肾囊性病变临床病理分析（附3例报告）

目的 探讨肾囊性病变的临床病理学特点、免疫表型和鉴别诊断。方法 采用常规HE和免疫组织化学染色,观察3例肾囊性病变组织学形态,并复习有关文献。结果 3个病例临床症状均为腰痛或血尿,最后经病理确诊为囊性肾瘤2例和多房性囊性肾癌1例。囊性肾瘤为多房囊腔组织,囊壁薄,内衬单层上皮。免疫表型：上皮细胞角蛋白（CK）、上皮细胞膜抗原(EMA)均呈阳性表达;间质成分波形蛋白阳性。多房性囊性肾癌囊壁被覆单层或多层胞浆透明的细胞,间隔内含聚集的透明细胞巢。免疫表型：透明细胞CK和EMA阳性,CD68阴性。结论 囊性肾瘤和多房性囊性肾癌均是少见的肾脏肿瘤。两种病变临床症状和影像学改变极为相似,确诊需依赖病理检查。两种病变均预后良好。     

超声造影评估复杂性囊性肾脏肿物的作用

目的：探讨超声造影（CEus）在鉴别囊性肾脏肿物良恶性方面的作用,并评估CEUS在预测恶性囊性肾脏肿物组织学类型方面的作用。方法：回顾性分析2007年1月～2011年12月经常规超声（US）和CEUS检查的43例患者的43个囊性肾性肿物,诊断结果经病理及随访证实。US观察肿瘤的位置、大小、多房或单房、囊壁及分隔最厚处厚度、有无钙化、囊内有无实性结节,实性结节有无彩色血流。CEUS观察病灶的囊壁及分隔增强后厚度、多房或单房、囊壁及囊内容物有无增强、增强程度等。结果：43个病灶中良性13例,恶性30例。恶性肿物中,透明细胞肾癌21例,乳头状肾癌2例,多房囊性肾癌5例,卵巢癌肾转移2例。cEus与US诊断恶性囊性肾脏肿物的ROC曲线下面积分别为0．950、0．806,差异有统计学意义（P=0．034）。多房囊性肾癌与其他亚型囊性肾细胞癌CEUS表现有所不同。多房囊性肾癌多表现为多房囊性肿物,囊内见增强分隔,不伴囊内增强实性结节。其他亚型肾细胞癌多可见囊内增强实性结节。结论：CEUS有助于囊性肾脏肿物良恶性鉴别及恶性囊性肾脏肿物组织学类型的判断。     

多房性囊性肾细胞癌一例报告

多房性囊性肾细胞癌是肾癌的少见类型 ,是一种恶性程度较低的肿瘤 ,需要与多种呈囊性表现的疾病进行鉴别。我院收治 1例 ,报道如下。患者 ,男 ,6 3岁。 1个月前用力后觉右上腹痛 ,外院ＣＴ检查发现“右肾上极占位病变”于 1998年 11月 2 5日转入我院治疗。无血尿 ,血沉在正常范围。Ｂ超见右肾上极有一 2 .7ｃｍ× 2 .3ｃｍ以液性回声为主的区域 ,有中等回声间隔 ,最厚处约 0 .6ｃｍ ,将液性范围分隔为三个部分 ,印象为囊实性肿物 ,性质难以确定。ＣＴ平扫示右肾上极一类圆形低密度区 ,ＣＴ值 2 2 .6ＨＵ ,增强后扫描显示病灶不均匀强化 ,延…     

肾脏混合性上皮间质肿瘤一例

正患者女,65岁。因"体检发现右肾囊肿2周"入院。CT检查显示右肾大小约7.8 cm×8.8 cm×7.5 cm的低密度影,内见线样分隔;增强后无强化;邻近肾盂、肾盏受压(图1~图4)。在全麻下行腹腔镜右肾探查术。术中见右肾上极与周围严重粘连。右肾上极8.0 cm×9.0 cm×8.0 cm多房囊性肿物,内充满淡绿色清亮液体,囊腔直径0.5~3.0cm,部分囊壁较厚呈厚实性(图5)。术     

