肾嫌色细胞癌(附15例报告)

目的　提高肾嫌色细胞癌的诊治水平和对此类型肾癌的认识。　方法　回顾性分析15例肾嫌色细胞癌的临床资料。男 10例 ,女 5例。年龄 4 7～ 74岁 ,平均 5 7岁。均行根治性肾切除术。　结果　术后病理证实为肾嫌色细胞癌。病理分期 :pT1N0 M0 6例 ,pT2 N0 M0 5例 ,pT3bN0 M0 2例 ,pT1N2 M0 1例 ,pT2 N2 M0 1例。病理分级 :G2 10例 ,G3 5例。 11例获随访 ,随访 2～ 31个月 ,平均19个月 ,1例死于心脏病 ,1例局部复发 ,9例无瘤生存。　结论　肾嫌色细胞癌是一种具有特殊形态的少见肾癌类型。肾根治性切除术是治疗肾嫌色细胞癌的首选方法。与同期、同级的其他类型肾癌相比 ,肾嫌色细胞癌预后较好。     

肾嫌色细胞癌的诊治（附4例报告）

目的 提高肾嫌色细胞癌的诊治水平。方法 回顾性分析4例肾嫌色细胞癌患者的临床资料。男3例，女1例，年龄34—76岁，平均52岁。结果 3例患者行肾癌根治术，1例行肾部分切除术。术后病理诊断为肾嫌色细胞癌，病理分期：pT1aNxMo 1例，pT1bNoMo3例。病理分级：G1 3例，G2 1例。免疫组织化学染色：CK8（低分子量细胞角蛋白）阳性，Vimentin（波型蛋白）阴性，Hale胶体铁阳性。随访4个月至8年，平均4年。4例患者均健在，无肿瘤复发或转移。结论 肾嫌色细胞癌是一种低度恶性的肾细胞癌，影像学检查对其诊断有重要帮助，确诊有赖于组织病理学检查，手术治疗后预后较好。     

肾嫌色细胞癌29例临床分析

目的探讨肾嫌色细胞癌的临床特点,提高其临床诊治水平。方法回顾性分析2006年6月至2012年4月期间收治的29例肾嫌色细胞癌患者的临床资料,包括临床表现、影像学检查、治疗方法、病理分期和随访等。结果 29例患者均缺乏典型的临床症状,术前影像学检查亦未发现特异性表现。16例行根治性肾切除术,其余13例行保留肾单位手术,病理分期:pT1N0M027例,pT2N0M02例。29例患者均获得随访,随访13~72个月,平均(35.0±7.2)个月,29例均无瘤生存。结论肾嫌色细胞癌是肾细胞癌的一个独立类型,CT和B超检查缺乏特异性表现,主要通过病理学进行诊断,但CT表现与常见的肾透明细胞癌有所不同,手术切除是治疗肾嫌色细胞癌的首选方法,其预后较好。     

肾嫌色细胞癌29例临床分析简

目的 探讨肾嫌色细胞癌的临床特点,提高其临床诊治水平。方法 回顾性分析2006年6月至2012年4月期间收治的29例肾嫌色细胞癌患者的临床资料,包括临床表现、影像学检查、治疗方法、病理分期和随访等。结果 29例患者均缺乏典型的临床症状,术前影像学检查亦未发现特异性表现。16例行根治性肾切除术,其余13例行保留肾单位手术,病理分期： pT 1 N 0 M 0 27例,pT 2 N 0 M 0 2 例。29例患者均获得随访,随访13-72个月,平均（35.0±7.2）个月,29例均无瘤生存。结论 肾嫌色细胞癌是肾细胞癌的一个独立类型,CT和B超检查缺乏特异性表现,主要通过病理学进行诊断,但CT表现与常见的肾透明细胞癌有所不同,手术切除是治疗肾嫌色细胞癌的首选方法,其预后较好。     

