Angiomyolipoma of the liver: case report

Hepatic angiomyolipoma is a rare benign mesenchymal tumor of the liver. Most multiple hepatic angiomyolipomas have appeared in patients with renal angiomyolipoma and tuberous sclerosis. A 38-year-old female patient without chronic hepatitis B or C was hospitalized because of epigastric fullness for 2 months. Radiologic studies showed a large solid tumor with a small daughter nodule in the right hepatic lobe. Upon intravenous bolus injection of contrast medium, both tumors showed weak heterogeneous enhancement in the delayed phase. Although hepatocellular carcinoma was suspected by the findings of computed tomography, percutaneous transhepatic ultrasound-guided biopsy was performed for the large tumor. The histopathology showed many mature fat cells intermingled with thick-walled blood vessels, and epithelioid cells with eosinophilic cytoplasm; the epithelioid cells stained positively for HMB-45 and smooth muscle actin. Angiomyolipoma of the liver was confirmed. The main tumor enlarged considerably during a follow-up period of 3 years. Surgical resection was performed due to persistent symptoms. She had an uneventful postoperative recovery and was well when followed up 10 months after surgery. We should be aware that a hepatic angiomyolipoma can change in size during its natural course, and this finding does not necessarily indicate malignancy.     

肾上皮样血管平滑肌脂肪瘤的临床病理和免疫组化特征

目的：探讨肾上皮样血管平滑肌脂肪瘤(AML)的临床病理特点及鉴别诊断。方法：对2例肾上皮样AML的临床资料、随访结果及组织病理进行分析，应用免疫组化染色观察了黑色素瘤相关抗原(HMB45)、(Pan)melanoma markerAb-1、角蛋白(CK)、平滑肌肌动蛋白(SMA)、上皮膜抗原(EMA)、波形蛋白(VIM)、肿瘤抑癌基因(p53)、增殖细胞核抗原(PCNA)、细胞增殖标记(Ki67)等在肾上皮样AML的表达，并与国外报道的28例进行比较。结果：组织学特点：瘤细胞呈上皮样或短梭形，细胞质为嗜酸性，核大，较深染、异形，可见病理性核分裂相。瘤细胞排列密集成片，伴大片坏死，瘤组织中散在多核巨细胞。免疫组化：HMB45和(Pan)Melanoma Marker Ab-1阳性，上皮标记EMA、CK阴性。结论：在未出现远处转移前，肾上皮样AML一般属潜在恶性病变。免疫组化对鉴别诊断有重要意义。     

肾上皮样血管平滑肌脂肪瘤3例的临床病理分析

目的探讨肾上皮样血管平滑肌脂肪瘤(EAML)的病理诊断要点、鉴别诊断及预后意义。方法对3例肾上皮样血管平滑肌脂肪瘤(EAML)患者的个案包括临床资料、光镜观察、免疫组化及随访结果进行分析。结果 3例患者其中1例无症状,2例主诉为腰部疼痛;1例术前考虑为错构瘤,2例疑为肾癌,镜下肿瘤主要成分为上皮样细胞,呈巢状分布,局部血管周围见少量平滑肌增生,肿瘤边缘见极少量脂肪组织。免疫组化:上皮样肿瘤细胞黑色素瘤相关抗原HMB45,Melan-A均呈表达阳性,局灶表达SMA,不表达CK、CK7、CK20、RCC、CD10、CD68、S-100、CgA。3例患者随访8～24个月均未见复发。结论肾上皮样血管平滑肌脂肪瘤易与肾细胞癌及其他恶性肾肿瘤相混淆,免疫组化有助于鉴别。     

保留肾单位手术治疗小肾癌的临床分析

目的探讨保留。肾单位手术治疗小肾癌的疗效。方法47例患者行保留肾单位的小肾癌切除术,男31例,女16例,平均年龄48岁。肿瘤直径0．8～3．0cm,平均2．3cm。透明细胞癌38例,嫌色细胞癌6例,乳头状肾细胞癌2例,囊性肾癌1例。术后定期行腹部CT、超声、尿常规及肾功能检查。结果47例手术均成功。术后随访45例,失访2例,平均随访17个月,45例肿瘤均无复发。结论保留肾单位手术治疗小肾癌安全有效。     

