多房性囊性肾瘤的诊断与治疗（附4例报告）

目的提高对多房性囊性肾瘤（MLCN）的诊断和治疗水平。方法回顾性分析4例MLCN患者的临床资料。男2例，女2例。年龄41-72岁，平均53岁。主要表现为血尿、腰部钝痛、肾绞痛和肾区肿块。分析其B超、IVU、CT、MRI检查所见征象，并与手术、病理所见对照。结果4例患者均行开放性手术治疗后痊愈。其中行肾切除3例，肾部分切除1例。患者术后随访6-18个月木发现复发。结论影像学检查是MLCN的重要检查手段，保留肾单值的肿瘤切除术是本病的首选治疗方法。多房性囊性肾瘤为良性肿瘤，术后均能获得痊愈。     

BosniakⅠ型肾囊性病变发生癌变的诊治经验(附5例报告)

目的:总结BosniakⅠ型肾囊性占位病变发生癌变的诊治经验。方法:回顾性分析5例BosniakⅠ型肾囊性恶性病变的B超、CT、病理特征、治疗方法和随访结果:男3例,女2例;年龄42～72岁,平均54岁。患侧腰酸1例,体检发现4例。囊腔直径5.5～8.0cm。术前B超及CT均诊断为肾囊肿。结果:5例均行腹腔镜下肾囊肿去顶术,术后病理检查诊断为透明细胞癌,再次行根治性肾切除术。5例随访6～33个月,4例无瘤存活,1例因心血管疾病死亡。结论:重视BosniakⅠ型肾囊性病变的影像学和病理学特征,术中行冷冻切片病理检查是提高BosniakⅠ型囊性肾癌诊治水平的关键。     

低度恶性潜能多房性囊性肾肿瘤临床病理分析

目的分析低度恶性潜能多房性囊性肾肿瘤患者的临床病理资料,探讨其临床病理特征及预后。方法收集南阳市第一人民医院2014-01—2015-12间病理科确诊的低度恶性潜能多房性囊性肾肿瘤3例及会诊病例2例,采用HE及免疫组织化学染色进行病理学观察,并结合临床特征进行分析及文献复习。结果 5例患者年龄37～65岁,均位于左肾。2例以间断性血尿为主要症状,2例为体检发现,1例以腰痛、尿频、尿颜色加深为主要症状。大体标本切面均为多囊性或囊性,边界清楚,内有少量暗褐色液体。肿瘤镜下呈囊性,内壁衬覆单层透明细胞,偶见复层上皮,少量区域纤维间隔内可见透明细胞,核异型性小,Fuhrman核分级1级。免疫表型:CD10(+),Vimentin(+),EMA(+),CD117(-),CD68(-),CK7(-),KI-67(增殖指数3%～5%)。结论该肿瘤在肾脏肿瘤中属少见类型,预后相对较好,但需要和肾透明细胞癌和肾良性囊性病变进行鉴别。     

Bosniak肾囊性病变分类的临床应用价值

目的 探讨Bosniak分类在肾囊性病变中的临床应用价值.方法 收集2002至2007年手术治疗497例肾囊性病变患者资料.男284例,女213例.平均年龄42岁.病变位于左侧212例,右侧265例,双侧20例.病变直径1.8～11.5 cm,平均5.4 cm.按照Bosniak分类,I类囊肿339例、Ⅱ类49例(其中Ⅱ F 23例)、Ⅲ类44例、Ⅳ类65例.行肾囊肿去顶减压术372例,肾部分切除术51例,根治性肾切除术74例.结果 病理报告为肾恶性肿瘤89例(透明细胞癌74例、乳头状癌12例、低分化癌3例),良性病变408例(单纯囊肿382例、囊肿伴出血6例、囊肿伴感染6例、多房囊性肾瘤5例、纤维囊壁组织9例).I类囊肿中恶性病变3例(O.9%)、Ⅱ类中5例[10.2%,其中非ⅡF为7.7%(2/26),ⅡF为13.O%(3/23)3、Ⅲ类中23例(52.3%)、Ⅳ类中58例(89.2%).组间比较差异有统计学意义(P0.05).403例获随访,随访时间1～5年.75例恶性病变患者中术后1～5年出现肿瘤局部复发和(或)转移9例;328例良性病变中,术后2～5年出现囊肿复发26例.结论 Bosniak分类I类和Ⅱ类肾囊肿一般并不需要积极的外科处理,但ⅡF类囊肿和直径进行性增大以及形态变化明显的囊肿需要引起重视;Ⅲ、Ⅳ类肾囊肿恶变率较高,具备明确手术治疗指征,建议积极处理.     

