原发性膀胱透明细胞癌(附二例报告并文献复习)

目的：探讨原发性膀胱透明细胞癌的临床、病理、组织化学特性和诊治方法。方法：回顾分析2例患者临床资料，结合文献复习讨论。结果：2例肿瘤发生于膀胱右侧壁近膀胱颈处，以血尿就诊。组织学以大片透明样癌细胞、腺管样结构为特征。电镜下癌细胞核大而畸形，细胞器较少，部分癌细胞内有细胞内微小腺腔。免疫组化示PAS（＋）、AB（＋）。1例行膀胱部分切除术，30个月后出现淋巴结转移；1例行肿瘤电切术，15个月后未见复发。结论：此病以血尿为主要症状，病理检查才能确诊，应与转移性癌及肾源型腺瘤相鉴别，治疗以根治性手术为主，预后较其他非尿路上皮癌好。     

原发性附睾肿瘤的诊断与治疗(附35例报告)

目的:探讨原发性附睾肿瘤的诊断及治疗方法。方法:回顾性分析本院35例原发性附睾肿瘤患者的临床资料。行肿瘤切除术10例,患侧附睾切除23例,患侧睾丸附睾切除加腹股沟淋巴结清扫1例,患侧根治性睾丸切除加二期腹膜后淋巴结清扫术1例。附睾恶性纤维组织细胞瘤1例术后辅以放疗及化疗。结果:术后病理诊断良性肿瘤33例,其中腺瘤样瘤21例,平滑肌瘤7例,纤维瘤4例,乳头状囊腺瘤1例;恶性肿瘤2例,附睾恶性纤维组织细胞瘤1例,附睾腺癌1例。35例术后随访10个月至6年,未见复发、转移及死亡病例。结论:原发性附睾肿瘤术前明确诊断困难,对于高度怀疑附睾肿瘤的患者应首选手术探查,良性者可行肿瘤或附睾切除,恶性者行根治性睾丸切除加腹膜后淋巴结清扫术。     

原发性前列腺滑膜肉瘤的诊断和治疗（附1例报告及文献复习）

目的：探讨前列腺滑膜肉瘤的影像学特点、临床病理和诊治方法。方法：对1例原发性前列腺滑膜肉瘤的临床诊治资料进行回顾性分析。该例患者行超声、CT、MRI检查。手术后病理证实（免疫组化）。结果：该患者行前列腺肿瘤根治性切除术。病理：镜下所见异型性细胞片状分布,免疫组化：CK34（＋）,CD99（＋）,Ki67（＋）,MYOD1（＋／-）,Actin（＋）,CD117（＋）,dog-1（＋／-）,Vimentin（＋）。诊断原发性前列腺滑膜肉瘤随访6个月,患者存活。结论：原发性前列腺滑模肉瘤临床罕见,确诊依赖病理及免疫组化检查。应与梭形细胞肿瘤、恶性神经鞘瘤、横纹肌肉瘤、间质肉瘤鉴别。治疗以手术为主,需根据肿瘤分级分期决定手术方案及术后是否需行辅助治疗。     

肾癌附睾转移一例报告

患者，男，50岁。左肾癌根治术后2年，发现左阴囊内肿块于2005年4月入院。患者3年前因左腰部酸痛伴全程肉眼血尿入院，B超示左肾实质性肿瘤，腹主动脉旁未见淋巴结肿大。CT示左肾巨大占位，直径约10cm。行左肾肿瘤根治性切除术。术后病理示：肾透明细胞癌，累及肾盂，未侵犯肾包膜，肾门处血管未见癌浸润，肾门及腹主动脉旁淋巴结未见转移，肾盂未见癌浸润。S-100蛋白、p21单克隆抗体、癌胚抗原（＋），增殖细胞核抗原60％（＋），p53单克隆抗体、波形蛋白（-）。术后未进行其他辅助治疗。     

