肾细胞癌的影像分析

本文报告35例肾细胞癌,均做了CT平扫和增强扫描,并经手术、病理证实.本文详细描述了肾细胞癌的CT表现,并总结肾细胞癌的诊断依据,指出CT在肾细胞癌分析中所起的作用及鉴别诊断的要点.     

一肾内同时存在肾细胞癌和移行细胞癌(文献复习及附一例报告)

作者结合文献及个人工作实践报道—肾内同时存在肾细胞癌和移行细胞癌共23个病例。认为提高对此种病例发生的警惕性,争取术前诊断,正确处理本病及提高疗效至为重要。     

肾嫌色细胞癌1例报告

嫌色细胞型肾细胞癌(chromophobe renal cell carcinoma,CRCC)是肾细胞癌少见的亚型,占肾癌的5%.我科于2004年2月收治1例,现报告如下.     

肾细胞癌病理形态与临床预后的关系

One hundred and six cases of renal cell carcinoma (RCC) were studied with an objective to investigate the effects of clinical stages, histological patterns (grading), cell types, nuclear grading and tumor sizes on the postoperative survival time of the patients. The results showed that there were no statistical differences in the postoperative survival time among different histological patterns and among different cellular types, such as clear cell, granular cell and mixed cell. But those with either diffuse sarcomatoid pattern or undifferentiated cell type had poor prognosis. The patients with tumor size greater than 10 cm in diameter had poor prognosis. The prognosis-deciding factors for RCC patients were the clinical staging and nuclear grading. We suggest that the nuclear grading of RCC be noted in every pathological report, so as to provide reference for clinical evaluation of the prognosis and further treatment.     

Multicentricity and its associated factors in renal cell carcinoma

Objective To investigate the incidence and associated factors of multicentricity in renal cell carcinoma (RCC) in Chinese patients.Methods One hundred and two kidney samples from radical nephrectomy due to RCC were step sectioned at 3 mm intervals and examined. All tissue abnormalities were removed, stained and examined for multicentricity. Then, on each slice of the sample, both the parenchymal margin of 15 mm beyond the pseudocapsule and tissue around the renal sinus were continuously sectioned and examined for completeness of the pseudocapsule and vascular and lymph node invasion. The relationship between muliticentricity and other pathological parameters was evaluated..Results The incidence of multicentricity was 15.7% (16/102); it was significantly lower in primary tumors ≤4.0 cm than in tumors ＞4.0 cm (4.9%, 2/41 vs 23.0%, 14/61; χ(2)=6.055, P=0.014). The incidence was 9.8% (8/82) in tumors without vascular invasion and 40.0% (8/20) in those with it (P=0.003, Fisher’s exact test). The incidence of multicentricity was 1.9% (1/53) in tumors with a complete pseudocapsule and 30.6% (15/49) in those without it (χ(2)=15.885, P=0.000). The grade, stage, subtypes and lymph node invasion of the primary tumor were not significantly associated with multicentricity. Multiple logistic regression analysis showed that pseudocapsular incompleteness and vascular invasion were two significant predictors of RCC multicentricity (P=0.005 and 0.023).Conclusions The incidence of multicentricity of RCC in this group of patients was in accordance with published studies. Multifocality was significantly associated with tumor size, pseudocapsule completeness and vascular invasion. NSS should be limited to tumors less than 4.0 cm when the contralateral kidney is normal and careful long-term follow-up is necessary in tumors with positive vascular invasion and incomplete pseudocapsule.     

联苯胺致输尿管癌肾孟癌三例浅析

联苯胺所致的膀胱癌 ,在国内外的书刊杂志上已陆续有所报道 ,但其所致的输尿管癌和肾盂癌却较少见有报道。我公司前身为染化五厂 ,是我国生产联苯胺最早的厂家(195 6～ 1975年 ) ,我厂对联苯胺操作工 (直接接触者 2 76人 )进行长期尿脱落细胞学监护 2 0余年 ,对早期发现癌前病变 ,及时采取治疗措施 ,取得显著效果。我厂从 1970年首次发现 1例联苯胺制造工患膀胱癌至今已陆续发现 2 1例恶性肿瘤患者 ,其中膀胱癌 18例 ,膀胱癌 输尿管癌 2例 ,左肾盂癌 1例。本文侧重对后三例患者的尿脱落细胞演变过程、病史、诊断过程及治疗等依次叙述 ,并予…     

肉瘤样肾细胞癌5例临床病理学观察

目的：观察肉瘤样肾细胞癌(SRCC)的临床病理特征。方法：对5例SRCC的临床病理特征、免疫表型及影响预后的因素进行评价。结果：组织学检查分为双相性SRCC4例，由癌和肉瘤样成分组成；单相性1例，由差分化的肉瘤样梭形细胞、单核细胞与破骨细胞样多核巨细胞组成。5例肉瘤样成分角蛋白阳性，4例波形蛋白阳性。结论：SRCC为高度恶性的上皮性肿瘤，形态特征为癌细胞具有双重分化，临床分期是影响患者预后的重要因素。     

老年肾细胞癌的诊断与处理(附12例报告)

１９８４年６月～１９９７年６月，我院手术治疗肾细胞癌６８例，其中年龄在６５岁以上老年患者１２例，占１７．６％，现将老年组诊治情况分析报告如下。１临床资料１．１一般资料１２例老年肾细胞癌中，男９例，女３例。年龄６５～８２岁，平均７２．１岁。病变位于左侧...     

