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。     

乳头状肾细胞癌的临床特征分析（附7例报告）

目的：观察乳头状肾细胞癌的临床特点,提高对其诊断要点、治疗及预后的认识。方法：回顾性分析7例乳头状肾细胞癌患者的临床资料,复习相关文献,并对患者进行随访。结果：7例患者均经病理证实为乳头状肾细胞癌,1例并发肾上腺腺瘤;首发症状主要以腰痛、血尿、消瘦、低热为主;CT影像均提示肿瘤密度在肾髓质期强化程度明显弱于肾皮质,且在肾髓质期和排泄期呈均匀强化;6例经腹行根治性肾切除,1例经腰行根治性肾切除,术后均辅以免疫治疗,未行放化疗;6例获随访,随访时间为3个月～2年,1例于术后6个月出现急性肾衰死亡,1例于12个月因肝及淋巴结转移死亡,其余4例在随访期间未出现复发和转移,无瘤生存至今。结论：乳头状肾细胞癌与其它肾细胞癌在临床表现上基本相同,但在影像学表现,病理形态及生物学行为上均与其他类型的肾细胞癌不同,诊断主要依靠CT影像,确诊有赖于病理和免疫组织化学检查,早期手术是首选治疗方式,其预后可能与分期及转移有关。     

乳头状肾细胞癌的诊断和预后

乳头状肾细胞癌 ( papillaryrenalcellcarcinoma)是一种较少的肾细胞癌病理类型 ,占肾癌的 5 %～1 0 %。发病年龄在 5 0岁左右 ,多发于男性 ,男女发病率为 ( 5～ 8)∶1。乳头状肾细胞癌往往发生在肾脏的远曲小管 ,可为多中心性和双侧性。临床上85 %的病例其肿瘤均局限于肾内 ,且形态学和细胞遗传学与传统肾细胞癌和嫌色细胞癌有明显区别 ,其诊断的确定有赖于对其特有的病理学和细胞分子遗传学特征进行分析。1　病理学特征乳头状肾细胞癌的瘤体外观呈球形改变 ,体积较大 ,直径多大于 3cm ,呈黄色或白色。肿瘤细胞为柱状上皮细胞 ,中间为纤维…     

马蹄形肾并发肾细胞癌的胚胎发生学及诊治（附3例报告）

目的：探讨马蹄形肾并发肾细胞癌的诊断与治疗，并结合胚胎发生学进展初步分析其发生的可能原因。方法：回顾性分析3例蹄形肾并发肾细胞癌患者的临床资料并复习相关文献。结果：3例均经手术和后手术病理检查证实为马蹄形肾并发肾细胞癌。1例术后3个月死于远处转移，另2例术后至今已分别生存3年和2年，无复发。结论：马蹄形肾并发肾细胞癌较罕见，诊断主要依靠影像学检查，治疗主要是行肾细胞癌根治加峡部切除术。峡部为实质的马蹄形肾来源于后生肾区域细胞的相互移行，而这种移行有可能更易导致肿瘤的发生。     

乳头状肾细胞癌临床分析

目的：总结分析乳头状肾细胞癌的临床特点,提高其诊治水平.方法：回顾性分析2003～2009年收治的乳头状肾细胞癌的临床资料.并与同期53例肾透明细胞癌比较.结果：乳头状肾细胞癌组患者年龄57.3（47～78）岁,皆为男性,占同期肾细胞癌9.4%.就诊时3例无症状,2例出现肉眼血尿,1例双侧腰痛伴腹部包块.肿瘤平均最大径为6.6（2.6～16.0）cm,未见多中心病灶.TNM分期：T1a N0 M0 3例,T1b N0 M0 1例,T2 No M0 2例 病理分型I型3例,Ⅱ型3例 Fuhrman分级Ⅱ级2例,Ⅲ级4例.与肾透明细胞癌相比,乳头状肾细胞癌好发于男性,影像学检查不具备恶性肿瘤特征,确诊有赖于病理和免疫组织化学检查.临床分期皆为I期或Ⅱ期.就诊时无一例出现远处转移.结论：乳头状肾细胞癌在临床表现上与肾透明细胞癌相似,但在影像学表现、病理形态及生物学行为上均与肾透明细胞癌有所不同.根治性肾切除术是目前首选治疗方式.靶向治疗有可能成为转移性乳头状肾细胞癌治疗的新方向.     