泌尿系统肉瘤样癌和癌肉瘤八例报告并文献复习

目的 探讨泌尿系统肉瘤样癌和癌肉瘤的组织学特点、临床表现、治疗和预后.方法 泌尿系统肉瘤样癌和癌肉瘤8例.其中膀胱肉瘤样癌4例,男3例,女1例,年龄58、63、78、79岁,均因无痛性肉眼血尿就诊,肿瘤直径平均4.5(1.5～6.7)cm,为不规则、广基的浸润性肿物.行膀胱部分切除术2例,TURBt 1例,膀胱癌根治术1例.肾肉瘤样癌1例,男,64岁,因肉眼血尿就诊,伴同侧肾上腺和胰腺转移,行肾癌根治术和胰腺体尾切除术.转移性右肾上腺肉瘤样癌1例,男,47岁,原发灶为左肺肉瘤样癌,行左肺下叶和右肾上腺切除术.肾盂癌肉瘤1例,女,64岁,表现为无痛性肉眼血尿,行左肾、输尿管及部分膀胱切除术.膀胱癌肉瘤1例,男,77岁,无痛性肉眼血尿,肿瘤直径2.5～3.0 cm,行TURBt术.8例均经病理检查确诊.8例均获随访,随访时间36～96个月.结果 膀胱肉瘤样癌4例中:1例G_3、T_(2a)者行TURBt,术后行丝裂霉素膀胱灌注化疗,随访96个月无瘤生存;1例63岁女性先行TURBt,术后病理为肉瘤样癌、T_1伴有原位癌(T_m),1个月后行膀胱癌根治切除术.随访36个月无瘤生存;1例T3a者行膀胱部分切除术,术后辅以放疗,随访36个月无瘤生存;1例T4a者行姑息性膀胱部分切除术,术后病理切缘阳性,术后2个月死于肿瘤多脏器转移.肾肉瘤样癌患者术后2个月开始化疗(盐酸吉西他滨加卡铂),又出现肝、肺转移,术后5个月死亡.转移性右肾上腺肉瘤样癌患者术后在外院行3个疗程化疗(顺铂加依托泊苷),5个月后出现左肾上腺转移,术后7个月死亡.肾盂癌肉瘤患者的肿瘤以软骨肉瘤为主,伴少许鳞状细胞癌及未分化癌,随访60个月无瘤生存.膀胱癌肉瘤患者肿瘤病理分期为T2a,主要是平滑肌肉瘤,伴有鳞状细胞痛和腺癌,术后予以全身化疗(盐酸吉西他滨加卡铂),随访12个月死于慢性阻塞性肺气肿、肺部感染.结论 泌尿系统肉瘤样癌和癌肉瘤少见,多见于老年男性,恶性程度高,浸润性强,预后差.肿瘤的病理分期和治疗是影响预后的因素,早期诊断和积极的综合治疗可望获得较好的治疗结果、延长患者生存期.     

前列腺原发移行细胞癌（附1例报告）

目的 提高对前列腺原发移行细胞癌的认识，探讨其诊治方法。方法 通过诊治1例原发前列腺移行细胞癌（PTCC）患者，并复习相关国内外文献进行讨论。结果 患者行根治性前列腺膀胱切除术，病理证实为PTCC，免疫组化染色：S100阴性（-），CK阳性（＋＋＋），P53阳性（＋＋＋），PSA阴性（-），术后随访至今无瘤存活。结论 原发PTCC比较少见，其临床表现无特异性，确诊依靠病理学检查，其恶性程度高，对激素治疗不敏感。早期发现并手术，术后联合放疗有望提高疗效。     

附睾腺瘤样瘤1例报告

患者男性,32岁,因左附睾无痛性肿物2年于1988年11月25日入院。查左附睾尾部有一约1.5×1.0×1.0cm椭圆形肿物,表面光滑,质地硬,与皮肤无粘连,无压痛。左侧睾丸、输精管无异常。血沉1mm/小时,肾图及IVP正常,诊断为左附睾结核。于12月5日在局麻下行左侧附睾切除术。术后标本剖面外层为纤维状,核心为乳白色组织。病理报告:附睾腺瘤样瘤(adenomatoid tumor)。讨论:原发性附睾肿瘤中以腺瘤样瘤最多见。国外统计附睾腺瘤样瘤占附睾良性肿瘤半数以上。国内统计文献报告的87例附睾良性肿瘤中腺瘤样瘤占44例,超过良性肿瘤     

原发性精囊透明性细胞癌1例报告并文献复习

目的:探讨原发性精囊透明细胞癌的临床表现、病理特征及诊断治疗。方法:对我院收治的1例原发性精囊透明细胞癌患者的临床资料进行回顾分析,并复习相关文献。结果:本例患者因反复血精2年入院,术前经影像学及精囊镜活检证实为右侧精囊原发透明细胞癌,免疫组织化学检查示PSA-,CK7-,CD125-,CD20-,RCC+,CD10+,EMA+,行开放性膀胱前列腺精囊切除术、盆腔淋巴结清扫术及回肠膀胱术。术后随访1年,未见肿瘤复发及肾脏占位病变。结论:原发性精囊癌病理分型为透明细胞癌类型极为罕见,手术为其主要治疗方法,需达到肿瘤切缘阴性,术后是否行抗雄激素治疗或放化疗等辅助治疗尚存在争议。     

