原发性肾脏类癌2例报告并文献复习

目的：探讨原发性肾脏类癌的临床特征及诊治方法。方法：总结2例原发性肾脏类癌患者的临床资料结合文献复习讨论。例1,女,48岁。因右腰酸痛1个月入院。B超示右肾中上极中等回声占位,边界清楚,内有血流信号。CT示右肾中上极10．0cm×7．5cm实性占位,增强后病灶均匀轻度强化。例2,男,44岁。体检发现左肾占岱40天入院。B超示左肾门处中等回声占位,边界清楚,内有血流信号。CT示左肾中极肾门处3．7cm×3．5cm实性占位,增强后病灶均匀轻度强化;其内伴-钙化点。结果：2例均行根治性肾切除术。病理检查镜下肿瘤细胞形态为多边形,嗜酸性颗粒状细胞质,边界不清,呈柱状或缎带状排列混合有实性巢状排列;细胞核呈园形大小一致,核分裂像难见。免疫组化：突触素、波形蛋白均为阳性。病理诊断为肾脏类癌伴淋巴结转移。例1术后30个月死于肝骨转移;例2术后随访26个月,未见肿瘤复发转移。结论：原发性肾脏类癌临床罕见,易发生淋巴结转移,确诊依靠病理学检查,根治性肾切除应为治疗原发性肾类癌的首选方法。     

肾透明细胞癌骨化一例报告并文献复习

目的 探讨肾癌钙化骨化的发病机理、病理特点、鉴别诊断及预后. 方法 患者,男,48岁.因体检发现右肾钙化性占位2周人院.CT示右肾外形不规则,肾上极町见一类圆形占位性病变,伴明显骨化.PET-CT检查示右肾上极类圆形肿块,明显钙化,不伴有高功能性,考虑良性病变.术前拟诊断为肾癌,取右侧腹直肌旁切口行右肾探查术. 结果 术中见右肾中上极7.5 cmX5.0cm肿块,质硬如石,肾门周围未见肿大淋巴结,行右肾部分切除,术中冰冻病理提示肾透明细胞癌伴明显骨化,即行根治性肾切除加肾门周围淋巴组织清扫.术后病理报告:肾透明细胞癌伴广泛骨化纤维化,输尿管残端、血管残端及肾周组织未见癌组织浸润,未见转移淋巴结.术后随访8个月未见复发转移. 结论 肾癌骨化较少见,肾实质性占位伴明显钙化骨化术前应按恶性肿瘤对待,肾癌骨化预后相对较好.     

马蹄肾合并高分化神经内分泌肿瘤1例报告

原发于肾的神经内分泌肿瘤(NET)占肾脏上皮恶性肿瘤不足1%, 合并马蹄肾者更罕见, 本文报道1例高分化肾NET合并马蹄肾。患者因左侧腰背部疼痛1个月余就诊, 增强CT检查示马蹄肾, 左肾肿物, 大小约5.0 cm×4.0 cm, 肿物距峡部约2 cm;峡部有单独血液供应。行腹腔镜根治性左肾切除术, 术中离断峡部, 完整切除肿瘤及左肾。术后病理为肾高分化NET。术后未行辅助治疗, 术后随访15个月, 未见肿瘤复发及转移。     

巨大肾孤立性纤维性肿瘤1例报告

孤立性纤维性肿瘤是一种罕见的NAB2-STAT6融合基因相关的间质源性肿瘤, 发生于肾脏者极罕见。本文报道1例16岁男性患者, 因左侧腰背部疼痛3年余入院, 腹部CT/MRI检查可见左肾巨大占位性病变, 行腹腔镜根治性左肾切除术, 因肿瘤巨大, 术中中转开放手术。术后病理诊断为肾孤立性纤维性肿瘤。术后随访2个月, 患者症状消失, 未见肿瘤复发。     

肾盂肉瘤样癌术后复发应用PD-1抑制剂治疗获完全缓解1例报告

肾盂肉瘤样癌在肾盂的恶性肿瘤中占比极低, 预后差。本文报道1例肾盂肉瘤样癌患者。患者以肉眼血尿为首发症状, 腹部增强CT提示左肾占位, 行单侧肾切除术, 病理提示肾盂肉瘤样癌。术后3周复查腹部CT提示肿瘤复发。予程序性死亡受体1(PD-1)抑制剂治疗, 每3周1次。治疗24周后复查CT, 提示复发的肿瘤消失。术后随访42个月, 未见肿瘤再次复发及转移。     

