肾透明细胞癌中VHL基因失活的检测及意义

目的 探讨肾透明细胞癌中Von Hippel-Lindau(VHL)基因突变和超甲基化情况及其在肾癌发生发展中的作用及临床意义.方法 采用聚合酶链反应-单链构象多态性分析(PCRSSCP)银染法,甲基化特异性PCR(MSP)及测序等方法对33例肾透明细胞癌和相应远离肿瘤正常肾组织VHL基因突变和超甲基化情况进行检测.结果 19/33(57.6%)例肾透明细胞癌中出现VHL基因突变;6/33(18.2%)例肾透明细胞癌中出现VHL基因超甲基化;VHL基因突变和超甲基化与肾癌临床分期和淋巴结转移相关.结论 肾癌中存在VHL基因突变和超甲基化,且与临床分期、淋巴结转移相关;VHL基因失活的检测可作为肾透明细胞癌的诊断指标,VHL基因可望成为肾透明细胞癌基因治疗的重要目的 基因.     

嫌色细胞癌与透明细胞癌混合性肾癌的诊断

目的 探讨嫌色细胞癌与透明细胞癌混合性肾肿瘤的诊断及鉴别诊断。 方法 回顾性分析1例嫌色细胞癌与透明细胞癌混合性肾肿瘤的临床资料，结合文献复习进行讨论。结果 病理检查证实该肿瘤为嫌色细胞癌与透明细胞癌混合性肾肿瘤，免疫组织化学揭示嫌色细胞癌可能来源于肾集合小管，Hale胶体铁染色阳性。电镜下胞浆内见大量小囊泡是嫌色细胞癌特征表现。结论 该类肿瘤临床无特异性，需借助病理、免疫组织化学和超微结构特征等明确诊断及相关组织来源。     

同侧肾脏同时发生透明细胞型与乳头状肾细胞癌

目的探讨同侧肾脏发病并且相对独立的透明细胞型和肾乳头状细胞癌的临床病理特点及免疫表型,提高对该肿瘤的认识和诊断水平。方法本研究回顾了2例病理诊断为透明细胞型合并肾乳头状细胞癌的临床资料,通过光镜和免疫组织化学染色,针对肾细胞癌相关蛋白标志物[包括 Vimentin、CD10、CK（AE1/AE3）、CK7、CK8/18、PAX2、PAX8、CAⅨ、AMACR]进行了观察和分析。结果2例患者为男性,年龄分别为70、63岁。2例患者的两处独立肿瘤均位于左侧肾脏,镜下观察均可见两处独立肿瘤,肿瘤间隔有正常肾脏组织,分别为乳头状肾细胞癌及透明细胞型肾细胞癌,且免疫组化显示2例患者肿瘤的表型一致。结论单侧肾脏肾透明细胞癌合并肾乳头状细胞癌是一种少见的临床现象,这种现象的存在以及类似的免疫组化表型提示透明细胞型肾细胞癌和乳头状肾细胞癌在发生过程中可能存在着内部的联系。     

肾透明细胞癌胰腺转移瘤3例临床分析

目的 探讨肾透明细胞癌胰腺转移瘤的临床特点。方法 分析复旦大学附属中山医院自2003?01?01至2009?05?31病理确诊肾透明细胞癌胰腺转移3例病人的临床资料。结果 （1）肾透明细胞癌胰腺转移瘤的B超表现为低回声团块,难以与胰腺癌鉴别;而在CT动脉期可表现为增强病灶,又难以与神经内分泌肿瘤鉴别。（2）术后病理大体标本表现为边界清晰,切面灰黄,伴有灰红色坏死区域肿块。镜下为细胞质量多呈透明色的成片状排列。（3）1例病人术后11个月死亡,另2例病人随访至2009年5月,术后生存时间分别为21个月和2个月,现仍在继续随访中。结论 肾透明细胞癌胰腺转移瘤的共同特点为B超表现为低密度团块,CT表现为动脉期明显增强病灶。术前诊断主要依靠既往病史及CT检查。根治性胰腺转移瘤切除术后生存状况仍难确定,通常认为若无复发、转移,则有望获得长期生存。     