原发性气管肿瘤的外科治疗

目的探讨原发性气管肿瘤外科治疗特点及预后,提高其诊治水平。方法回顾性分析1982年2月至2009年8月中南大学湘雅医院和湖南省肿瘤医院收治的38例原发性气管肿瘤患者的临床资料,其中男24例,女14例;年龄7～65岁。良性病变2例,腺样囊性癌13例,鳞癌11例,粘液表皮样癌5例,腺癌4例,其他组织类型3例。1例行开胸探查术,33例行肿瘤切除术和气道重建术,根据肿瘤生长特征行气管环形切除术＋端端吻合术或气管楔形切除术,1例在纤维支气管镜下行乳头状瘤切除术;另3例未行手术治疗。采用Kaplan-Meier法计算生存率,采用log-rank法比较不同气管肿瘤组织类型及行不同术式患者的生存率。结果行开胸探查术1例患者术后第3d死于呼吸衰竭,围术期病死率2.94%（1/34）,余33例术后康复出院。术后早期并发症发生率35.29%（12/34）,其中肺部感染6例、肺不张4例及声音嘶哑2例。随访6个月～15年,随访率97.29%（36/37）。3例未手术患者均在出院后6个月内死亡。33例患者术后1年、5年和10年生存率分别为88%[95%CI（0.77,0.99）]、47%[95%CI（0.29,0.66）]和41%[95%CI（0.21,0.61）]。腺样囊性癌及粘液表皮样癌术后生存率明显高于鳞癌及其他组织类型（χ2=17.581,P=0.001）。患者行气管楔形切除术与环形切除术后5年生存率分别为63%[95%CI（0.34,0.91）]和77%[95%CI（0.44,0.99）],其差异无统计学意义（χ2=0.021,P=0.886）。结论原发性气管肿瘤首选手术治疗,术后远期生存率与肿瘤组织类型有关     

直肠类癌误诊为肛乳头瘤1例

患者女,47岁。以排便时肛门肿物脱出1个月入院。专科检查：齿状线上有一约1．5cm×1．5cm×1．5cm粉白色带蒂广基、质地略韧的瘤结节。临床诊断为肛乳头瘤,行肿物切除术。病理检查：组织1．5cm×1．5cm×1．5cm,表面光滑,淡黄色,质韧。镜下所见肠黏膜上皮下腺样及团状、条索状排列的瘤细胞,细胞小,多角形,核圆形,位于细胞中央,核分裂相少见。免疫组化：Syn（＋＋）,NSE（＋＋）,CgA（＋＋）。病理诊断为直肠类癌。     

原发性膀胱透明细胞癌一例报告并文献复习

目的 探讨原发性膀胱透明细胞癌的临床、病理、组织化学特征以及诊疗方法. 方法 原发性膀胱透明细胞癌患者1例,女,71岁.因尿频尿急4个月,下腹隐痛2个月入院.盆腔CT及膀胱镜检查示膀胱三角区近左侧直径约4.0 cm隆起性占位,基底宽,表面充血明显.病理活检示膀胱黏膜固有层小巢性透明细胞癌组织浸润,癌细胞排列呈大小不等腺管状、巢状分布,大部分细胞胞质丰富、透明.入院后出现反复无痛性肉眼血尿,并伴有下腹胀痛. 结果术中发现肿瘤位于膀胱左后侧壁,呈浸润性生长,膀胱组织与子宫前壁黏连明显,行膀胱部分切除、输尿管膀胱移植术联合全子宫双附件切除术.术后病理示:透明细胞癌组织浸润膀胱全层.子宫前壁内可见少量癌组织浸润,呈透明细胞癌图像.组织化学:PAS(+),免疫组化染色:CK7、CK5/6及EMA标记(+),CK20、Vimentin、Claretinin、PSA、CEA及NSE表达均为(-).电镜下瘤细胞胞质多呈大空泡状,细胞器稀少,局部残留密集的糖原颗粒;部分瘤细胞胞质器以丛状聚集的糖原颗粒和小泡状结构为主.术后行全身化疗2次,随访6个月未见复发. 结论原发性膀胱透明细胞癌是一种少见的膀胱腺癌,确诊需依据临床表现、病理学检查及组织免疫学检查.治疗以手术为主,预后好于其他非尿路上皮癌.     

