成人肾母细胞瘤一例

本文报道1例女性患者,35岁,因间断性左侧腰部疼痛1周住院.经腹部超声及CT发现左肾肿物,行左肾根治性切除术,病理示肾母细胞瘤.术后行放线菌素D+长春新碱+阿霉素三联化疗4个周期,复查未见新的病灶.成人肾母细胞瘤(adult Wilms' tumor)是一种非常罕见的恶性肾实体瘤,仅占肾母细胞瘤患者中的1%～2%.由于患者临床症状并不典型,成人Wilms瘤主要依靠术后病理证实.成人Wilms瘤影像学诊断方面仅能显示肾肿物的存在,无明显特异性,术前诊断比较困难.术后临床分期和病理诊断为成人患者的进一步治疗以及预后提供了依据.回顾分析北京大学第一医院泌尿外科自1950年至2007年共收治的6例成人肾母细胞瘤病例以及国内外相关的文献报道可以看出,依据儿童Wilms瘤治疗指南对成人患者行术后辅助治疗可以显著提高生存率.

A case of adult Wilms' tumor

A 35-year-old woman patient, complained of intermittent pain in the left flank for a week. Abdominal ultrasound and computed tomography scan revealed a left renal mass. Nephrectomy was performed, and a final diagnosis of adult Wilms' tumor was made based on histopathology and immunohistology. Chemotherapy was conducted for 4 times with dactinomycin D, vincristine and doxorubicin after surgery. At the time of the last recheck, the patient was alive with no evidence of disease. Adult Wilms' tumor is the exceptional malignant renal tumor. Only 1%-2% of Wilms' tumor is diagnosed in adult patients. Because of unspecific tumor symptoms in adults, the diagnosis is frequently made by histology. The diagnosis of adult Wilms' tumor is difficult to make preoperatively because diagnostic imaging only confirms the presence of a renal mass. Stage and histology are the clinical factors guiding the selection of postsurgical treatment and prognosis. Having retrospected 6 cases of adult Wilms' tumor between 1950 and 2007 and reviewed related reports, we conclude that the proper strategies of adjuvant treatment as applied to childhood Wilms' tumor patients after surgery can conspicuously improve the outcome in adult patients.