76例肾嫌色细胞癌的临床诊治分析

目的:分析总结肾嫌色细胞癌的临床特点,提高其临床诊治水平。方法:回顾性分析2010年1月~2013年7月期间收治的76例病理诊断为肾嫌色细胞癌患者的临床及病理资料。其中男40例,女36例,年龄22~71岁,平均49岁。病变位于左侧37例,右侧39例。结果:76例均行手术治疗,其中根治性肾切除术47例,保留肾单位手术29例。73例行腹腔镜手术,3例行开放手术治疗,两组手术时间差异无统计学意义,但腹腔镜组平均术中出血量明显低于开放手术组。肿瘤最大径为1~11cm,平均4.6cm。病理分期:64例pT1N0M0,10例pT2N0M0,1例pT3N0M0,1例pT1N0M1。Fuhrman分级:Ⅰ级50例,Ⅱ级16例,Ⅲ级6例,Ⅳ级4例。术后76例均获得随访,随访时间15~58个月,平均(33.8±12.0)个月,未出现复发或因肿瘤导致死亡者。结论:肾嫌色细胞癌是肾细胞癌的一种少见类型,手术切除是目前首选的治疗方式,腹腔镜手术与开放手术治疗效果相似,微创优势显著。本病较少复发和转移,预后良好。     

乳头状肾细胞癌的临床病理表现

目的 探讨乳头状肾细胞癌的临床病理表现,提高对此类型肾癌的认识。方法 回顾性分析9例乳头状肾细胞癌患者临床病理资料并进行随访。结果 9例乳头状肾细胞癌占同肾癌的1.9％,平均发病年龄52岁。无自觉症状者5例,血尿4例。7例行肾癌根治术,1例行肾输尿管全长切除术,1例保留肾单位的肿瘤切除术。肿瘤最大径4－15cm,多位于肾皮质,淡黄色到金黄色,单灶或多灶性结节性长。均以乳头或乳头管状结构为主,乳头轴心可见泡沫细胞。9例均有细胞角蛋白CK7表达。Fuhrman病理分级G13例、G24例、 G32例。TNM病理分期pT27例、pT3a1例、pT3bN1V1b1例。随访7例无瘤生存36－134个月,1例G2pT3b者无瘤生存11个月,1例G3pT3a者13个月后死于肾癌转移。结论 乳头状肾细胞癌是少见的肾癌,表现为低分期,预后好。     

多房囊性肾细胞癌手术治疗的预后特点分析

目的探讨多房囊性肾细胞癌患者手术治疗的预后特点。方法回顾性分析482例肾癌患者中22例多房囊性肾细胞癌患者资料，分析其手术治疗的预后特点。多房囊性肾细胞癌占同期肾癌病例的4．56％，男女比例为2．67：1．00，年龄32～74岁，平均47岁。结果22例患者中行肾癌根治术18例，行肾部分切除术4例。肿瘤直径1．8～11．0cm，平均4．8cm。其中透明细胞癌21例，透明细胞癌与颗粒细胞癌混合型1例；pT1N0M019例，pT2N0M02例；pT3bN0M01例；G15例，G217例。失访2例，20例获随访，随访时间9～56个月，平均27．6个月。其中1例因肝硬化、上消化道出血死亡，无瘤存活21例。结论多房囊性肾癌是肾癌的一种特殊类型，多为肾偶发癌，病理分期分级低，预后与肿瘤大小无关，手术治疗效果满意，预后佳。     

乳头状肾癌的诊治（附32例报告及文献复习）

目的：提高乳头状。肾癌的诊治水平。方法：回顾性分析32例乳头状肾癌患者的临床资料。28例行开放性根治性肾切除术,3例行后腹腔镜下根治性肾切除术,1例行后腹腔镜下肾部分切除。结果：术后病理均为乳头状肾癌。采用2002年AJCC肾癌TNM病理分期：pT1oNoMo4例,pT1bNoMo14例,pT2oNoMo10例,pT2bNoMo1例,pTzbN·Mo1例,pT3oNoMo2例,病理分级：G121例,G210例,G31例。28例获16～30个月随访,平均20个月,2例死于心脏病,3例死于脑血管意外,1例局部复发,22例无瘤生存。结论：乳头状肾癌是一种具有特殊形态和表现的少见肾癌类型,部分。肾切除及根治性肾切除术是治疗乳头状。肾癌的首选方法,与其他类型肾细胞癌相比,乳头状肾癌预后较好。     