成人型多囊肾囊内肾癌1例

患者 ,女 ,6 7岁。家族中有常染色体显性遗传性多囊肾 (ＡＤＰＫＤ)病史。发现右肾囊肿内实性占位病变 3个月入院。患者 1 5年前Ｂ超检查发现双肾、肝、脾脏小囊肿 ,右肾下极错构瘤 (ＡＭＬ)。 3个月前例行Ｂ超复查 ,发现右肾上极有一直径为 2 .8ｃｍ囊肿壁增厚 ,其内有 1 .1ｃｍ× 1 .0ｃｍ中等强回声 ,回声均匀 ,有点状血流信号。ＣＴ增强扫描示囊壁肿物有强化 ,ＣＴ值明显低于同期肾实质。ＭＲＩ检查示右肾上段有直径为 2 .8ｃｍ囊内实性肿物 ,并可见实性肿物明显不均匀强化 ,考虑为右肾癌。患者无血尿、腰痛、腹部包块等症状 ,血常规、…     

重复肾囊性肾癌一例报告

患者,男,48岁.主因“肉眼血尿伴右腰疼痛1d”于2010年8月1日入院.查体右肾区叩痛,余未见异常.血常规:白细胞16.15×109/L.B超检查示右肾下极直径约12 cm囊实性占位,多普勒超声检查示肿物实性部分血流丰富.CT检查示右肾下极实质内囊实性肿块,大小为11.2cmx9.7cm,增强后皮质期其内实性成分及分隔可见明显强化,并可见明显强化壁结节影,实质期强化程度减低,肾盂期呈低密度影,其内囊性部分于增强各期均未见强化;右肾盂内高密度影未见强化;重建示右肾可见副肾动脉,起源于L4水平腹主动脉,包绕并进入右肾下极肿块.     

肾炎性肌纤维母细胞瘤一例报告

患者,男,44岁.因左下腹隐痛伴间断肉眼血尿1周于2009年6月3日人院.查体:左肾区轻度叩击痛,双侧输尿管走形区无压痛、叩击痛,未扪及包块.尿常规示红细胞(+++).B超检查示左肾下极类圆形囊性低回声肿物,大小约4.0 cm×5.0 cm,内部回声尚均匀,壁呈略高回声;多普勒超声示肿物内血流较少,考虑左肾囊实性乏血供型占位,肾癌伴坏死可能.CT平扫示左肾中下部见囊样低密度占位,部分突出于肾轮廓外,边缘见稍高密度厚壁影,与正常肾组织境界欠清;三期动态增强扫描示肿瘤囊壁厚薄不均,轻度强化,以延迟期明显,肿瘤内低密度灶未见明显强化,未见明显分隔征象.     

隆乳术后并发腋窝囊状淋巴管瘤一例

患者女,51岁,洗澡时发现左侧腋窝肿物1周来我院外科就诊,患者7年前曾行硅凝胶假体隆乳术.查体:左侧腋窝近胸大肌后缘可见隆起,可触及8 cm×7 cm大小质软肿物,移动度大.B超检查发现:双侧乳房各组织层次显示清晰,双侧胸大肌深方见边界清晰的无回声区,左侧腋下皮下软组织内见不规则的7.2 cm×6.6 cm无回声区,内部见多个分隔样强回声,边界清晰,提示:左腋下多房性囊性病变,假体破裂硅凝胶外渗所致.     

同侧肾脏的同时性重复癌1例

患者,男,81岁.因B超检查发现右肾占位5d入院.无腰腹部疼痛及肉眼血尿,无发热.体检:一般状态可.彩超提示右肾占位性病变,左肾囊肿;CT平扫 增强提示右肾占位、右肾癌可能性大,左肾囊肿;IUP示右肾上盏消失、上部肾盂内可见充盈缺损.尿脱落细胞学检查阴性.血、尿常规及各项生化学检查未见异常.术前诊断为"右肾癌"于2002年5月22日在全麻下行经腰根治性右肾切除术.右中取出右肾纵行剖开后可见两个肿物.一个位于上极肾实质,直径约3.0 cm,切面黄黑相间;另一个位于上部肾盂内,直径约2.0 cm,呈菜花样.根据大体标本所见补充诊断为右肾癌并发右肾盂癌,另取Gibson切口行右侧输尿管部分膀胱切除术.术后病理诊断:透明细胞癌和移行细胞癌工～Ⅱ级.术后1年复查未见复发、转移.     