透明细胞乳头状肾细胞癌临床病理特征与预后分析

目的 探讨透明细胞乳头状肾细胞癌(CCPRCC)的临床病理特征和预后情况。方法 回顾性分析2011年6月—2021年10月于南京大学医学院附属金陵医院泌尿外科治疗的40例CCPRCC患者的临床、病理及随访资料。比较其与我院同时期40例透明细胞肾细胞癌(CCRCC)和19例乳头状肾细胞癌(PRCC)患者的预后情况。生存分析采用log-rank检验并绘制Kaplan-Meier生存曲线。结果 40例患者中，男性28例，女性12例；年龄31～84岁；38例为单侧，2例为双侧肿瘤；3例呈多灶性病变。所有患者均行手术治疗。肿块最大径3.0～95.0 mm,平均(27.6±18.1)mm。病理分级均为Fuhrman 1～2级。免疫组织化学检测CK7、CA-IX阳性。患者术后随访5～129个月，中位随访时间56个月：1例骨转移后死亡，2例同侧复发，1例罹患原发食管癌。CCPRCC患者生存预后明显好于CCRCC(P<0.001)和PRCC(P=0.005)患者，而CCRCC与PRCC患者预后差异无统计学意义(P=0.93)。结论 CCPRCC恶性程度低，确诊依靠特征性的病理学与免疫组化特点，手术...     

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）。     

肾梭形细胞癌的诊断和治疗(附8例报告)

目的提高肾梭形细胞癌的诊治水平和对此类型肾癌的认识。方法回顾性分析8例肾梭形细胞癌的临床资料,结合文献复习进行讨论。结果8例均行根治性肾切除术,术后病理证实为肾梭形细胞癌;随访6-17个月,7例死于术后肿瘤复发或转移,1例随访9月出现肺转移。结论肾梭形细胞癌是一种高度恶性少见的肾细胞癌,确诊有赖于影像学检查及典型病理表现,治疗以手术为主,预后不良。     

保留肾单位的肾癌切除术探讨

目的 探讨保留肾单位的肾癌切除术的适应证及术中处理。方法 肾癌患者53例。男32例，女21例。年龄21～76岁。病程1周～13个月。均经B超检查发现为单侧肾脏肿瘤，均除外对侧肾病变。肿瘤位于肾上极和下极者38例行肾部分切除术，肿瘤位于肾中部者15例行肾楔形切除术。术中肾血管全阻断，10～15min放松肾蒂钳，肾创面采用止血纱布填塞加可吸收线涤纶布外固定缝合。术后行干扰素治疗（500万U皮下注射，隔日1次，共3个月），每3个月复查。结果 肿瘤切除时间7～21min，平均12min。53例患者均经术中冰冻切片及术后病理学检查确诊为肾细胞癌，切缘阴性。肾癌最大直径6cm者1例，余均〈4cm。临床分期均为T1N0M0。术后随访6．48个月，肿瘤无复发，术侧肾脏功能良好。结论肾癌的快速切除可缩短肾血管全阻断时间，手术效果满意。对于直径〈4cm单发肿瘤或肿瘤直径〉4cm但位于肾浅表呈外凸性生长的T1肾癌，保留肾单位的肾癌切除术是值得积极尝试的治疗方式之一。     

32例囊性肾细胞癌诊治分析

目的：加深对囊性。肾细胞癌的认知,提高囊性肾细胞癌的诊治水平。方法：回顾性分析2007～2011年收治的32例具有显著囊性特点的肾细胞癌患者的临床表现、影像学、病理学及治疗手段等临床资料。结果：囊性肾细胞癌无特征性l临床表现,术前影像学检查可以提供诊断线索。28例为囊性变性肾细胞癌,4例为多房囊性肾细胞癌。21例行根治性肾切除术,10例行肾部分切除术,l例行患侧根治性肾切除及输尿管全长切除术。31例获得随访,平均随访期为18．0个月（4-49个月）。结论：囊性肾细胞癌是一类在影像学和大体病理上具有显著囊性改变的肾癌统称,临床上主要关注多房囊性肾细胞癌和囊性变性肾细胞癌两种亚型,两者在预后上存在巨大差异,应采取不同的治疗方式。     

Morphological subtyping of papillary renal cell carcinoma: Clinicopathological characteristics and prognosis

AIM: The aim of the study was to evaluate the clinicopathological and prognostic significance of morphological subtyping of papillary renal cell carcinoma (PRCC). METHODS: The patients treated for renal cell carcinoma in our department from January 1985 to March 2006 were evaluated retrospectively. Thirty-two of the 591 patients (5.4%) were diagnosed with PRCC. To determine the prognostic factors, we re-evaluated the pathological stage according to the 2002 TNM classification of malignant tumors, and the tumor type of renal cell carcinoma according to the 2004 World Health Organization histological classification. Survival was analysed using the Kaplan-Meier method and the log-rank test. RESULTS: The age at diagnosis ranged from 33 to 81 years (median: 63 years old) and the follow-up time after the surgical treatment ranged from 4 to 191 months (median: 54 months). The cancer-specific 5-year survival rate of the 32 PRCC patients was 74%. Pathologically, 17 patients (53%) and 15 patients (47%) were diagnosed with type 1 and type 2 PRCC, respectively. The type 2 PRCC patients had a significantly higher tumor grade (P < 0.001), a more advanced stage (P < 0.001), more frequent vascular invasion (P < 0.001), and a higher sarcomatoid component (P = 0.038) compared to the type 1 PRCC patients. The type 1 patients had a better cancer-specific 5-year survival rate than the type 2 patients (94% vs 50%) (P = 0.008). CONCLUSION: The morphological subtyping of PRCC is significantly associated with clinicopathological features and the prognosis. Our results provide evidence of the clinical utility of dividing PRCC into two subtypes.     