囊性肾癌的诊治及预后(附31例报告)

目的提高囊性肾癌的诊治水平，提高对于囊性肾癌的认识。方法回顾性分析1994年6月-2004年6月收治的31例囊性肾癌患者的流行病学、病理学、临床表现、影像学特征及临床治疗资料，并与TNM分期构成与囊性肾癌组相同的21例非囊性肾癌比较预后。结果囊性肾癌无特征性的临床表现，术前影像学检查可以提供诊断线索，经病理确诊肾癌囊性变19例，多囊性肾癌9例，单纯性囊肿癌变3例。17例行根治性肾切除术，14例行单纯性肾切除术。术后21例获得随访，生存时间平均38个月。总体上与非囊性肾癌的预后尤统计学差异。站论囊性肾癌是一类在影像学和大体病理上具有囊性改变的肾癌的统称，由3种病理学类型构成，术前正确鉴别各亚型是选择手术方式和判断预后的关键。     

多房性囊性肾瘤1例报告并文献复习

多房性囊性肾瘤（multilocular cystic nephroma,MCN）是一种临床上较罕见的肾脏原发良性肿瘤,因其无特异的临床表现,术前常常无法明确诊断,与其他肾脏囊性病变的鉴别诊断较为困难,如多囊肾、多发性肾囊肿、囊性肾癌等。我科于2011年收治1例 MCN,现报告如下,以进一步提高对该病的认识。     

多房性囊性肾瘤的诊断和治疗

目的：提高对多房性囊性肾瘤的认识，熟悉对该病的诊断和治疗方法。方法：回顾性分析２例本病患者的临床资料并结合文献讨论本病的诊断和治疗。结果：１例接受了患肾切除术，另１例接受了肿瘤切除术。结论：对儿童患者的治疗以患肾切除术为主，成人患者可行肾部分切除术或肿瘤切除术。     

多房性囊性肾癌一例报告及文献复习

目的 提高多房性囊性肾癌的诊治水平.方法多房性囊性肾癌患者1例,男,49岁.体检B超偶然发现右肾下极多囊性肿物1个月.囊内无回声区,其间混杂低回声区;CT检查右肾下极见多囊性低密度病变,边界清楚、光整,内见薄壁分隔,增强扫描分隔可见强化;MRI检查示右肾下极多囊性病变,增强扫描囊壁可见强化.行右肾部分切除术,完整切除肿瘤.结果 病理报告:肾被膜下见多房状肿物,大小约3.0 cm×2.0 cm×2.0 cm,囊壁光滑,腔内含清亮的浆液性及血性液体,囊壁厚约0.1～0.2 cm,与肾周脂肪粘连.镜下多数囊腔内衬单层或复层立方状透明细胞,细胞核小而圆,位于细胞中央,无明显核仁;有的囊腔内衬扁平上皮细胞或无内衬上皮,偶见由透明细胞覆盖的小乳头;囊腔间隔由胶原纤维组成,部分间隔内可见灶状透明细胞,但未形成肉眼可见的结节.病理诊断:多房性囊性肾癌.术后随访20个月未见复发和转移.结论 多房性囊性肾癌是肾癌的一种罕见亚型,发病率低,是一种完全由囊腔构成的肿瘤;影像学检查可提供直接依据,确诊需依靠病理学检查;外科手术治疗预后良好.     

多房性囊性肾癌一例报告及文献复习

Objective To discuss the diagnosis and outcome of multilocular cystic renal cell car-cinoma. Methods The clinic data of 1 case of multilocular cystic renal cell carcinoma were reviewed with its clinical manifestation, imaging, pathology and therapy in our hospital. The male patient aged 49 was incidentally found to have a right renal tumor. The CT scan showed a multiloeular cystic tumor in the low pole of the right kidney with a clear outline. The thin septa were found in the tumor, which were enhanced in the enhancement CT scan. The enhancement MRI showed the cystic wall was en-hanced. Results The patient received a partial nephrectomy as his treatment. The pathological char-acteristics were as following: the multilocular cystic tumor was about 3 cm×2 cm×2 cm with clear serosity in it. The cystic wall was smooth with the width of 0.1-0.2 cm. Most of the cystic cavities were covered by monostratified or stratified cubic clear cells, and some were covered by squamous epi-thelium or no epithelium at all. The septum was composed of collagen fiber, and clear cells were found in it. The clear cells form small collections but do not form expansile nodules. The final pathological diagnosis was multilocular cystic renal cell carcinoma. The follow-up was 20 months, without local re-currence or distant metastasis was found. Conclusions Multilocular cystic renal cell carcinoma (MCRCC) is a rare variant of renal cell carcinoma with a good prognosis. MCRCC is an uncommon tumor of the kidney composed of multiple cysts with clear cells in the septa indistinguishable from grade I renal cell carcinoma. Most patients are asymptomatie and the tumors are discovered inciden-tally. The preoperative diagnosis of MCRCC immediately depends on imaging studies. Pathology is the key to diagnosis.     