根治性膀胱切除+直肠代膀胱术后再发输尿管末端肿瘤1例报告

对于根治性膀胱切除+直肠代膀胱术后再发输尿管肿瘤患者, 予肾输尿管切除+乙状结肠还纳术治疗的报道少见。我院收治1例膀胱癌行直肠代膀胱术后再发输尿管肿瘤患者, 行左肾输尿管切除+乙状结肠还纳+右输尿管皮肤造口术。术后随访1年未复发。     

肺癌肉瘤一例

患者男,59岁。咳嗽、咳痰、痰中带血2个月。查体：消瘦,左肺呼吸音减弱。胸部CT示：左肺上叶有占位性病变（图1）;颅脑和腹部CT、骨核素断层扫描未见转移灶。2008年3月4日在全身麻醉下行左肺上叶切除＋纵隔淋巴结清扫术,术中见肿瘤完全位于左肺上叶内,质硬,大小约10cm×15cm,切除左肺上叶,清扫纵隔淋巴结。术后病理检查：肺癌肉瘤（鳞癌＋纤维肉瘤,图2）,纵隔及肺内淋巴结未见转移。术后3个月返院复查胸部CT示：纵隔淋巴结肿大;术后9个月电话随访患者死于肿瘤全身转移。     

肾脏原发性淋巴瘤一例报告

肾脏原发性淋巴瘤罕见 ,仅占结外原发性恶性淋巴瘤的 0 .7%。我们收检1例 ,报告如下。患者 ,女 ,5 0岁。因发热、乏力、体重减轻 3个月入院。查体 :体温 37.8℃。呼吸 16次 /ｍｉｎ。未见全身浅表淋巴结肿大。ＣＴ检查见左肾上极有一 6 .0ｃｍ× 5 .5ｃｍ的高密度肿块影 ,边缘光滑 ,密度均匀。腹膜后及胸腔内未见肿大的淋巴结。临床诊断为肾结核 ,抗结核治疗无效 ,以左肾占位转入外科行左肾根治性切除术。术中见主动脉旁淋巴结肿大 ,一并切除。术后对患者进行了化疗 ,随访 3个月未见肿瘤复发征象。病理检查 :左肾上极可见 7.5ｃｍ×6 .0ｃｍ…     

膀胱、直肠及肾多原发恶性肿瘤1例报告

多原发恶性肿瘤(MPMs)是指在同一患者同时或特定时间内诊断出两个或多个原发性恶性肿瘤, 且不代表第一个肿瘤的进展、复发或转移。MPMs极少见, 本文报道1例男性患者, 先后诊断为浸润性尿路上皮癌、直肠腺癌、肾透明细胞癌和膀胱肉瘤样癌, 分别行开放膀胱部分切除术、腹腔镜直肠癌根治术、腹腔镜左肾部分切除术+经尿道膀胱肿瘤电切术、腹腔镜根治性膀胱切除术+输尿管造口术治疗。末次手术后随访16个月, 患者一般状况良好, 未见肿瘤复发及转移。     

腹腔镜下根治性肾切除并肾静脉及腔静脉取栓术

目的 探讨腹腔镜下根治性肾切除并肾静脉及腔静脉取栓术的可行性. 方法 右肾占位病变患者2例.增强CT显示1例肿物部分延伸至肾静脉及腔静脉内,1例右肾静脉内可见充盈缺损并突入腔静脉内.均在全麻下行经后腹腔镜下根治性右肾切除及肾静脉、腔静脉取栓术.术中放置4个穿刺套管针,切断肾动脉后游离腔静脉及肾静脉,腔镜血管阻断钳部分阻断腔静脉,切开腔静脉取出瘤栓,缝合腔静脉,完整切除肾脏及瘤栓. 结果 2例患者的腔静脉瘤栓长度分别为0.3和1.0 cm,均安全取出,术后恢复良好,5 d出院.病理诊断分别为上皮样肾血管平滑肌脂肪瘤和肾透明细胞癌1～2级.术后随访5个月未见肿瘤复发和转移. 结论 对选择性肾肿瘤并肾静脉及腔静脉瘤栓患者行腹腔镜下根治性肾切除并肾静脉及腔静脉取栓术安全可行.     