MR在肾肿瘤诊断中的应用

目的探讨MR在肾肿瘤临床诊断中的价值。方法回顾分析24例经病理证实的肾肿瘤患者临床资料,病理类型包括透明细胞性肾癌20例、乳头状肾细胞癌2例及血管平滑肌瘤2例。所有患者均行T1wI、T2WI、STIR序列检查,同时做MR动态增强扫描。结果透明细胞癌20例,T1wI均匀等信号7例,混杂信号10例,均匀低信号3例;T2WI均匀略高信号9例,明显高信号1例,混杂信号10例;显示假包膜者10例;肾窦侵犯3例,肾周侵犯4例,下腔静脉癌栓1例,腹膜后或肾门淋巴结肿大3例,腰大肌转移1例。注入造影剂后,7例病灶均匀强化,13例不均匀强化。乳头状肾细胞癌2例,T2wI低信号,增强后表现为持续轻度强化。血管平滑肌瘤2例,T1wI上的明显的高信号,T2WI为中等信号,无假包膜,脂肪可被明显抑制,无明显强化。结论MR对于肾肿瘤的术前检出、诊断有较高的准确率,具有重要的临床应用价值。     

囊性肾癌的诊治及预后(附31例报告)

目的提高囊性肾癌的诊治水平，提高对于囊性肾癌的认识。方法回顾性分析1994年6月-2004年6月收治的31例囊性肾癌患者的流行病学、病理学、临床表现、影像学特征及临床治疗资料，并与TNM分期构成与囊性肾癌组相同的21例非囊性肾癌比较预后。结果囊性肾癌无特征性的临床表现，术前影像学检查可以提供诊断线索，经病理确诊肾癌囊性变19例，多囊性肾癌9例，单纯性囊肿癌变3例。17例行根治性肾切除术，14例行单纯性肾切除术。术后21例获得随访，生存时间平均38个月。总体上与非囊性肾癌的预后尤统计学差异。站论囊性肾癌是一类在影像学和大体病理上具有囊性改变的肾癌的统称，由3种病理学类型构成，术前正确鉴别各亚型是选择手术方式和判断预后的关键。     

Increasing expression of extracellular matrix metalloprotease inducer in renal cell carcinoma: Tissue microarray analysis of immunostaining score with clinicopathological parameters

AIM: Renal tumor cell invasion is responsible for both local tissue destruction and distant metastasis. Invasion is largely mediated by matrix metalloproteases that are thought to be induced by tumor cell-derived extracellular matrix metalloprotease inducer (EMMPRIN) in surrounding fibroblasts. We hypothesized that EMMPRIN and matrix metalloproteinase-9 (MMP-9) are over-expressed in renal cell carcinoma. METHODS: Immunohistochemical analysis of EMMPRIN and MMP-9 was performed in tissue microarrays of 79 renal cell carcinomas including 12 cases of chromophobe renal cell carcinoma (ChRCC), 53 cases of clear cell renal cell carcinoma (CRCC), 8 cases of papillary renal cell carcinoma (PRCC), and 6 cases of carcinoma of the collecting ducts of Bellini (CoRCC). RESULTS: All renal cell carcinomas showed significant immunohistochemical expression of EMMPRIN. The EMMPRIN score in ChRCC (321+/-21) was significantly higher than in other histological subtypes of RCC (166+/-19 for CRCC; 276+/-24 for PRCC; 98+/-17 for CoRCC). MMP-9 was mainly expressed in tumor stromal cells and not in non-cancerous fibrovascular regions. The percent positive staining of MMP-9 at the invasive front of tumor cells was significantly higher in CRCC than in ChRCC, PRCC, or CoRCC. Higher EMMPRIN scores in CRCC were associated with shorter survival time, and correlated with higher T staging and nuclear grading. CONCLUSIONS: Our findings demonstrate for the first time that EMMPRIN is over-expressed in renal cell carcinomas. Increased expression of EMMPRIN in tumor cells is associated with poor prognosis of patients with CRCC.     