多房性囊性肾癌一例报告及文献复习

Objective To discuss the diagnosis and outcome of multilocular cystic renal cell car-cinoma. Methods The clinic data of 1 case of multilocular cystic renal cell carcinoma were reviewed with its clinical manifestation, imaging, pathology and therapy in our hospital. The male patient aged 49 was incidentally found to have a right renal tumor. The CT scan showed a multiloeular cystic tumor in the low pole of the right kidney with a clear outline. The thin septa were found in the tumor, which were enhanced in the enhancement CT scan. The enhancement MRI showed the cystic wall was en-hanced. Results The patient received a partial nephrectomy as his treatment. The pathological char-acteristics were as following: the multilocular cystic tumor was about 3 cm×2 cm×2 cm with clear serosity in it. The cystic wall was smooth with the width of 0.1-0.2 cm. Most of the cystic cavities were covered by monostratified or stratified cubic clear cells, and some were covered by squamous epi-thelium or no epithelium at all. The septum was composed of collagen fiber, and clear cells were found in it. The clear cells form small collections but do not form expansile nodules. The final pathological diagnosis was multilocular cystic renal cell carcinoma. The follow-up was 20 months, without local re-currence or distant metastasis was found. Conclusions Multilocular cystic renal cell carcinoma (MCRCC) is a rare variant of renal cell carcinoma with a good prognosis. MCRCC is an uncommon tumor of the kidney composed of multiple cysts with clear cells in the septa indistinguishable from grade I renal cell carcinoma. Most patients are asymptomatie and the tumors are discovered inciden-tally. The preoperative diagnosis of MCRCC immediately depends on imaging studies. Pathology is the key to diagnosis.     

多房性囊性肾瘤的诊断与治疗

目的提高对多房性囊性肾瘤(MLCN)的诊断和治疗水平。方法回顾性分析5例MLCN患者的临床资料并结合文献探讨本病的特点、诊断和治疗。男3例,年龄分别为8、51、67岁;女2例,年龄为40、45岁。临床表现为肉眼血尿1例,腹部包块1例,无症状体检发现3例。均为单发,大小1.5cm×2.0cm～11.0cm×5.5cm。5例均行B超、IVU和CT检查。结果B超诊断MLCN1例、肾囊肿2例、囊性肾癌2例;CT诊断MLCN2例,囊性肾癌2例、未定性1例;IVU均未定性。行肾脏切除术3例,肿瘤剜除术2例。术后病理诊断均为MLCN。随访6～25个月均未见复发,肿瘤剜除者患侧肾功能良好。结论影像学检查是MLCN的重要检查手段,保留肾单位的肿瘤切除术是本病的首选治疗方法。     

多房性囊性肾癌八例报告

目的 提高对多房性囊性肾癌(MCRCC)临床、影像学和病理特点的认识及诊治水平.方法 2004年至2006年共收治符合2004 WHO诊断标准的MCRCC患者8例,其中男5例,女3例,平均年龄49岁.以肉眼血尿就诊1例,查体发现5例,初诊肾囊肿、随访发现影像学改变确诊2例.8例术前均行B超、CT检查.二维超声表现为分隔型囊性结构4例,囊实性占位3例,1例诊断为肾囊肿.CT平扫或强化后7例可见囊壁或分隔不规则增厚,但无明显的肿块及结节,1例因肿瘤较小分隔不明显.8例患者中行开放根治性肾切除术4例,肾部分切除术1例;后腹腔镜下根治性肾切除术2例,肾部分切除术1例. 结果 术后病理证实8例均为MCRCC,肿瘤最大直径2.5～10.0 cm,平均5.6 cm.镜下主要表现为纤维组织间隔被覆单层或多层透明细胞,细胞异型性小,核分裂象少.病理分级G17例,G2 1例.TNM分期均为T1 N0 M0期.7例随访6～18个月,平均8个月,均无瘤生存,未见复发转移.1例失访. 结论 MCRCC为肾癌的一种少见类型,术前诊断主要依赖于影像学检查,与其他类型肾癌相比,恶性程度低,预后良好,手术以保留肾单位的肾部分切除术为宜.     