Carcinoids of the kidney: case report and literature review

Primary carcinoids of the kidney are very rare, only 10 cases having been reported in the literature. The authors report a case of primary renal carcinoid in a 50-year-old woman. A radical nephrectomy with lymphadenectomy was successfully performed and there was no residual or recurrent tumour at 2-year follow-up. A review of the reported cases revealed a variable, nonspecific presentation. Most laboratory tests were non-contributory except for urinalysis. When a renal carcinoid is diagnosed, a search should be made for a possible primary elsewhere. Primary renal carcinoid does exhibit malignant behaviour. It should be managed by radical nephrectomy with retroperitoneal lymphadenectomy.     

Lymph nodal involvement by renal angiomyolipoma

Angiomyolipoma of the kidney is a clonal neoplasm, apparently part of a family of neoplasms derived from perivascular epithelial cells. A 40-year-old woman presented with right flank pain and an otherwise non-significant medical history. An abdominal computed tomography scan revealed an 18 cm solid mass in the mid-portion of the right kidney and multiple perihilar lymph nodes. Presumptive diagnosis was renal cell carcinoma. Right radical nephrectomy and a perihilar lymph node dissection was performed through a Chevron incision for the anticipated diagnosis of renal adenocarcinoma. The renal tumor was diagnosed as angiomyolipoma and a component was identified pathologically in a dissected lymph node. There was no evidence of tumor recurrence in the follow-up period of eight years. The consensus from other studies suggests that this phenomenon is a manifestation of the multicentric nature of angiomyolipoma, rather than due to metastasis. Genetic studies may resolve this question in the future.     

Two cases of renal angiomyolipoma

Two cases of renal angiomyolipoma without tuberous sclerosis are reported. The first case was of a 35-year-old man with complaints of right upper abdominal and right flank pain. Preoperative diagnosis was right renal angiomyolipoma. Thoracoabdominal radical nephrectomy and lymphadenectomy were performed. The pathological diagnosis was renal angiomyolipoma with lymph node involvement. The second case was of a 46-year-old woman whose left renal mass had been accidentally found by ultrasound study. Preoperative diagnosis was left renal angiomyolipoma. This tumor was enucleated from the left kidney through flank incision.     

Unusual solitary metastasis of the ciliary body in renal cell carcinoma

Abstract:   Renal cell carcinoma (RCC) usually metastasizes to the lung, liver, bone; ocular metastasis is uncommon. We describe a rare case of metachronous ciliary RCC metastasis in a 42-year-old man who had undergone left radical nephrectomy for conventional RCC (pT3aN0M0, G2 Fuhrman) 6 years earlier. Solitary metastasis of the left eye presented with inflammatory symptoms, but examination of the fundus and bulbar ultrasound revealed a small mass of the ciliary body. Initial radiotherapy was unsuccessful and definitive treatment consisted of ocular enucleation with radical result and no further evidence of local and distant disease. Ocular metastasis of RCC is rare, can appear years after treating the primary tumor and should not be excluded in RCC follow-up. As for other RCC solitary metastasis, the best option remains the radical surgical approach.     

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.     

Collecting duct carcinoma (Bellini duct carcinoma) of the kidney with tumor extension into the inferior vena cava]

We report a case of collecting duct carcinoma (Bellini duct carcinoma) of the left kidney accompanied with a tumor thrombus in the inferior vena cava and the lymph node metastasis. A 69-year-old male presented with gross hematuria and left flank dullness. Computed tomography revealed an isodensity tumor in the left kidney with tumor extension into the inferior vena cava and the regional lymph node swelling. The T1-weighted magnetic resonance image displayed a slightly heterogeneous low-intensity-mass. Renal angiography revealed a hypervascular tumor. We performed left radical nephrectomy with tumor thrombectomy and regional lymphadenectomy. Histopathological examination revealed a collecting duct carcinoma (pT3bN1M0V2a). Seven months after surgery, multiple metastates in bone and liver developed. Then we performed systemic chemotherapy consisting of methotrexate and cisplatin. However, the patient died from the carcinoma 10 months postoperatively.     