A case of metastatic renal cell carcinoma to the ovary

A 52-year-old woman had a pathological fracture of the right femur. On histopathological examination bone metastasis from renal cell carcinoma was suspected. Abdominal computed tomography showed a heterogeneous mass (9.1 x 7.8 x 6.5 cm) in the left kidney and a cystic multilocular mass (12 x 10 cm) in the pelvis. Bone scintigraphy revealed an abnormal uptake in the left coracoid process, right third rib, and right distal femur and proximal tibia. Clinical diagnosis was left renal cancer with multiple bone metastases (cT2NOM1, stage IV) and a right ovarian tumor. We performed left radical nephrectomy and resection of right ovarian tumor by bilateral adnexectomy. On histopathological examination, the left kidney tumor was diagnosed as renal cell carcinoma (clear cell carcinoma with chromophobe component, G2 > G1). The ovarian tumor consisted of carcinoma of clear cell type (G2) that resembled components of left renal cell carcinoma, confirming the diagnosis of metastatic renal clear cell carcinoma to the ovary. Although she underwent immunotherapy with interferon, she died 10 months after nephrectomy. Metastasis to the ovary from renal clear cell carcinoma is very rare and only 18 cases have been reported in the literature. This rarity may be related to the difficulty of differential diagnosis between metastatic renal cell carcinoma to the ovary and primary ovarian clear cell carcinoma. Elaborate analysis of microscopic features and immunohistochemical profiles may help in the distinction of this metastatic lesion.     

Renal cell carcinoma metastatic to the ovary: a case report]

A 47-year-old woman underwent left radical nephrectomy in 1995, and pathological diagnosis showed a primary renal cell carcinoma with clear cell subtype. Four years later on her routine checkup, abdominal computerized tomography revealed a 9-cm of predominantly solid and partially cystic tumor in the pelvic cavity. The patient was referred to Gynecologic Department and a total hysterectomy with bilateral salpingo-oophorectomy was subsequently performed under the diagnosis of a left ovarian tumor. A cut surface of the solid component of the tumor was macroscopically yellowish. Pathological examination revealed alveolar growth of tumor cells with abundant clear cytoplasm including fat components. In some areas of the tumor, there were patterns of tubular structures which were cystically dilated. The typical findings usually found in the primary ovarian clear cell adenocarcinoma were absent in the tumor, and the final pathological diagnosis was left ovarian metastasis of renal cell carcinoma. The ovarian metastasis of renal cell carcinoma is quite rare and to our knowledge only eleven cases were reported in the past 20 years. We report on a case and review the literature.     

Clear cell papillary cystadenoma of the epididymis and mesosalpinx: immunohistochemical differentiation from metastatic clear cell renal cell carcinoma

Clear cell papillary cystadenoma is a rare epithelial tumor of the epididymis, which may present as an isolated lesion or as a component of von Hippel-Lindau disease (VHLD). Recently, tumors have also been described in the female genital tract with similar histology. Recognition of clear cell papillary cystadenoma is critical because of its association with VHLD and its potential diagnostic confusion with metastatic renal cell carcinoma because of a shared architecture and clear cells. In this study, we report on the immunohistochemical differentiation of 5 clear cell papillary cystadenomas, 3 of the epididymis and 2 of the mesosalpinx, from metastatic renal cell carcinoma. In 2 cases, there was a history of renal cell carcinoma in the setting of VHLD; and in 1 of these cases, an epididymal papillary cystadenoma was initially considered to be metastatic renal cell carcinoma. Immunohistochemically, tumor cells were moderately intensely positive for cytokeratin AE1/AE3 and epithelial membrane antigen, strongly positive for CK7 and negative for CK20 and RCC. Four of 5 cases were negative for CD10. This staining profile contrasts with that reported for clear cell renal cell carcinomas, which are typically negative for CK7 and immunoreactive for renal cell carcinoma (RCC) and CD10. Our findings indicate that, in cases where there is uncertainty about the histologic diagnosis of clear cell papillary cystadenoma, the above immunohistochemical panel helps to rule out metastatic renal cell carcinoma.     

原发性附睾富于细胞性血管纤维瘤1例报告并文献复习

目的 探讨原发性附睾富于细胞性血管纤维瘤的临床病理特征、诊治方法及预后,加强对附睾良性肿瘤病理类型和诊断的认识.方法 回顾性分析1例附睾富于细胞性血管纤维瘤的病例资料,并结合相关文献进行复习讨论.结果 患者右侧阴囊内肿物被完整切除,镜下见肿瘤境界清楚,似有纤维包膜,主要由稀疏小梭形细胞以及丰富胶原和散在分布的小血管组成.免疫组化:SMA(血管壁+),Caldesmon(血管壁+),Desmin(血管壁+),ER(梭形细胞+),AR(梭形细胞+),Ki-67(-),CD34(-).最终病理诊断为(右侧阴囊内肿物)良性肿瘤,符合血管纤维瘤.术后随访6个月,未见肿块复发.结论 富于细胞性血管纤维瘤在附睾肿瘤类型中罕见,其主要好发于两性生殖区,镜下可见梭形细胞和厚壁血管分布于富含胶原纤维的间质中,属于良性的间叶性肿瘤.附睾肿瘤大部分为良性,其治疗以手术切除为主,预后良好,一般不复发.     