Dicer表达与肾透明细胞癌发生及转移的关系

目的：探讨Dicer在肾透明细胞癌发生及转移中的作用。方法：选取正常肾小管上皮细胞株HKC、非转移性肾透明细胞癌细胞株769P、转移性肾透明细胞癌细胞株Caki-1以及36例肾透明细胞癌手术标本（其中11例已发生远处转移）和相应癌旁正常肾组织,应用实时定量PCR和Western blot方法检测Dicer在肾透明细胞癌细胞株和组织中mRNA和蛋白的表达情况,并分析Dicer的mRNA水平与临床病理资料的关系。结果：和正常肾小管上皮细胞株HKC相比;Dicer的mRNA水平在肾透明细胞癌细胞株769-P和Caki-1中均降低（P〈0．001）,而转移性肾透明细胞癌细胞株Caki-1比非转移性肾透明细胞癌细胞株769-P表达水平更低（P〈0．001）;和癌旁正常肾组织相比,Dicer的mRNA水平在‘肾透明细胞癌手术标本中明显降低（P〈0．001）,且已发生远处转移的。肾癌标本比未发生远处转移的肾癌标本表达水平更低（P=0．04）;Dicer在细胞株和组织中的蛋白水平的变化与mRNA水平的变化一致（P〈0．001）;Dicer的mRNA水平在不同年龄、性别、组织学分级、肿瘤大小及T分期组间无统计学差异（P〉0．05）。结论：Dicer表达降低可能在。肾透明细胞癌的肿瘤发生中发挥作用,且其表达的进一步下降可能与肾透明细胞癌的远处转移有关。     

肾细胞癌病理亚型相关的二次原发肿瘤

作者评价肾细胞癌组织病理亚型——透明细胞癌、乳头状癌和嫌色细胞癌罹患二次肿瘤的风险。回顾性分析1970年至2000年因散发肾细胞癌行肾切除的2722例患者的病例资料，所有病理标本都由一位泌尿外科病理医师进行分型，二次原发肿瘤与肾细胞癌病理亚型的关系通过X^2检验和Fisher精确检验评价。结果：所有患者中，透明细胞癌2188例（80．4％），乳头状癌378例（13．9％），嫌色细胞癌128例（4．7％）。乳头状肾细胞癌患者比透明细胞癌患者更容易患结肠癌（P=0．041）、前列腺癌（P=0．003）和其他肿瘤（P＜0．001）。     

肾透明细胞癌胆囊转移2例报告并文献复习

目的提高对肾透明细胞癌胆囊转移的认识,探讨其临床及病理特点。方法报告2例经本院收治的肾透明细胞癌胆囊转移患者的临床资料,回顾性分析其临床特征以及影像学表现。2例均为男性,年龄分别为56岁及61岁。患者均无特征性临床表现。其中1例患者行腹腔镜根治性肾切除术后6个月复查B超发现胆囊腔内肿物增大,遂在全麻下行腹腔镜胆囊切除术。另1例发现肾脏及胆囊病变后同期在全麻下行腹腔镜根治性肾切除术及胆囊切除术。检索Pubmed和CBM数据库,对该疾病相关文献进行复习。结果2例术后病理诊断为肾透明细胞癌胆囊转移。术后随访3个月及25个月未见肿瘤复发。结论肾透明细胞癌胆囊转移临床罕见,对于肾癌患者或既往有肾癌病史的患者,应该关注其胆囊上存在的病变性质,PET／CT对诊断该病有一定帮助,同时比较原发灶和转移灶二者病理的异同能更准确地进行病理诊断。     

肾透明细胞癌发生膀胱转移1例报告并文献复习

本文报道1例肾透明细胞癌发生膀胱转移的临床病理资料。患者女,71岁,于2011年7月29日因"右肾癌合并肺转移瘤"就诊,2011年8月3日行开放经腹腔右肾切除术,术后辅助靶向治疗。2016年4月28日发现左侧孤立肾肾癌,合并膀胱转移,肺、骨转移。2016年5月10日行经尿道膀胱肿瘤电切术。术后病理符合肾透明细胞癌转移至膀胱。2016年5月17日行腹腔镜下左侧孤立肾肾部分切除术。术后病理提示左肾高级别透明细胞癌,伴肾门淋巴结转移。术后第2日急性肾小管坏死,予血液透析治疗。术后随访2个月。血肌酐289μmol/L。双肾区及膀胱未见肿瘤复发。     