胰尾内异位副脾表皮样囊肿一例

患者男,42岁.因"发现胰尾部占位8个月余"入院.否认外伤史及胰腺炎病史.查体:皮肤巩膜无黄染,全腹无压痛,未及腹部包块.CT示胰尾部可见一大小约为1.7 cm×1.5 cm的低密度类圆形小肿块,未见明显强化,边界欠清(图1).临床诊断:胰尾部占位.行保留脾脏的胰尾切除术,术中见肿物位于胰尾的背面,质软,色泽暗红.手术顺利,术后9 d康复出院.病理报告:切除胰尾内有一大小为2.0 cm×1.6 cm×1.6 cm囊性肿块,界清,单房性,囊液淡黄色,浑浊,切面见囊肿外围约2/3被一肿块包裹,3.0 cm×2.0 cm×2.0 cm,与周围胰腺组织界限清楚,灰红色,质软.镜下:副脾组织内见多个囊腔样结构,囊壁内多量淋巴细胞浸润,并衬以鳞状上皮(图2),该内衬上皮CEA和CA199(+).病理诊断:"胰尾"副脾表皮样囊肿.     

Cystic renal cell carcinomas in adults. Is preoperative recognition of multilocular cystic renal cell carcinoma possible?

PURPOSES: We correlated clinicopathological and imaging features of multilocular cystic renal cell carcinoma (MCRCC) to propose preoperative criteria for therapeutic modalities. MATERIALS AND METHODS: A total of 24 RCCs with a chiefly cystic component were identified from 1993 to 2002. In each case histological slides and available imaging studies were retrieved. Two tumor groups were defined, namely MCRCC and clear RCC with cystic change (CRCC) by intrinsic growth or necrotic degeneration. Radiological correlation using computerized tomography and magnetic resonance imaging was performed considering criteria such as an expansile nodule, cyst wall thickness and septa. RESULTS: On imaging MCRCC presented as a multilocular cystic mass lacking an expansile nodule, and with regular thin cyst wall and septa. On pathological study MCRCC presented as complex, multilocular cystic carcinoma with septa covered by low nuclear grade clear renal tumor cells without a grossly expansile nodule. They were staged pT1 with a free clinical course. In contrast, CRCC was identified on imaging with an expansile nodule (5 mm or greater), thick, irregular cyst wall and septa. On pathological study CRCC was characterized by a grossly expansile nodule in the septa and/or cyst wall. Nuclear grade and TNM stage were higher in CRCC. CONCLUSIONS: Preoperative recognition of MCRCC is possible using strict computerized tomography and/or magnetic resonance imaging criteria. The current study confirms the low malignant potential of MCRCC. Nephron sparing surgery should be proposed when MCRCC is suspected.     

多房性囊性肾癌八例报告

目的 提高对多房性囊性肾癌(MCRCC)临床、影像学和病理特点的认识及诊治水平.方法 2004年至2006年共收治符合2004 WHO诊断标准的MCRCC患者8例,其中男5例,女3例,平均年龄49岁.以肉眼血尿就诊1例,查体发现5例,初诊肾囊肿、随访发现影像学改变确诊2例.8例术前均行B超、CT检查.二维超声表现为分隔型囊性结构4例,囊实性占位3例,1例诊断为肾囊肿.CT平扫或强化后7例可见囊壁或分隔不规则增厚,但无明显的肿块及结节,1例因肿瘤较小分隔不明显.8例患者中行开放根治性肾切除术4例,肾部分切除术1例;后腹腔镜下根治性肾切除术2例,肾部分切除术1例. 结果 术后病理证实8例均为MCRCC,肿瘤最大直径2.5～10.0 cm,平均5.6 cm.镜下主要表现为纤维组织间隔被覆单层或多层透明细胞,细胞异型性小,核分裂象少.病理分级G17例,G2 1例.TNM分期均为T1 N0 M0期.7例随访6～18个月,平均8个月,均无瘤生存,未见复发转移.1例失访. 结论 MCRCC为肾癌的一种少见类型,术前诊断主要依赖于影像学检查,与其他类型肾癌相比,恶性程度低,预后良好,手术以保留肾单位的肾部分切除术为宜.     