重复肾合并肾癌肾积水1例报告并文献复习

目的探讨重复肾合并肾癌肾积水的诊断和治疗,提高罕见病例的诊疗水平。方法回顾我院收治的1例重复肾合并肾癌肾积水患者的临床资料,结合文献讨论该病的临床特点以及诊断、治疗方法。结果患者明确诊断后行经腹左肾癌根治术,术后病理提示透明细胞癌伴淋巴结转移,给予辅助靶向治疗,随访6个月未见肿瘤复发及转移。结论重复肾合并肾癌肾积水临床上较为罕见,且影像学诊断容易误诊,CT尿路成像技术(CTU)应该成为诊断的首选。手术是首要治疗方法,一般认为早期确诊及治疗对疾病的预后有较大作用。     

A case of primary carcinoma of the epididymis

We present a rare case of primary carcinoma of the left epididymis in a 32-year-old man. Pathological diagnosis was anaplastic carcinoma of epididymis. The patient is alive and free of metastases 2 years after orchidectomy. Clinical and pathological aspects of epididymal carcinomas are discussed with reference to previously reported cases.     

非霍奇金淋巴瘤合并原发肾细胞癌：一种偶然的巧合？（1例报告及文献复习）

目的提高对非霍奇金淋巴瘤合并原发性肾细胞癌的认识,总结其临床特点。方法回顾性分析1例非霍奇金淋巴瘤合并原发性肾细胞癌的诊治经过,并结合文献报道进行分析总结。结果本例患者初诊时误诊为非霍奇金淋巴瘤伴左肾侵犯,给予CHOP方案化疗3个周期后左肾肿块较前无明显变化,行左肾肿块穿刺活检,结果为肾透明细胞癌,遂在全麻下行左肾癌根治术,术后病理证实为左肾透明细胞癌,随访12个月,未见肿瘤复发及转移。结论非霍奇金淋巴瘤合并原发性肾细胞癌临床少见,但并非偶然,需要进一步的研究来阐明两者相关的危险因素,同时在临床工作中亦需提高对非霍奇金淋巴瘤合并原发性肾细胞癌的认识。     

Metastasis to the funiculus spermaticus as the first sign of renal cell carcinoma

A patient who had renal cell carcinoma metastatic to the funiculus spermaticus is reported. On the basis of the detailed physical, radiological, and laboratory examinations, it was concluded that the tumor in the funiculus spermaticus represented a metastasis of clear cell carcinoma of the left kidney. The patient also had adenoma of the prostate. Surgery was performed in 2 stages. In the first stage, pannephrectomy and ablation of tumor from the funiculus spermaticus were performed. In the second stage, adenomectomy by a retropubic approach was performed 6 months following the first intervention. Histological sections of the renal tumor and of the funiculus spermaticus tumor showed clear cell carcinoma (Carcinoma lucidocellulare), while sections of the prostatic tissue showed adenomyomatosis of the prostate.     

Metastatic tumor of the epididymis from pancreatic carcinoma: a case report]

A 58-year-old male who complained of painful left scrotal swelling consulted a local clinic in August 1998. Because his symptoms did not improve after antibiotic therapy, he was transferred and admitted to Jyouhoku City Hospital on September 14, 1998. Pelvic computed tomography (CT) was performed, and revealed left epididymitis. However, antibiotic treatment did not improve the condition. Then, because carcinoma of the epididymis was suspected, left inguinal orchiectomy was performed. We found a tumor in the spermatic cord and another tumor in the epididymis. The pathological diagnosis was adenocarcinoma, and metastatic carcinoma from the digestive tract was suspected. Therefore, examinations were performed to detect the primary cancer. CT and magnetic resonance imaging (MRI) demonstrated an invasive irregular tumor from the pancreas to the left kidney. Irregular mucosa was observed by gastrointestinal fiberscopy. A biopsy was performed and the pathological diagnosis was adenocarcinoma. Based on these findings, the patient was diagnosed as having a metastatic tumor of the epididymis and spermatic cord caused by pancreatic carcinoma. This is the 3rd case of adenocarcinoma of the pancreas that presented as an epididymal nodule, and this is the 12th case of adenocarcinoma of the pancreas that presented as a spermatic cord nodule.