索拉非尼治疗转移性非透明细胞肾癌的疗效观察

目的 初步探讨索拉非尼治疗转移性非透明细胞肾癌的疗效.方法 转移性非透明细胞肾癌21例,中位年龄45(25～76)岁.12例为根治性肾切除术后出现转移,9例就诊时诊断为肾癌伴转移,行减瘤性肾切除术.术后病理证实乳头状癌15例、嫌色细胞癌1例、未分类癌5例.转移部位包括肺、淋巴结、肾上腺、骨、肝和甲状腺.治疗方法:①索拉非尼400 mg,2次/d治疗15例;②索拉非尼400 mg,2次/d加干扰素α 300万U,每周连续5 d皮下注射治疗6例.中位治疗时间8(2～21)个月.随访0～22个月.结果 部分缓解(PR)3例(14.3%),其肿瘤病理亚型分别为乳头状癌、嫌色细胞癌和未分类癌各1例,转移灶分别位于腹膜后加纵隔淋巴结、肺加腹膜后淋巴结和腹膜后加盆腔淋巴结.疾病稳定(SD)13例(61.9%),疾病进展(PD)5例(23.8%),疾病控制率76.2%.截至2009年7月,出现PD 13例,中位无疾病进展时间为7(0～21)个月.结论 索拉非尼治疗转移性肾乳头状癌、嫌色细胞癌、未分化癌有效,对淋巴结转移及肺转移者的疗效相对较好.     

肾嫌色细胞癌临床病理特征及预后分析

目的 分析肾嫌色细胞癌的临床病理特征及预后,提高对肾嫌色细胞癌的认识. 方法 对1998年2月至2009年7月行根治性肾切除术后病理诊断为嫌色细胞癌的75例患者资料进行回顾性研究.男42例,女33例.平均年龄56(25～74)岁.均为单发肿瘤,左肾36例,右肾39例.比较患者性别、年龄、肿瘤大小、分级、分期与预后的关系,Kaplan-Meier生存曲线分析生存关系.结果 肿瘤平均直径7.3(2.5～17.0)cm,大体切面以灰黄、灰红色为主(50/75例),肿瘤细胞多为体积较大的多角形嫌色细胞和小圆形嗜酸细胞.T1N0M0 30例,T1N0M11例,T2N0M0 26例,T2N0M11例,T3N0M0 11例,T3N0M1 3例,T3N1M0 1例,T4N0M1 1例,T4N1M11例.依照Fuhrman分级系统,Ⅰ级3例,Ⅱ级24例,Ⅲ级46例,Ⅳ级2例.平均随访44(9～93)个月,死亡7例,其余均无瘤生存.3、5年生存率分别为93.3%和90.7%.单因素分析示肿瘤大小(P=0.028)、TNM分期(P=0.000)和肿瘤侵袭、预后有关;多因素分析显示,TNM分期可作为肾嫌色细胞癌独立的预后因素.结论 肾嫌色细胞癌是一种具有特殊形态的少见肾癌类型,多数瘤体较大,预后较好;细胞核分级较高,不适用Fuhrman分级系统;TNM分期可作为肾嫌色细胞癌预后的独立因素.     

