肾嫌色细胞癌的临床研究

目的 探讨肾嫌色细胞癌的临床特点,提高肾嫌色细胞癌的诊断和治疗水平.方法 针对1例肾嫌色细胞癌的临床资料,结合相关文献进行分析.结果 病理结果示为肾嫌色细胞癌.免疫组化:CK部分细胞(+),CD10(-),CK8(+),RCC(-),vimentin(-),Ki-67(＜5%+),Hale胶状铁染色(+).结论 肾嫌色...     

肾嫌色细胞癌临床特征分析

目的 探讨肾嫌色细胞癌的临床特点并分析其预后.方法 对1998年1月至2008年1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、Ptnm分期和生存期随访等,进行回顾性分析.结果 所有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.23例患者行根治性肾切除术,6例行保留肾单位手术(NSS),病理分期:Pt1n0m0 11例,Pt2n0m0 8例,pT3aN0M0 5例,Pt1nm0 3例,Pt2n1m0 2例.26例患者获得随访,随访24～144个月,平均90个月;3例死于心脑血管疾病,6例局部复发后4例再次手术,1例远处转移,21例无瘤生存.与同期肾透明细胞癌患者相比,累积5年生存率两者分别为83.9%和63.8%,差异无统计学意义(P＞0.05),累积10年生存率分别为77.9%和49.9%,差异具有统计学意义(P＜0.01).结论 肾嫌色细胞癌是一种少见的具有特殊形态的肾细胞癌病理亚型,主要通过病理学予以鉴别诊断,手术切除是治疗初发或复发的肾嫌色细胞癌的首选方法,其预后较好.

Abstract：

Objectives To explore the clinical, pathological features and prognosis of patients with chromophobe renal cell carcinoma. Methods From January 1998 to January 2008, clinical data of 29 patients with chromophobe renal cell carcinoma including clinical manifestations, imaging examinations,treatment models, pTNM stages and follow-up results, were summarized to investigate its features and prognosis. Results All cases had no obvious clinical and preoperative imaging presentation. There were 23 patients underwent radical nephrectomy, and 6 cases underwent nephron sparing surgery. Postoperative pathological findings confirmed the diagnosis of chromophobe renal cell carcinoma. Macroscopically, the cut surface of the tumors were generally beige in color. Histologically, it showed polygonal chromophobe cells and small round eosinophilic cells with eccentric hyaline degeneration. These tumor cells had a clear and sharp membrane, lightly stained abundant cytoplasm with a fine reticular translucent pattern and irregular nuclei. And a perinuclear halo was often seen in these cells. Histochemically, the tumor cells generally show a diffuse and strong reaction for CK-8 with a negative expression of Vimentin. The pTNM stages of the tumor were as follows, pT1N0M0 in 11 cases, pT2N0M0 in 8 cases, pT3aN0M0 in 5 cases, pT1N1M0 in 3 cases,pT2N1M0 in 2 cases. Twenty-six cases of patients were followed up (24 to 144 months, with an average of 90 months), 3 cases died of cardio-cerebrovascular disease, and local recurrence involved in 6 cases with reoperation in 4 cases, as well as distant metastasis in 1 case. Twenty-one cases survived with tumor-free.The statistical results indicated that the survival rates of the patients with chromophobe renal cell carcinoma in five years and ten years were 83.9%, 77.9%, respectively, compared with renal cell carcinoma of the same stage 63. 8% and 49. 9% at the same periods, and there is no difference in the survival rate of five years( P ＞ 0. 05 ) but significant difference in that of ten years ( P ＜ 0. 01 ). Conclusions Chromophobe renal cell carcinoma is a morphologically uncommon subtype of renal cell carcinoma with the good prognosis. Definite diagnosis depends on its typical pathological feature. Radical nephrectomy is the first choice for the treatment of chromophobe renal cell carcinoma.     