囊性肾癌的诊断和治疗(附7例报告)

目的：提高对囊性肾癌的认识。方法：对7例囊性肾癌的临床、超声及CT的特点，以及病理学特征、手术方式和预后进行回顾性分析。结果：术前超声诊断囊性肾癌4例，CT诊断囊性肾癌7例；术后病理诊断肾癌囊性坏死5例，多房性囊性肾癌1例，单纯性囊肿恶变1例。5例行根治性肾切除术，1例行肾部分楔形切除术，1例行肿瘤切除术。6例获随访，5例生存至今。结论：熟悉囊性肾癌的病理学特征及影像学的特点是提高囊性肾癌诊断率的关键。     

Asymptomatic Infantile Cystic Nephroma: A Diagnostic Dilemma

Cystic nephroma, also called multilocular cystic nephroma, is a relatively rare, nongenetic, benign, unilateral, renal multicystic lesion. The non-specific clinical findings and the poor contribution of imaging examinations make the preoperative diagnostic dilemma from other cystic renal neoplasia; thus nephrectomy seems to be the most preferable treatment. We report a case of cystic nephroma in 11 months old male child presented with asymptomatic lump in abdomen. After a series of examinations including abdominal ultrasound, intravenous pylography and computed tomography, he underwent radical nephrectomy and diagnosis is confirmed on histopathology.     

长期血透患者获得性囊性肾病合并肾癌8例报告并文献复习

目的:学习长期血透患者获得性囊性肾病合并肾癌的筛查和诊治方法。方法:回顾性分析我院维持性血透获得性囊性肾病合并肾癌患者8例,均为B超和CT诊断为双肾多发性囊肿合并肾实质性占位,并行后腹腔镜下根治性肾切除术,术后维持规律性血透,并严密随访。结果:长期血透患者226例,获得性囊性肾病105例(46.5%),获得性囊性肾病合并肾癌8例(3.5%),在获得性囊性肾病中发生率为7.6%(8/105),其中男5例,女3例,年龄(58.6±16.4)岁,血透(12.2±6.9)年。8例患者(9次)行后腹腔镜下根治性肾切除术,手术均成功,出血(45.2±20.3)ml,手术时间(72.5±20.3)min,无严重手术并发症,术后病理3例为透明细胞癌和6例为乳头状癌。住院天数为(7.5±2.4)d。随访12～63个月,无瘤存活5例。结论:肾癌在获得性囊性肾病患者中发病率高,随着血透患者寿命的延长,血透3年后需重视和建立肾癌筛查机制,腹腔镜下根治性肾切除术安全有效、恢复快,并注重患者心脑血管疾病及糖尿病等并发症的积极治疗,有助于进一步延长血透患者寿命。     

Cystic nephroma and localized renal cystic disease in children: diagnostic clues and management

Background and Purpose

Cystic nephroma (CN) and localized renal cystic disease (LRCD) are rare benign renal entities that can occur in children. A retrospective evaluation of the experience with these conditions was performed to emphasize the importance of differential diagnosis, recognition, and selection of the proper mode of treatment.

Materials and Methods

The medical records of patients treated for CN (n = 4) and LRCD (n = 1) between 1980 and 2007 were retrospectively evaluated. The age, sex, family history of renal cystic disease, presenting symptoms, physical examination findings, diagnostic radiologic imaging used, operative findings, details of the surgical procedure, histopathologic features, and outcomes were evaluated.

Results

There were 4 cases of CN and 1 case of LRCD without a positive family history. The age and sex of patients with CN were two 1-year-old girls and two 1.5-year-old boys. The patient with LRCD was a 4.5-year-old girl. The presenting symptoms were palpable mass in patients with CN and urinary tract infection in the patient with LRCD without impairment of renal function. Intravenous pyelography (n = 2), abdominal ultrasonography (n = 4), and computed tomography (n = 4) were used. All patients underwent an operation. Nephrectomy was performed in all 4 CN cases, and total excision of the cyst was performed in the LRCD case.

Conclusion

Pediatric surgeons should be familiar with the clinical, radiologic, surgical, and histopathologic characteristics of CN and LRCD. The presumptive diagnosis of CN prompts surgical intervention. Enucleation or partial nephrectomy is the treatment of choice in suitable cases. Nephrectomy should be reserved for CN, which totally replaces the parenchyma. Conservative treatment with follow-up imaging may be considered in selected cases of LRCD that have characteristic computed tomographic criteria. Operative intervention is indicated in symptomatic cases and should be limited to simple excision of the cysts.     

Multilocular cystic nephroma: A case report and review of the literature

Multilocular cystic nephroma is a rare cystic renal tumor, which is benign and has an excellent prognosis. However, preoperative diagnosis is challenging and is made exclusively by pathological findings. We reported a 41-year-old woman with chronic flank pain, and abdominal computed tomography revealed a multiloculated renal cystic tumor. The possibility of a cystic variant of renal cell carcinoma could not be excluded. Laparoscopic radical nephrectomy was performed, and diagnosis of multilocular cystic nephroma was made. In this report, we describe the clinical presentation, radiological finding, and histopathology of this case.