上尿路罕见肿瘤2例报告及文献复习

目的：探讨上尿路罕见肿瘤的诊治和预后。方法：回顾性分析2007年2月和12月收治的同时同侧肾及肾盂透明细胞癌和原发输尿管鳞状细胞癌患者各1例的临床资料,并结合文献进行总结。结果：2例患者术前未能明确诊断,实施了探查性手术,成功切除肿瘤,术后至今无复发或转移。结论：同时同侧‘肾及肾盂透明细胞癌和原发输尿管鳞状细胞癌均属罕见病例,但有其特点,可通过病史、辅助检查等初步与移行细胞癌等常见肿瘤相鉴别,从而选择恰当的治疗方式。预后有待进一步随访。     

肾癌不同病理亚型的MRI特点

目的探讨肾癌不同病理亚型的MRI表现。方法回顾性分析了2009年1月至2013年6月本中心收治的47例肾癌病例,所有病例均经MRI检查,术后病理确诊为肾细胞癌。以正常肾皮质信号强度为标准,采用目测法比较总结各病例的MRI特点。用SPSS 13.0统计软件,以P=0.05为标准进行卡方分析。结果肾透明细胞癌T1WI增强序列强化幅度明显高于其他两个亚型,且具有明显的"快进快出"的特点,有统计学意义(P0.05)。而肾乳头状细胞癌与肾嫌色细胞癌的T1WI增强序列图像无明显差异(P0.05)。肾透明细胞癌及肾乳头状细胞癌的化学位移图像中反相位图像部分区域较同相位图像有所降低,而肾嫌色细胞癌无此特点,有统计学意义(P0.05)。三种肿瘤均在DWI及ADC图像上呈略高信号,无明显差异(P0.05)。结论 MRI对鉴别肾透明细胞癌、乳头状肾细胞癌、肾嫌色细胞癌均有一定的参考价值,其中增强序列是鉴别肾透明细胞癌和乳头状肾细胞癌及肾嫌色细胞癌的重要参数。而通过化学位移成像能较好地鉴别肾嫌色细胞癌与肾透明细胞癌及肾乳头状细胞癌。     

An unusual cause of irritable urinary bladder symptoms

A metastasis from a renal cell carcinoma to a seminal vesicle is extremely rare. This pattern of metastatic disease has been reported once previously in the Japanese literature. We describe a patient with irritability symptoms of the urine bladder and involuntary loss of stool caused by obstruction of the bladder by a large metastasis from a renal cell carcinoma to the seminal vesicle. The mode of diagnosis and treatment of this patient are described.     

Solitary metastasis of renal cell carcinoma to the parotid gland 10 years after radical nephrectomy

Abstract Renal cell carcinoma metastasis to the parotid gland after tumor nephrectomy is extremely rare. We report a case of solitary parotid metastasis from clear cell renal cell carcinoma in a 59‐year‐old woman, who presented 10 years after primary treatment. To our knowledge this is the first case in the published literature presenting with solitary parotid metastasis after such a long time. Superficial parotidectomy with preservation of the facial nerve was performed. One year after, the patient developed contralateral multiple kidney tumors and underwent left radical nephrectomy. She is currently on a dialysis program and no additional metastasis has been observed for 18 months.     

An unusual case of Von Hipple Lindau (VHL) syndrome with bilateral mutlicentric renal cell carcinoma with synchronous solitary urinary bladder metastasis

In VHL syndrome, renal cell carcinoma is distinctive for its early age of onset, for its bilateral and multifocal involvement. Synchronous solitary urinary bladder metastasis from renal cell carcinoma is extremely rare. We report an unusual case of VHL with bilateral multicentric renal cell carcinoma and synchronous solitary urinary bladder metastasis. To the best of our knowledge this is the first case reported in literature with this combination.     