影响肾癌根治术后病人生存率的因素分析

目的探讨影响肾癌根治术后病人预后的因素。方法对1990年1月-2006年12月收治并采用“肾癌根治术”治疗的肾细胞癌患者359例进行随访。将所有资料编码后建立数据库，经校对无误后输入SPSS12．0统计包。采用寿命表法计算总体生存率，采用Cox回归模型比较多种因素对生存时间的影响。所有统计描述及统计分析均在SPSS12．0统计包上进行，以P〈0．05为统计学上差异有显著性意义。结果按病理分型：透明细胞癌264例，颗粒细胞癌43例，混合细胞癌29例，其他（嫌色细胞癌、肉瘤样肾癌等）23例。按TNM分期：T1N0M0　197例，T2N0M0　118例，T2N2M0　6例，T3N0M0　5例，T3N1M0　8例，T3N2M03例，T3N0M1　22例。220例获得随访。一年生存率为84．47±2．45％，三年生存率为73．26±3．28％，五年生存率为65．21±4．29％，十年生存率为55．18±7．47％。结论“性别”、“合并瘤栓”、“TNM”、“Robson”、“后期治疗”对肾癌根治术后病人预后的影响有显著意义（P〈0．05）；而“年龄”、“三联征”、“病程”、“侧别”、“合并内科病”、“手术人路”、“手术方式”对肾癌根治术后病人预后的影响无显著意义（P〉0．05）。     

肾细胞癌48例CT表现

对手术和病理证实的8例肾细胞癌均行平扫＋增强，结果：肾细胞癌CT表现为肾实质内不规则边界欠清的低密度软组织块影，动态增强后可呈一过性强化，应用动态薄层增强扫描法准确检出小肾癌（最大径＜3cm)10例，该法为目前检查小肾癌的最佳影像方法，增强前后CT扫描对肾细胞癌的定位，定性分析及术前分期均具十分重要的价值。     

肾癌细胞的增殖和凋亡状态

探讨肾癌的发生和发展机制。方法：采用免疫组织化学和原位缺口末端标记方法对４８例肾癌和３０例癌旁正常肾组织进行细胞寺殖和凋亡状态的研究。结果；４８例肾细胞增殖指数为３５．７９，对照组为２．２３，两组间经统计学分析差异非常显著。     

肾细胞癌淋巴清扫的意义

近年来，由于影像学检查的普遍应用，使得偶发肾癌诊断机率增加，但偶发癌并非低期肾癌的同义词。当前肾癌临床所面对的仍是分期诊断和手术方式选择的问题，如何选择适宜的手术，是否实行淋巴结清扫，虽有争议，但在临床上有着重要的意义。１　资料与方法１９８２～１９９２年间，我院共收治了９７例肾细胞癌患者，平均年龄５６－２岁（４２～７６）岁。男女比例为２－６∶１。入院患者均经系统检查，包括病史，体格检查，血尿液检查，胸部Ｘ线检查，腹部超声，肾脏ＣＴ或ＭＲＩ，ＩＶＵ或肾动脉造影（选择性）。当胸片模糊或Ｂ超提示其他部…     

保留肾单位手术术中切缘冰冻病理与术后病理对比分析

对163例行保留肾单位手术治疗的肾细胞癌患者术中切缘快速冰冻病理检查与术后病理检查资料进行分析。患者平均年龄58岁（21—87岁）,肾肿瘤平均大小2．8cm（1．0～4．0cm）。5例（3．1％）术中切缘病理为阳性,行。肾根治性切除,术后病理检查未发现肿瘤残余;158例术中病理为阴性者中,术后病理检查证实6例（3．8％）手术切缘存在肿瘤组织浸润。提示肾部分切除术的术中冰冻病理检查临床意义较小,对其应用价值应重新评估。     

Management of solid renal tumour associated with von Hippel-Lindau disease

Von Hippel-Lindau （VHL） disease is a rare autosomal dominant disorder caused by germ line mutations of the VHL tumour suppressor gene. it predisposes affected individuals to develop a variety of neoplasms, including haemangioblastomas of the central nervous system, retinal angiomas, renal cell carcinomas （RCCs）, pheochromocytomas and cysts of the kidneys and epididymis. Germ line VHL mutations have been found in all VHL disease families. RCC occurs in 25% to 45% of patients with VHL disease and is one of the leading causes of death.[第一段]