Oncologic outcome of 132 cases of laparoscopic radical nephrectomy with intact specimen removal for T1-2N0M0 renal cell carcinoma

We present the short and long-term oncologic outcome of 132 patients with pathologically confirmed T1–T2, N0M0 renal cell carcinoma (RCC), who underwent laparoscopic radical nephrectomy with intact specimen removal at our institution. Beginning January 1998, we prospectively collected data of 132 patients undergoing laparoscopic radical nephrectomy, whose final pathologic stage was T1 or T2, N0M0, RCC. The clinical data of three groups categorized as group (pT1a)—36 patients, group (pT1b)—51 patients and group (pT2)—45 patients were analyzed statistically to assess oncological outcome. The specimens were removed intact without morcellation in all patients in a homemade plastic bag. The total median follow-up was 56 months (range 3–80 months) and there were no local or port-site recurrences or hernia. Patients with pT2 tumors had significantly greater operating time, blood loss and analgesic requirements than pT1a/pT1b tumor patients. The distant metastases were found in 1, 4 and 5 patients in group pT1a, pT1b and pT2, respectively. The 5-year cancer-specific survival was 97.2, 86.3 and 82.2%, respectively, in pT1a, pT1b and pT2 tumor patients (significantly lower in pT2 than pT1a, P = 0.008). The 5-year recurrence-free survival was 97.2, 84.3 and 82.2%, respectively, in pT1a, pT1b and pT2 tumor patients (significantly lower in pT2 than pT1a, P = 0.02). Laparoscopic radical nephrectomy (retroperitoneal and transperitoneal route) with intact specimen removal for localized renal cell carcinoma (T1-2N0M0) provides satisfactory short and long-term oncologic efficacy.     

Oncological outcome of minimum incision endoscopic radical nephrectomy for pathologically organ confined renal cell carcinoma

Objective:   To date, follow-up after minimum incision endoscopic radical nephrectomy (MIES radical nephrectomy) for renal cell carcinoma (RCC) has not been reported. Minimum incision indicates an incision that narrowly permits the extraction of the specimen. To evaluate the oncological outcome of the patients with pathologically organ confined (pT1-2N0M0) RCC treated with this operation, the results in those patients were analyzed.
Methods:   From 1998 to 2006, 154 consecutive patients underwent MIES radical nephrectomy under diagnosis of clinical T1-2N0M0 RCC in our hospital. Of the patients, 127 patients with pathologically confirmed organ confined (pT1-2N0M0) RCC constituted the current study population. Overall, the recurrence-free and cancer-specific survival rates of the patients treated with MIES radical nephrectomy were calculated using the Kaplan-Meier method and compared with those of the patients treated with open radical nephrectomy using the log rank test.
Results:   The median follow-up period was 34 months (range: 3–98 months). Of the 127 pT1-2N0M0 patients treated with MIES radical nephrectomy, the disease recurred in nine patients and four patients died of the cancer during follow-up. The five-year overall, recurrence-free and cancer-specific survival rates were 95.0%, 90.8% and 95.8%, respectively. Overall, the recurrence-free and cancer-specific survival rates were not different from those of patients treated with open radical nephrectomy.
Conclusion:   MIES radical nephrectomy has the validity in adequate cancer control and is one of the recommendable options as a minimally invasive surgery for patients with organ confined RCC.     

Clinicopathological factors predicting recurrence of N0M0 renal cell carcinoma: A case series analysis of one facility

BACKGROUND: Although many factors have been reported as predictors of the recurrence of renal cell carcinoma (RCC), none of the factors are consistent among different studies. In the study presented here, the potential clinicopathological predictors of the recurrence of N0M0 RCC were examined. METHODS: A total of 201 patients who underwent nephrectomy for N0M0 RCC were examined to determine the pathological tumor stage (pT stage), pathological tumor grade of malignancy (tumor grade), symptoms, and tumor size. RESULTS: RCC recurred in 29 patients (14.4%), 50% of whom developed new tumors within 24 months after nephrectomy. The disease-free 3- and 10-year survival rates declined as the pT stage and tumor grade increased: these rates were, respectively, 98.6% and 86.5% for pT1a; 93.7% and 87.9% for pT1b; 100% and 100% for pT2; 78.6% and 58.0% for pT3a; and 88.9% and 16.7% for pT3b. Significant differences in the recurrence rate were noted between pT3 and pT1 or pT2, as well as between grade 3 disease and grade 1 or grade 2 tumors. Multivariate analysis showed that a combination of the pT stage, grade, and presence of symptoms was useful for predicting the recurrence of RCC. CONCLUSION: The present study showed that patients undergoing nephrectomy for N0M0 RCC should be followed-up carefully for 2 years postoperatively with special attention to high pT stage, high grade, and the development of symptoms.     