保留肾单位手术治疗肾肿瘤临床效果观察

目的探讨肾癌保留肾单位手术的治疗效果。方法 85例行保留肾单位的肾癌切除手术,肿瘤直径1.5～5.6 cm,平均3.4 cm;肿瘤位于肾上极37例、中极33例、下极15例。所有病例TNM分期均为T1N0M0。透明细胞癌54例,颗粒细胞癌21例,乳头状肾细胞癌7例,嫌色细胞癌3例。结果 85例均成功手术,随访78例,随访时间10～55个月,平均随访时间26个月,2例术后20个月出现同侧肾上腺肿瘤转移,行肾上腺切除术。余76例均未发现肿瘤局部复发和远处转移迹象。结论保留肾单位手术是治疗肾肿瘤安全有效,可在不降低生存率的前提下保留患肾功能,其临床应用越来越广。     

肾脏上皮样血管平滑肌脂肪瘤的临床特点分析

目的:探讨肾脏上皮样血管平滑肌脂肪瘤（EAML）的临床特点。方法:回顾性分析在2012年6月-2018年11月收治的10例EAML患者的临床资料,对其临床表现、影像特点、病理特征、治疗方法和预后进行分析。结果:10例患者中,女性9例,男性1例,平均年龄36岁,3例在体检时发现,7例有阳性体征。彩超可见囊实性或不均匀实性病灶;CT平扫呈低密度或稍高密度影,可见不同程度的强化;MRI在Ｔ2WI上表现为低信号,呈不均匀强化。8例行肾脏部分切除术,1例行根治性肾脏切除术,1例行肾脏切除术。术后病理8例诊断为EAML;２例病理诊断为肾脏血管平滑肌脂肪瘤（AML）,部分呈EAML。免疫组化染色HMB-45（+）、Melan-A（+）、SMA（+）、CK（-）。术后随访时间7～50个月,平均随访时间28个月,暂未发现复发或远处转移。结论:EAML在临床上较少见,早期症状不明显,确定诊断依靠术后病理HE染色和免疫组化染色。EAML具有恶性潜能,治疗主要以手术切除为主,目前预后尚无统一认识,需要长时间密切随访。     

肾结石伴无功能肾合并肾盂癌的漏诊分析

目的 探讨肾结石伴无功能肾合并肾盂癌的漏诊原因。方法 选取2014年6月～2019年6月我院收治的4例肾结石伴无功能肾合并肾盂癌患者为研究对象,其中男性3例,女性1例;年龄70～78岁;肾结石病史11～16年。4例患者均出现腰痛、血尿及合并泌尿道感染,其中2例合并发热,静脉尿路造影、彩超及CT等检查均未发现肾盂癌。1例患者因合并输尿管下段结石及膀胱结石,遂行肾输尿管切除及膀胱切开取石术,其余3例行单纯肾切除。结果 术后病理检查发现原发肾盂腺癌1例,肾盂尿路上皮细胞癌2例,肾盂鳞状细胞癌1例。对所有患者进行随访,1例半年后死于肿瘤复发转移,1例半年后失访,1例随访4.5年肿瘤无复发,1例随访1.5年肿瘤无复发。结论 肾结石伴无功能肾合并肾盂癌患者临床表现及影像学检查无特异性,容易漏诊,年龄较大、长期肾结石合并重度肾积水伴感染的患者应考虑合并肾盂癌可能,需进一步检查,术中应常规仔细检查切除的肾脏标本。     

肾脏上皮样血管平滑肌脂肪瘤临床病理分析

目的 探讨肾上皮样血管平滑肌脂肪瘤的临床病理特点、诊断及鉴别诊断.方法 肉眼观察手术切除肾脏肿瘤标本,镜检肿瘤组织形态和免疫组化表达.结果 患者多为中年女性,临床症状不明显或以腹部包块、大出血而就诊,组织学形态表现为圆形、多边形和梭形上皮样细胞灶性分布于脂肪瘤中,上皮样瘤细胞免疫组化标记SMA、Vimentin、HMB45均表达阳性.结论 肾脏上皮样血管平滑肌脂肪瘤较少见,多为良性,依赖于光镜及免疫组化进行诊断及鉴别.     

肾移植术后双侧乳头状肾癌1例

肾移植是目前终末期肾病患者最佳的治疗方式,随着肾移植技术的不断进步和免疫抑制药物研发的不断发展,肾移植术后患者的生存期也有所延长.但是同时,肾移植患者术后的远期并发症也逐渐引起重视,当前恶性肿瘤已成为继心血管疾病和感染后造成肾移植患者死亡的第三大原因[1].     