Multifocal tubulopapillary tumors of the kidney. Morphologic features and prognosis. Three cases

Tubulopapillary tumors of the kidney represent a particular group of renal tumors characterized by their less aggressive behavior. These tumors are distinguished from non papillary tumors by their morphologic, cytochemical and genotypic features. They correspond to a continuous spectrum of tumors ranging from papillary renal cell adenoma to papillary renal cell carcinoma. These TTPR show multifocal, bilateral development and chronic lesions of the kidney parenchyma in nearly all cases. The authors report three cases of multifocal TTPR, including one bilateral case. Based on analysis of these cases and a review of the literature, they discuss the histogenetic features and prognosis of TTPR.     

成人 Xp11．2易位/TFE3基因融合相关性肾癌的临床分析

目的：探讨成人 Xp11．2易位/TFE3基因融合相关性肾癌的临床特点和诊治方案.方法结合文献,回顾性分析2009年5月至2015年6月我院收治的8例经病理检查确诊为Xp11．2易位/TFE3基因融合相关性肾癌成人患者的临床资料.结果8例患者结合组织病理学和免疫组化结果得以确诊,均行手术治疗,3例辅助靶向治疗,术后随访3~69个月,5例无瘤存活,3例复发死亡.结论 Xp11．2易位/TFE3基因融合相关性肾癌是一种罕见的肾癌亚型,成年患者预后欠佳,早期诊断、积极治疗、密切随访能有效改善预后.     

Stemness-associated senescence genes as potential novel risk factors for papillary renal cell carcinoma

BackgroundPapillary renal cell carcinoma (PRCC) is the 2nd most common type of renal carcinoma; however, there is limited data about PRCC, and strategies for the diagnosis and treatment of PRCC need to be identified.MethodsIn this study, the stemness-associated senescence (SAS) phenotype of PRCC was obtained by a bioinformatics analysis. We acquired the gene expression profiles of patients with PRCC and calculated the PRCC messenger ribonucleic acid stemness index (mRNAsi). We then screened the SAS genes from the GenAge database. A least absolute shrinkage and selection operator–Cox regression was conducted to examine correlations between risk signatures and the abundance of the SAS genes in the PRCC samples. Functional enrichment analyses were then performed via molecular co-expression studies of mRNAsi, and the risk scores of PRCC patients were calculated.ResultsWe identified the following 8 SAS signatures that were strongly associated with prognosis in PRCC patients: cyclin-dependent kinase 1, heat shock protein family D member 1, platelet-derived growth factor receptor A, cyclin-dependent kinase inhibitor 2B, pyrroline-5-carboxylate reductase 1, sequestosome-1, sirtuin-3, and cyclin-dependent kinase inhibitor 1A. The SAS signatures were significantly associated with the stage and type of PRCC. The calculated risk scores can be used to divide PRCC patients into low- and high-risk groups, and provide guidance in determining treatment plans.ConclusionsWe have developed a reliable prognostic tool to predict the clinical outcomes of PRCC patients. This tool could improve treatment decisions regarding drug therapy, surgery, and conservative options.     

Tumors masquerading as type 2 papillary renal cell carcinoma: pathologists’ ever-expanding differential diagnosis for a heterogeneous group of entities

Although papillary renal cell carcinoma has historically been classified as either type 1 or type 2, data from The Cancer Genome Atlas (TCGA) has demonstrated significant genomic heterogeneity in tumors classified as “type 2 papillary renal cell carcinoma” (T2PRCC). Papillary renal cell carcinoma is expected to have a favorable clinical course compared to clear cell renal cell carcinoma (CCRCC). However, tumors with poor outcome more similar to CCRCC were included in the T2PRCC cohort studied by the TCGA. The differential diagnosis for T2PRCC includes a variety of other renal tumors, including aggressive entities such as TFE3 translocation-associated renal cell carcinoma, TFEB-amplified renal cell carcinoma, fumarate hydratase-deficient renal cell carcinoma, high-grade CCRCC, and collecting duct carcinoma. Accurate classification of these tumors is important for prognostication and selection of therapy.     

隐匿型肾癌误诊原因分析(附8例报告)

目的:探讨隐匿型肾细胞癌(ORCC)误诊的原因。方法:报告8例ORCC男性患者的临床资料:患者平均年龄65岁。术前误诊为骨肿瘤3例,左锁骨上淋巴结肿大1例,颈部肿物2例,脑肿瘤2例。8例均经手术或活检诊断为肾癌,其中4例行根治性肾切除术加内照射治疗,2例行介入治疗,2例未行介入或手术治疗。结果:随访8～18个月,4例行根治性肾切除术加内照射治疗者,存活2例,死亡2例;另4例行介入治疗或未行治疗者均死亡。结论:ORCC术前诊断困难,确诊需要病理检查。综合分析临床资料,提高对本病的临床认识是避免误诊的关键。