肾嫌色细胞癌临床与病理学特点分析

目的探讨肾嫌色细胞癌的临床及病理学特点，提高对此病的诊治水平。方法总结19例肾嫌色细胞癌患者的临床及病理资料。男10例，女9例。平均年龄53岁。左侧9例，右侧10例。偶发12例，7例有肉眼血尿、腰痛不适和腹部包块等症状。结果B超主要表现为包膜完整的低回声肿块。CT扫描肿瘤多为均匀低密度，边界清晰。肿瘤平均直径8．2cm。TNM分期T1N0M0 8例，T2N0M0 11例。行根治性肾切除17例，肾部分切除2例。16例获得随访，随访时间3个月～16年，平均无瘤生存4．8年。病理特点：肿瘤大体标本多为均匀深棕色实体，1例瘤体中央有纤维瘢痕；光镜下瘤细胞由典型型和嗜酸型两种细胞组成，胞膜清晰；免疫组化检测CK8阳性、Vimentin阴性；Hale胶体铁染色阳性；电镜下胞质内有大量膜性小空泡。结论肾嫌色细胞癌具有独特的形态学特点。B超、CT检查缺乏特异性。多数病例瘤体较大，但TNM分期多为早期，预后良好。     

肾嫌色细胞癌的诊断和治疗（附五例报告）

目的 提高肾嫌色细胞癌的诊治水平。方法 回顾性分析5例肾嫌色细胞癌资料,结合文献复习进行讨论。结果 3例肾部分切除术,2例行根治性肾切除术,随访个月至4年,4例无瘤存活,1例于术后1年死于中风。结论 肾嫌色细胞癌是一种低度恶性的肾细胞癌,确诊有赖于影像学检查及典型病理表现,治疗以手术为主。     

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.     

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。     

104例肾嫌色细胞癌的临床分析

目的 探讨肾嫌色细胞癌的临床特点、治疗方式的选择及患者预后生存情况。方法回顾性分析陆军军医大学第二附属医院2012年1月至2022年1月收治的104例经术后病理诊断为肾嫌色细胞癌(chRCC)的患者临床资料。所有患者均行手术治疗,对患者的影像学资料、病理资料及术后生存情况进行分析和总结。结果 104例患者中有67例行CT检查,报告显示平扫期多数呈等密度或稍高密度软组织影,肿瘤内若存在坏死灶,则可能出现混杂密度影,部分肿瘤内有钙化,增强期大多呈现轻度或中度不均匀强化;4例行MRI检查,强化时均呈不均匀强化,静脉期强化均减退;病理结果示chRCC主要包括两种细胞类型,一种为体积较大的多角形半透明细胞,另一种为小圆形的嗜酸性细胞。8例患者失访,3例患者因非肾肿瘤性疾病死亡,2例因转移死亡,其余患者均长期生存,预后良好。结论 chRCC临床症状不典型,超声可作为首选体检筛查手段,CT和MRI检查在chRCC诊断上也具有一定优势。手术为早期chRCC首选治疗方案,多数患者预后良好,极少数患者术后出现转移或复发。晚期chRCC目前尚无统一治疗方案。     

肾嫌色细胞癌的超声造影表现

目的 分析肾嫌色细胞癌的超声造影特征,提高对该肿瘤的识别.方法 分析经手术病理证实的28例嫌色细胞癌超声造影资料,分析血供情况及造影特征,并进行时间-强度曲线参数分析.结果 28例嫌色细胞癌与肾皮质作参照均呈乏血供造影表现,且肿块呈不均匀增强,肿块局部呈"快进快出"造影表现,强化程度低于周围肾皮质,其中15例(54%)病灶内可出现辐射样分布的强回声带.时间-强度曲线显示嫌色细胞癌组曲线达峰绝对值、曲线下面积低于肾皮质(P＜0.05),造影剂到达时间、达峰时间、曲线上升支斜率高于肾髓质组(P＜0.05).结论 超声造影检查中,肾嫌色细胞癌瘤体内辐射状增强和瘤体呈乏血供型增强为诊断提供了依据.

Abstract：

Objective To discuss the imaging characteristics of chromophobic cell renal carcinoma (CCRC) and study the features on the contrast-enhanced ultrasound (CEUS). Methods The CEUS features of CCRC in 28 cases identified by pathology were reviewed. The blood supply and enhancement characteristic were observed and analyzed on time intensity curve parameters. Results The 28 cases of CCRC showed poor blood supply in contrast with the renal cortex. The CCRC presented with heterogeneity enhancement, part of the tumor took on a high wash-in and wash-out, and enhanced less intense than the surrounding renal cortex. The actinomorphous strong echo of the tumors might be revealed with CEUS in 15 cases (54%). The time intensity curve analysis demonstrated that the CCRCs' difference of peak intensity and area under the curve were lower than the renal cortex (P＜0.05), but arrival time, time-to-peak and slope of ascending curve were higher than the renal medulla (P＜0.05). Conclusion The actinomorphous enhancement and poor blood supply in the tumor of CEUS could provide diagnostic evidence for CRCC.     