肾移植术后双侧乳头状肾癌1例

With the continuous development of kidney transplantation technique, the survival time after kidney transplantation is gradually prolonged. Thus, the malignant tumor has been the important influencing factor on the long-term survival for kidney transplantation patients. Renal cell carcinoma is a relatively common tumor after kidney transplantation. Besides, clear cell renal cell carcinoma and papillary renal cell carcinoma are the relatively common pathological types for renal cell carcinoma following kidney transplantation. However, bilateral renal cell carcinoma following kidney transplantation is comparatively rare. In this article, we presented a case of bilateral papillary renal cell carcinoma, which occurred after kidney transplantation. And the diagnosis and treatment were introduced in detail. The patient was 37 years old, and he underwent kidney transplantation 13 years ago in our hospital, because of kidney failure. After kidney transplantation, he had regular medical check-up every year. In this year, his urological ultrasound results indicated bilateral renal tumors. And then, he received abdominal and pelvic computed tomography, and the result also showed bilateral renal tumors, which were likely to be malignant tumors. After adequate consultation, the patient chose surgical treatment. The patient received long-term immunosuppressive therapy, because of kidney transplantation. Considering this, the surgeon decided to choose a staging surgical treatment, in order to reduce the bad influence of one-stage surgery. Then, the patient first underwent retroperitoneal laparoscopic radical nephrectomy for right renal tumor in our hospital, and he had no complications after operation. The pathological results showed papillary renal cell carcinoma. He was discharged successfully. He underwent retroperitoneal laparoscopic radical nephrectomy for left renal tumor in our hospital one month later, and he had no complications after operation. The pathological results also showed papillary renal cell carcinoma. He was discharged successfully two days after surgery. In the 3-month follow-up, the patient was recovering well. To sum up, the incidence of bilateral renal cell carcinoma following kidney transplantation is relatively rare, and bilateral radical nephrectomy is effective and safe treatment. Above all, it is the patient''s condition that determines the choice of staging surgery or simultaneous surgery.     

多层螺旋CT对肾上皮样血管平滑肌脂肪瘤的诊断价值

目的探讨多层螺旋CT在诊断肾上皮样血管平滑肌脂肪瘤中的应用价值。方法回顾性分析我院2005年7月到2014年3月经术后病理证实的5例肾上皮样血管平滑肌脂肪瘤患者的CT资料,并分析其CT特点。结果 5例患者中男性2例,女性3例;1例患者病灶为两个,其余4例为单发;其中2例误诊为肾癌。6个病灶的肾皮质期表现为均匀或不均匀强化,肾实质期肿瘤强化程度不一,可表现为明显减退、轻度减退及持续强化。结论肾上皮样血管平滑肌脂肪瘤可含有脂肪成分,也可不含脂肪成分;CT表现在与其他疾病鉴别诊断方面具有一定的价值。     

后腹腔镜肾部分切除术治疗T1b期肾癌

目的:探讨后腹腔镜肾部分切除术治疗T1b期肾癌的临床经验及疗效。 方法:回顾性分析2007年11月至2011年6月15例T1b期肾癌患者的临床资料,其中男10例,女5例,平均年龄(56.2±9.8)岁,其中左侧8例,右侧7例。肿瘤平均直径（5.5±1.4）cm,15例患者R.E.N.A.L.评分均为中度复杂性（7-9分）,其中肿瘤靠近肾门血管2例;15例患者均行后腹腔镜肾部分切除术。结果:所有手术均顺利完成,无中转开放,围手术期无严重并发症。平均手术时间(100±23.6 )min,术中平均热缺血时间（21.3±8.6）min,术中平均出血量(35.3±11.6)ml,术后尿漏1例,肌酐短暂升高1例;术后平均住院时间(5.7±1.8)d,术后平均随访(21.2±10.1) m,所有患者肾功能正常且未见肿瘤复发及转移。结论:后腹腔镜肾部分切除术治疗T1b期肾癌安全、有效,具有创伤小、恢复快的优点,但其远期疗效尚需大样本对照研究和长期随访观察。     

超选择性肾动脉化疗栓塞术在肾癌根治术前的临床应用价值

目的探讨肾癌根治术前超选择性肾动脉化疗栓塞术的临床应用价值。方法对30例术后病理证实的肾癌患者在肾癌根治术前均行超选择性肾动脉造影及化疗栓塞。结果所有病例均成功实施术前栓塞，栓塞后出现轻度栓塞反应。根治术中可见肿瘤血供基本中断，肿瘤周围界限清楚，易于剥离；术中出血量明显减少；镜下可见肿瘤坏死明显且与周围组织界限清楚。结论肾癌根治术前超选择性肾动脉化疗栓塞是一种安全、有效的治疗方法，有助于肾癌的手术切除，对肾癌的治疗具有重要的意义。     