多房囊性肾细胞癌的临床特点及预后

目的评价多房囊性肾细胞癌的诊疗特点及预后。方法回顾性分析6例多房囊性肾细胞癌的临床特点、影像学表现、外科手术方法、病理特点,随访其预后。站果男3例,女3例,肿瘤最大直径3．0～7．5cm。CT示多囊性肿物,实性部位平扫CT值30～36Hu,皮质期88～130Hu,排泄期75～96Hu,为隔膜型增强型。腹腔镜肾部分切除术1例,根治性肾切除5例。病理TNM分期,pT1aN0M0 2例,pT1bN0M03例,pT2N0M01例,癌细胞核分级均为G1。中位随访24个月,随访期内未发现远处转移及肿瘤复发,无瘤存活100％。结论多房囊性肾细胞癌为一种特殊的病理类型,病理分期、分级低,预后良好,术前怀疑或术中证实为多房囊性肾细胞癌应考虑行腔镜保留肾单位的肾部分切除术。     

Evaluation of the intact specimen after laparoscopic radical nephrectomy for clinically localized renal cell carcinoma identifies a subset of patients at increased risk for recurrence

PURPOSE: Laparoscopic radical nephrectomy (LRN) is emerging as a standard approach for low stage renal cell carcinoma (RCC). Some suggest that specimen morcellation for extraction results in less morbidity and a faster recovery. However, morcellation may preclude accurate pathological staging and may hinder precise pathological grading. With pathological evaluation of an intact specimen we identified patients harboring high risk disease that was not anticipated preoperatively, defined as pT2 high grade (G3-4) or lesions greater than pT2. MATERIALS AND METHODS: We retrospectively reviewed the records of 192 patients who underwent LRN for renal lesions at The University of Texas M. D. Anderson Cancer Center between April 2002 and April 2004. RESULTS: A total of 192 patients underwent LRN for presumed RCC. In all cases specimens were removed intact. Of these cases 137 were cT1/T2 N0 M0 and had a final pathological diagnosis of RCC. All surgical margins were negative. Of the 137 patients 40 (29.2%) were at increased risk for recurrence based on high risk features. Specifically up staging from cT1-2 to pT3 disease occurred in 30 patients (21.9%) while 12 patients (8.8%) were found to have pT2 G3-4 disease. All 40 patients with high risk disease underwent more intensive surveillance and 17 (43%) participated in adjuvant systemic therapy trials. CONCLUSIONS: In our study 21.9% of patients with clinical T1-2 disease were pathologically up staged and 29.2% were identified as being at high risk for recurrence after intact specimen extraction for localized RCC. These patients are candidates for more intensive followup treatment and may benefit from enrollment in adjuvant therapy protocols.     

多房性囊性肾癌的诊治体会

目的:提高对多房性囊性肾癌(MCRCC)的诊治水平。方法:2006年1月～2011年3月我院共收治MCRCC患者12例,男8例,女4例,平均年龄50岁。该组患者均于体检时发现。术前均行B超、CT检查,其中有3例又行MRI检查,术前诊断囊实性占位10例,诊断肾囊肿2例,4例行根治性肾切除,6例行肾部分切除,1例术中病理为良性,行去顶减压术,术后病理为恶性而二次行肾切除术。1例患者术中取病理回报为恶性而行肾切除。结果:该组患者术后病理均证实为MCRCC,肿瘤最大直径为2.5～8.0cm,平均4.0cm。TNM分期均为T1N0M0期。病理分级G110例,G22例。随访3～62个月,平均36个月,均无瘤生存。结论:MCRCC恶性度低,预后好。术前诊断主要依赖于影像学检查,但影像学检查无特异性,不易与多房性肾囊肿鉴别,肾部分切除术是治疗的最佳选择。     

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.