肾嫌色细胞癌的超声造影表现

Objective To discuss the imaging characteristics of chromophobic cell renal carcinoma (CCRC) and study the features on the contrast-enhanced ultrasound (CEUS). Methods The CEUS features of CCRC in 28 cases identified by pathology were reviewed. The blood supply and enhancement characteristic were observed and analyzed on time intensity curve parameters. Results The 28 cases of CCRC showed poor blood supply in contrast with the renal cortex. The CCRC presented with heterogeneity enhancement, part of the tumor took on a high wash-in and wash-out, and enhanced less intense than the surrounding renal cortex. The actinomorphous strong echo of the tumors might be revealed with CEUS in 15 cases (54%). The time intensity curve analysis demonstrated that the CCRCs' difference of peak intensity and area under the curve were lower than the renal cortex (P＜0.05), but arrival time, time-to-peak and slope of ascending curve were higher than the renal medulla (P＜0.05). Conclusion The actinomorphous enhancement and poor blood supply in the tumor of CEUS could provide diagnostic evidence for CRCC.     

肾嫌色细胞癌的超声造影表现

Objective To discuss the imaging characteristics of chromophobic cell renal carcinoma (CCRC) and study the features on the contrast-enhanced ultrasound (CEUS). Methods The CEUS features of CCRC in 28 cases identified by pathology were reviewed. The blood supply and enhancement characteristic were observed and analyzed on time intensity curve parameters. Results The 28 cases of CCRC showed poor blood supply in contrast with the renal cortex. The CCRC presented with heterogeneity enhancement, part of the tumor took on a high wash-in and wash-out, and enhanced less intense than the surrounding renal cortex. The actinomorphous strong echo of the tumors might be revealed with CEUS in 15 cases (54%). The time intensity curve analysis demonstrated that the CCRCs' difference of peak intensity and area under the curve were lower than the renal cortex (P＜0.05), but arrival time, time-to-peak and slope of ascending curve were higher than the renal medulla (P＜0.05). Conclusion The actinomorphous enhancement and poor blood supply in the tumor of CEUS could provide diagnostic evidence for CRCC.     

A rare case of synchronous association of chromophobe renal cell carcinoma with urothelial carcinoma of urinary bladder

Introduction

Chromophobe renal cell carcinoma accounts for 3–5% of all RCCs. However, its association with urothelial carcinoma of urinary bladder has never been reported. We report a case of synchronous association of chromophobe RCC with low grade urothelial carcinoma of urinary bladder.

囊性肾癌诊治体会

目的 提高囊性肾癌的诊治水平. 方法 回顾分析10例囊性肾癌患者术前影像学特点、病理特征和治疗方法.男7例,女3例.年龄38～74岁,平均56岁.患侧腰酸3例,体检偶然发现7例,有肾囊肿病史者2例.囊腔直径3.5～8.2 cm.术前B超检查诊断为肾癌6例,CT诊断为肾癌7例.8例术中行冰冻病理:肾细胞癌6例,未发现恶性倾向2例.10例均行根治性肾切除术. 结果 术后病理诊断:肾透明细胞癌9例,颗粒细胞癌1例.病理学分型:肾癌囊性坏死6例,多房囊性肾癌2例,肾囊肿恶变型2例.8例随访6个月～5年,6例无瘤存活,2例分别于术后13、20个月死于肿瘤转移. 结论 重视囊性肾癌独特的影像学特点、病理学特征,术中行冰冻病理检查,是提高囊性肾癌诊治水平的关键.     

Imaging techniques for the patient with renal cell carcinoma

The imaging of renal cell carcinoma continues to evolve from radiographic tomography to state-of-the-art three-dimensional imagery using computed tomography (CT) or magnetic resonance imaging (MRI). This article reviews the current techniques of imaging the patient with renal cell carcinoma. Careful and accurate imaging of these patients allows for the appropriate diagnosis, treatment planning, and follow-up care. At each point in the care of these patients, imaging plays an important role. In particular, the diagnosis and staging of renal cell carcinoma can be accomplished with CT and MRI, with each modality having strengths and weaknesses that are contrasted. Intraoperative ultrasound is used during laparoscopic or conventional partial nephrectomies, whereas ultrasound, CT, and MRI can be used for guiding ablative technologies. Imaging also plays an important role in the follow-up care of these patients. The particular follow-up care is dependent on the stage and grade of the lesion and the treatment modality used. In summary, this article reviews the current imaging approaches for the diagnosis, staging, treatment, and follow-up care of patients with renal cell carcinoma.     

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。