肾上皮样血管平滑肌脂肪瘤临床诊治分析(附7例报告)

肾上皮样血管平滑肌脂肪瘤(epithelioid angiomyolipoma,EAML)是血管平滑肌脂肪瘤(angiomyolipoma,AML)的亚型,为一种罕见的间叶源性肿瘤.因EAML短期内即会出现其他器官转移,呈现侵袭性生物学行为,逐渐引起人们对它的重新认识,因而被认为是一种具有恶性潜能的肿瘤[1-2].本研究回顾性分析了2012年12月至2014年3月第二军医大学长海医院泌尿外科收治的7例EAML患者的临床特点及诊治经验,现报告如下.     

后腹腔镜肾部分切除术治疗T1a期肾细胞癌32例报告

目的：评价后腹腔镜肾部分切除术（RLPN）治疗T1a期肾细胞癌的安全性和临床效果.方法：回顾性分析32例行后腹腔镜肾部分切除术的T1a期肾细胞癌患者的临床资料.观察手术时间、术中出血量、热缺血时间、术后住院天数.结果：31例手术均顺利完成,1例术中出血较多转开放性手术.手术时间90～155 min（平均115 min）;热缺血时间15～34 min（平均23 min）;术中出血40～280 mL（平均105 mL）;术后住院8～l0d（平均9d）.术后1例发生漏尿.患者均康复出院.术后病理：肾透明细胞癌24例,嫌色细胞癌6例,乳头状癌2例.随访3～79个月,患者均未见肿瘤局部复发、远处转移及切口种植等.结论：后腹腔镜肾部分切除术治疗T1a期肾细胞癌安全可行,是≤4.0cm的Tta期肾细胞癌的首选治疗术式,值得在具备条件的医院临床推广.     

Laparoscopic partial nephrectomy for T1a renal tumors is safe and feasible

Background  Some patients with exophytic renal masses less than 4 cm and suboptimal renal function, or a solitary kidney and bilateral renal tumors are considered for laparoscopic partial nephrectomy (LPN), which is feasible for early-stage renal tumors, although it is still considered technically difficult and time consuming. Shortening the time of the operation and renal warm ischemia are required urgently. In this study, we report our initial experiences of LPN, especially with some improved surgical techniques.

Methods  Between July 2005 and October 2009, 74 patients with T_1a renal tumor were treated by LPN, 39 using transperitoneal approach and 35 using retroperitoneal approach. In all cases, the tumor was removed with a margin of 0.5 cm. We compared glomerular filtration rate (GFR) preoperatively and postoperatively, and renal warm ischemia time between traditional ligature and Hem-o-lok methods.

Results  All operations were completed successfully, and there was no conversion to open surgery. Mean operation time was 76 minutes (range, 68–120), mean time of renal warm ischemia was 23 minutes (range, 15–32), and mean blood loss was 65 ml (range, 40–300). No hemorrhage or urine leak was observed in two cases with the collecting system sewn. Thirteen cases used Hem-o-lok to clamp the suture instead of traditional ligature, and mean time of renal warm ischemia was (16.5±2.3) minutes (range, 12–18). Mean postoperative hospital stay was 6.3 days (range, 5–12). Sixty-seven cases had renal clear cell carcinoma, six papillary renal cell carcinoma, and one renal collecting duct carcinoma. All the tumor margin specimens were negative. The mean follow-up was 30.6 months (range, 3–51), and no recurrence or metastasis was observed.

Conclusions  LPN for pT₁ stage renal tumor was safe and feasible. Hem-o-lok instead of traditional ligature to clamp the suture when sewing the renal wound could shorten the warm ischemia time.

     

肾嫌色细胞癌23例临床分析

目的 提高肾嫌色细胞癌的诊治水平.方法 回顾性分析23例肾嫌色细胞癌临床及病理资料,结合文献复习进行讨论.结果 21例行根治性肾切除术,2例行肾部分切除术.17例获得随访,随访9～74个月,所有患者均健康存活.结论 肾嫌色细胞癌是一种低度恶性的肾细胞癌,B超、CT检查缺乏特异性,确诊有赖于典型的病理表现.其TNM分期均为早期,治疗以手术为主,预后良好.     

