasion is significant correlation with tumor diameter and histological grade.2. The rate of positive expression of E-candherin and Bcl-2 in renal cell carcinoma and 0.5 cm at the adjacent normal tissue are statistically significant,while between the adjacent reanl parenchyma at 0.5,1.0 and 2.0 cm are no statistically significant.3. Simple tumor enucleation of renal cell carcinoma is not recommended to use.4. The safety excision margin with renal cell carcinoma(pT1a) could be within 0.5 cm of normal parenchyma tissue beyond pseudocapsule while the safety excision margin with renal cell carcinoma(pT1b) could be within 0.5~1.0 cm of normal parenchyma tissue beyond pseudocapsule.However,it should be fully imaging evaluated and tell patients in detailed before operation.The more scientific resection margins need to be further research.
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