Unexpected renal cell carcinomas found during the operation in renal calculus: report of two cases

Case 1: A 58-year-old man was seen with dull pain over the left flank. The X-ray examination revealed a renal stone in the left kidney. On operation, a globular hard mass was found in the lower portion of the posterior aspect of the kidney from which a biopsy specimen was obtained. A frozen section study showed renal cell carcinoma, and nephrectomy was performed. The patient is well four years after the operation without recurrence or metastasis. Case 2: A 50-year-old man consulted with microhematuria pointed out in a physical examination. At the operation for renal stone, we found the mass in the lower portion of the kidney. A frozen section study of the mass revealed renal cell carcinoma. We performed nephrectomy and lymphadenectomy on the renal pedicle. The patient is well three years after the operation. We reviewed the cases of renal cell carcinoma associated with renal calculi reported in Japan and discussed how the nephrectomy should be performed according to the frozen section study.     

Primary malignant teratoma of the kidney: a rare case report and literature review

Teratomas originate from pluripotent cells and can differentiate along one or more embryonic germ lines. Renal teratoma is infrequent and malignant renal teratoma is even rarer. Experience in the diagnosis and treatment of this uncommon malignancy is seriously limited. In this report, we described the case of a 64-year-old female who complained of right flank pain for 4 months. Computed tomography (CT) revealed a hypodense mass (50 mm in maximum diameter) with slow contrast enhancement and obscure boundary located in the lower pole of the right kidney. CT also showed multiple retroperitoneal lymphadenectasis. Retroperitoneal laparoscopic right radical nephrectomy along with regional lymphadenectomy was successfully performed, and postoperative pathological examination confirmed malignant teratoma of the kidney. After surgery, the patient received adjuvant chemotherapy with BEP (bleomycin, etoposide, and cisplatin) protocol. At the 6-month follow-up, pulmonary and liver metastases were discovered by CT and the patient refused any further treatment. Unfortunately, she died at 16 months postoperatively. Although primary renal malignant teratoma is extremely rare, this kind of tumor should be taken into consideration. Currently, there is no therapeutic standard consensus for this disease and the prognosis remains unclear. Early detection and surgical intervention is critical, and more research on postoperative adjuvant therapy should be performed.     

转移性恶性肾血管平滑肌脂肪瘤三例报告

目的 探讨转移性恶性肾血管平滑肌脂肪瘤(AML)的诊断和治疗. 方法转移性恶性AML患者3例.男1例,女2例.年龄分别为36、55和37岁.主诉为持续性患侧腰痛1～6个月.2例B超、CT检查发现患肾实性占位.1例B超见肾肿块内不均匀高回声光团,CT测得脂肪负值信号.2例行根治性肾切除术,1例行肾切除术.3例均未放化疗. 结果 肿块切面灰红、灰黄,质软.病理镜下观察:2例瘤细胞呈上皮样,核有异型,伴坏死;1例大多区域为梭形平滑肌,脂肪细胞和血管混杂生长,部分区域细胞呈上皮样.免疫组化结果 均为VM(+),HMIM5(+),Melan-A(+),S-100(-),CK(-).3例病理诊断均为恶性肾AML,2例为上皮样型,1例为经典型、部分上皮样型.1例术后7年出现肺转移,行肺叶切除加清扫,随访12年无瘤生存.1例术后6年复发,行肿块切除术;术后lO年发现肝、后腹膜转移,再行肿块部分切除,随访12年带瘤生存.1例术后4个月出现肝、后腹膜转移,行肿块部分切除,3个月后失访. 结论 恶性肾AML罕见,诊断依靠病理和免疫组化检查.治疗方法无特殊.     

A case report of collecting duct carcinoma of the kidney coexistent with giant adrenal myelolipoma

Collecting duct carcinoma (CDC) of the kidney coexistent with giant adrenal myelolipoma is rare. We report a case of 70-year-old female who presented with a history of gross hematuria and back pain. On investigation, she had a mass in the left kidney and left adrenal gland, respectively. The patient underwent left radical nephrectomy with left adrenalectomy. Pathological findings revealed a renal CDC with partial aquamous metaplasia, in addition to an adrenal myelolipoma. Interleukin-2 was administered for 3 months after operation. Neither signs of recurrence nor metastasis has developed after a 4-year follow-up.