输尿管软镜下钬激光切除术治疗肾盂癌6例报道及文献复习

目的：探讨输尿管软镜钬激光切除术治疗肾盂癌的应用价值,并总结治疗过程中的相关经验。方法：回顾性分析北京大学第三医院2015年1月至2017年1月输尿管软镜治疗6例肾盂癌患者的临床资料,手术均由同一名医师操作。患者于全身麻醉下行输尿管软镜钬激光肾盂肿瘤切除术,采用200 μm钬激光传导光纤,设置功率为0.5~1.5 J,10~20 Hz,能量10~30 W。采用窄带成像技术寻找肿瘤,并检查切除是否满意。术后4~6周常规行二次输尿管软镜探查,对可疑病变部位行汽化烧灼。术后每6个月行输尿管软镜复查,同时行彩色多普勒超声、CT尿路造影（computed tomography urography,CTU）或磁共振水成像（magnetic resonance urography,MRU）检查,复查手术前连续3天每天进行尿液细胞学检查,检测尿路上皮肿瘤标记物［如尿液核基质蛋白22 (nuclear matrix protein 22,NMP22)］。术后组织病理为高危尿路上皮癌且肾功能正常的患者,给予全身辅助化疗6个周期。结果：6例患者均顺利完成手术,手术时间45~115 min,平均77.5 min,失血量5~20 mL,术后住院2~5 d,平均3 d,术后随访13~34个月,平均22个月, 2例肿瘤复发。例5和例6两患者术后行全身辅助化疗,例5患者的组织病理为高级别尿路上皮癌,术后给予6个周期的全身化疗,化疗期间（术后4个月）患者出现局部复发,再次手术后1年未见复发;例6患者组织病理为低级别尿路上皮癌,但右肾上盏、下盏多发肿瘤,术后予6个周期的全身化疗,随访13个月未见复发。结论：输尿管软镜钬激光切除术治疗肾盂癌的手术技术相对安全,适合孤立肾、肾功能不全等特殊病例以及低危的尿路上皮肿瘤患者,但其复发率较高,需严格掌握适应证。选择行内镜下切除术的高危尿路上皮癌患者,术后应积极予吉西他滨与顺铂（gemcitabine and cisplatin, GC）方案的全身辅助化疗,采用内镜治疗和全身辅助化疗联合的方法提高尿路上皮癌患者的总体生存率。全身化疗联合内镜手术有可能成为治疗上尿路尿路上皮癌的新治疗手段。     

MicroRNA-218（miR-218）在肾透明细胞癌中的表达及临床意义

目的：研究miR-218在肾透明细胞癌中的表达及其与临床病理之间的关系。方法收集2012年3月-2013年5月间在该院就诊的46例病理确诊为肾透明细胞癌组织和30例癌旁≥3.0 cm正常肾组织作为对照组,采用Realtime PCR方法检测microRNA-218在肾透明细胞癌组织和癌旁≥3.0 cm正常肾组织的表达,分析microRNA-218表达水平与肾透明细胞癌临床病理参数之间的关系。结果与对照组癌旁正常肾组织相比, miR-218在肾透明细胞癌组织的的表达明显降低（P〈0.001）。同时, miR-218表达的降低与肿瘤的分期,转移和分化程度有密切关系。miR-218的表达与患者的年龄,性别,肿瘤位置及肿瘤大小无明显统计学意义。但是, miR-218的表达与肿瘤的转移（P=0.007）,肿瘤的 T分期（P=0.022）及肿瘤的分级（P=0.015）有统计学意义。结论 miR-218在肾透明细胞癌中和肿瘤分期、分化、转移有着很大的相关性。miR-218在肾透明细胞癌组织呈下调表达,其可能成为肾细胞癌新的潜在的治疗靶点及诊断预后的分子标志物。     

保留肾单位的肾癌手术(附65例报告)

目的:探讨保留肾单位的肾癌手术治疗方法和疗效。方法:65例行保留肾单位的肾癌切除手术,肿瘤直径(2.0～6.5)cm,平均3.9cm;肿瘤位于肾上极19例,肾中部16例,肾下极30例。TNM分期:T1a 42例,T1b 23例。透明细胞癌58例,颗粒细胞癌6例,乳头状肾细胞癌1例。结果:肾部分切除术65例,术中阻断肾蒂血管47例。所有病例手术切缘均为阴性。术后出现并发症5例,围手术期无患者出现急性肾功能衰竭。64例肾细胞癌患者获随访,平均随访时间61.4个月,5年生存率及5年无瘤生存率分别为98.4%和93.8%。结论:肾癌保留肾单位手术是治疗局限性肾癌的有效方法。