Multilocular cystic renal cell carcinoma: report of a case

We report a case of multilocular cystic renal cell carcinoma seen in a 54-year-old man. At the annual health check he was found to have numerous cysts of various sizes in the lower pole of the left kidney. Plain CT scan disclosed a mass in the lower pole of the left kidney. On enhanced CT scan septa were visible, suggesting a multilocular cyst. Left renal arteriography disclosed a hypervascular mass in the lower pole of the left kidney. Radical nephrectomy was performed. The gross appearance of the cut surface showed a feature of multilocular cyst. The histopathological diagnosis was clear cell carcinoma. We describe the clinical features of multilocular cystic renal cell carcinoma and discuss the differential diagnosis.     

多房性囊性肾癌与肾癌出血坏死囊性变的临床比较

目的:探讨多房性囊性肾癌(MCRCC)与肾癌出血坏死囊性变(NCRCC)的临床特点,提高两种疾病的诊治水平。方法:对MCRCC及NCRCC各10例的临床资料进行对比研究,并对其囊壁增厚、强化特点等CT征象以及病理分级进行统计学分析。结果:两组患者无特异性,NCRCC组最重要的CT征象为囊壁及分隔局部结节或肿块,与MCRCC组相比差异有统计学意义(P<0.01)。MCRCC组病理分级低,与NCRCC组相比差异有统计学意义(P<0.05)。结论:MCRCC与NCRCC是两种生物学行为不同的肾癌类型,应注意鉴别,鉴别主要依靠影像学检查。MCRCC恶性程度低,预后较好。     

多房囊性肾细胞癌的临床特点及预后

目的评价多房囊性肾细胞癌的诊疗特点及预后。方法回顾性分析6例多房囊性肾细胞癌的临床特点、影像学表现、外科手术方法、病理特点,随访其预后。站果男3例,女3例,肿瘤最大直径3．0～7．5cm。CT示多囊性肿物,实性部位平扫CT值30～36Hu,皮质期88～130Hu,排泄期75～96Hu,为隔膜型增强型。腹腔镜肾部分切除术1例,根治性肾切除5例。病理TNM分期,pT1aN0M0 2例,pT1bN0M03例,pT2N0M01例,癌细胞核分级均为G1。中位随访24个月,随访期内未发现远处转移及肿瘤复发,无瘤存活100％。结论多房囊性肾细胞癌为一种特殊的病理类型,病理分期、分级低,预后良好,术前怀疑或术中证实为多房囊性肾细胞癌应考虑行腔镜保留肾单位的肾部分切除术。     

多房囊性肾细胞癌影像学特征与病理学关系的研究

目的 探讨多房囊性肾细胞癌(Multilocular Cystic Renal Cell Carcinoma, MCRCC)的影像学特征与病理学特点的关系,提高诊断水平.方法 回顾性分析24例MCRCC患者的临床资料,分析影像学及病理学的特点,探讨两者之间存在的关系.结果 所有患者术前诊断肾癌18例,肾癌坏死3例,肾复杂囊肿3例;行肾部分切除术18例,肾根治性切除术6例,术后病理20例提示MCRCC,4例提示肾透明细胞癌合并MCRCC,术后随访14~120个月,平均36个月,均未见明确的肿瘤复发和转移.结论 MCRCC是一种病因不明、恶性程度低、预后良好的疾患,提高影像学检查技术并结合病理学特点,能有效提高术前确诊率.     