Solitary Thyroid Metastasis of Renal Clear Cell Carcinoma: Report of a Case

A case of solitary thyroid metastasis of renal clear cell carcinoma is described. The patient was a 77-year-old Japanese woman, who was referred to our department after a thyroid tumor was identified in May 1999. She had a history of renal clear cell carcinoma of the left kidney, which had been partially resected 3 years previously. Ultrasound sonography demonstrated that a well-demarcated hypoechoic mass containing high-echo spots representing small calcifications, which measured 45 × 34 × 31 mm in size, occupied the left lobe. Computed tomography revealed a low-density mass containing small calcifications. The results of preoperative fine-needle aspiration cytology strongly suggested a clear cell carcinoma metastasizing to the thyroid. A left hemithyroidectomy was performed on July 27, 1999. A histological examination revealed that the neoplasm was composed of tumor cells with abundant clear cytoplasm and round nuclei. The histological characteristics of this thyroid tumor were virtually identical to the renal cell carcinoma resected3 years previously. Thyroglobulin stained negatively in the clear cells of the resected thyroid tumor in an immunohistochemical analysis. Clinically, the thyroid gland is a rare site of tumor metastasis; however, we should also consider the possibility of metastasis in the case of thyroid tumor patients with a history of renal cell carcinoma. Received: March 3, 2000 / Accepted: September 26, 2000     

Urothelial carcinoma (clear cell variant) diagnosed with useful immunohistochemistry stain

The case is reported of urothelial carcinoma (clear cell variant) that was diagnosed with useful immunohistochemistry stain. A 70-year-old man, who had undergone left radical nephrectomy for renal cell carcinoma in August 2003 and partial lobectomy for pulmonary metastasis in May 2005, complained of hematuria in June 2005. On evaluation, a papillary pedunculated tumor was detected in the left wall of the urinary bladder. A transurethral resection of the bladder tumor (TUR-Bt) was performed in July 2005. The pathological diagnosis was difficult due to diffuse clear cell appearance. Immunohistochemistry stain showed urothelial carcinoma, not metastasis of the renal cell carcinoma. Finally it was diagnosed as urothelial carcinoma clear cell variant. Urothelial carcinoma has many variants that show a variety of appearances and characteristics. These should be well known before medical therapy is initiated.     

Late metastasis of renal cell carcinoma to the submaxillary gland 10 years after radical nephrectomy

Renal cell carcinoma metastasis to the submaxillary gland after tumor nephrectomy has not been previously recorded in the literature. Most reported cases have involved the parotid gland. We report in this article the first case of solitary submaxillary gland metastasis from clear cell renal cell carcinoma in an 83-year-old man who presented 10 years after primary treatment. The submaxillary gland was excised with preservation of the facial nerve.     

Contralateral ureteral metastasis 4 years after radical nephrectomy

IntroductionMetastasis of renal cell carcinoma to the contralateral ureter is extremely rare. To date, only 50 cases of metastatic RCC to the ureter have been reported, among whom 6 cases occur at the contralateral site. We herein report a rare case of metastatic RCC in the contralateral ureter 4 years after radical nephrectomy.Presentation of caseA 74-year-old man presented with gross, painless hematuria for one month. Computed tomography scan confirmed that a 1.5 cm × 0.5 cm tumor occurred in the contralateral distal ureter. A 3.5 cm segment of ureter was resected and a uretero-vesical anastomosis with psoas hitch was accomplished.DiscussionThe reappearance of hematuria after radical nephrectomy is the most common manifestation of the metastasis to the bladder or ureter. The mechanism of metastasis is not clear. In pathology, vimentin and cytokeratins might help to differentiate between metastatic clear cell renal cell carcinoma and clear cell transitional cell carcinoma.ConclusionMetastasis of renal cell carcinoma to the contralateral ureter is rare. Early recognition is extremely important in protecting the remaining renal function and prolonging life-expectancy for post-nephrectomy patients. Complete metastectomy suitable anastomosis have been shown to improve survival.     

Primary signet-ring cell carcinoma of the urinary bladder inducing renal failure

A case of primary signet-ring cell carcinoma of the urinary bladder that was found to have induced renal failure is the second such case reported in the world. Primary signet-ring cell carcinoma of the urinary bladder is a rare histologic variant of adenocarcinoma. The patient died of distant metastasis 8 months after undergoing total cystectomy. The neoplasm had a high stage at diagnosis, so the prognosis was very poor. To improve the prognosis, earlier diagnosis and establishing a regimen of chemotherapy is necessary.     

Retroperitoneal cystic metastasis from a small clear cell renal carcinoma

A 39-year-old housewife was referred to our hospital for the treatment of a small renal tumor. A 25 x 35 mm cystic mass that had been detected by computerized tomography scan just caudal to the renal hilus proved to be a metastasis from the renal carcinoma of clear cell type. The pathogenesis may have been due to tumor cells obstructing a lymphatic vessel draining the kidney. Cystic metastasis from renal cell carcinoma is very rare and this appears to be the second published case in the world.