多房囊性肾细胞癌2例报告及文献复习

目的：阐明多房囊性肾细胞痛（MCRCC）的概念及其鉴别诊断要点。方法：报告2例MCRCC的临床资料,结合文献进行归纳分析。结果：MCRCC病例占同期肾癌病例的0．67％。1例经影像学检查误诊为肾囊肿,1例经B超检查怀疑为“囊性肾癌”,而CT及MRI均误诊为多发性肾囊肿并结石。2例均先行保留肾单位的手术治疗,于术后病检确诊为MCRCC,然后再行根治性肾切除术。结论：MCRCC足肾癌中一种罕见的特殊类型,恶性度低,不同于其他类型的“囊性肾癌”。其术前诊断主要依赖影像学（CT或B超）检查,与良性肾囊性病变的鉴别诊断较困难;因此,确诊通常依赖术后的病理学诊断,同时需与其他类型的“囊性肾癌”相鉴别。     

Multilocular cystic renal cell carcinoma with osseous metaplasia in a 25-year-old woman

Multilocular cystic renal cell carcinoma, clear cell type, accounts for less than 1% of all renal tumors. It is characterized by variably sized, noncommunicating cysts separated by irregular, thick, and fibrous septa covered with clear cells microscopically. We report a case of a markedly calcified multilocular renal cell carcinoma, clear cell type, with diffuse osseous metaplasia.     

多房囊性肾细胞癌的临床分析及其与vonHippel-Lindau基因突变的相关性研究

目的 提高对多房囊性肾细胞癌(MCRCC)的认识及诊治水平,分析MCRCC中von Hippel-Lindau(VHL)基因的作用.方法 回顾性分析2000-2010年17例MCRCC患者资料,占同期收治512例肾癌的3.32%.男11例,女6例.年龄37～61岁,平均46岁.术前常规行B超、CT等检查,误诊为肾盂旁囊肿1例.应用PCR、PCR产物直接测序等方法分析11例MCRCC组织和相应远离病灶的正常组织中VHL基因突变的情况.结果 17例患者行根治性肾切除术14例,其中1例先行囊肿去顶术,术中囊壁组织冰冻病理检查提示透明细胞癌,改行根治性肾切除术;行肾部分切除术3例.肿瘤直径2.2～6.0 cm,平均(3.6±1.2)cm.术后病理均为MCRCC,镜下主要表现为纤维囊壁组织内衬单层或数层肿瘤细胞,核小致密,胞质透亮.TNM分期均为T1N0M0,病理分级G1 14例,G2 3例.术后随访9～36个月,平均12个月,均未见复发及转移.11例MCRCC组织中7例(64%)存在VHL基因突变,而正常组织标本均未发现VHL基因突变.结论 MCRCC作为肾细胞癌的一种少见的独立亚型,病理及临床上易漏诊或误诊.CT等影像学检查有助于术前诊断,因其预后良好,手术方式推荐保留肾单位手术.VHL基因突变与MCRCC的发生存在一定关系.

Abstract：

Objective To discuss the diagnosis and surgical management of multilocular cystic renal cell carcinoma (MCRCC) and to evaluate the gene function of the mutation of von Hippel-Lindau (VHL) gene in MCRCC. Methods Seventeen MCRCC cases (11 men and 6 women) out of 512 cases of renal cell carcinoma from 2000 to 2010 were retrospectively analyzed. The mean age of the 17 patients was 46 years (37-61 years). Ultrasonography and CT were available in all 17 cases, and 1 case was misdiagnosed as parapelvic renal cyst. The mutation of VHL gene was detected by PCR in the specimens of can-cerous tissue and adjacent normal tissue from 11 cases of MCRCC. Results Three of 17 cases underwent nephron sparing surgery, the others underwent radical nephrectomy. One case underwent unroofing of parapelvic renal cyst, but the rapid frozen pathology of the cyst wall showed renal cell carcinoma of clear type. As a result, radical nephrectomy was eventually performed. All 17 cases were confirmed as MCRCC by eva-luating pathological characteristics, such as the cyst wall lined by single or several layers of clear tumor cells and the nuclei which were small and anachromasis. Clinical stages of all cases were T1N0M0, in which there were 14 cases with pathological T1G1 and 3 cases with pathological T1G2. All patients underwent a follow-up of 9 to 36 months (mean, 12 months) without recurrence or metastasis. Mutation of VHL gene was detected in 7 of 11 cases (64%), but all adjacent normal tissues were negative. Conclusions As a rare subtype of renal cell carcinoma, MCRCC is difficult to diagnose. CT is an essential measure in diagnosis of MCRCC preoperatively. Because of the good prognosis of reported cases, nephron sparing surgery for the treatment of MCRCC is recommended. VHL gene mutations may play an important role in the carcinogenesis of MCRCC.