肾脏嗜酸细胞瘤的临床诊疗（附2例报告并文献复习）

目的：探讨肾脏嗜酸细胞瘤的症状、影像、病理、治疗及预后,以提高对该病的诊疗水平。方法：回顾分析2011年3月010月我院收治2例肾脏嗜酸细胞瘤患者的临床资料,结合文献复习并讨论。结果：2例肿瘤大小分别为3．0cm×4．0cm和1．5cm×2．0cm。1例行左肾部分切除术,另1例行后腹腔镜下根治性左肾切除术,术后病理回报均为肾脏嗜酸细胞瘤。镜检：肿瘤细胞圆形或类圆形,细胞均匀一致,呈腺泡状或管状排列,胞质内富含嗜酸性颗粒,肿瘤中心部可见玻璃样变性无细胞区;免疫组化：EMA（＋）、Vimentin（-）。本组中1例细胞核有一定程度异形性,另1例细胞核异形性明显,呈低度恶性。术后分别随访14个月及6个月,未见肿瘤复发,转移。结论：肾脏嗜酸细胞瘤是一种良性肿瘤,在临床症状、体征及影像学方面无明显特异性表现,确诊须依靠组织病理学检查。治疗以保留肾单位手术为宜,针对某些伴发恶性可能的肿瘤,肾根治性切除术也是积极的,术后需密切随访。     

29例恶性嗜铬细胞瘤诊治分析

目的总结恶性嗜铬细胞瘤的诊治经验。方法回顾性分析2003年4月至2011年1月诊治的29例恶性嗜铬细胞瘤患者的临床资料。高血压26例（89．7％）,血浆游离肾上腺素类物质（MNs）和24h尿儿茶酚胺（CA）升高者分别为92．3％（24／26）和86．2％（25／29）。B超、CT、MRI和^131I-间碘苄胍扫描（^131I-MIBG）定位准确率分别为86．2％（25／29）、96．6％（28／29）、88．9％（8／9）和81.2％（18／22）,拟诊恶性者分别为24．1％（7／29）、55．2％（16／29）、44．4％（4／9）和40．9％（9／22）。1例行放射治疗,27例行开放手术,1例行后腹腔镜手术。结果29例患者位于肾上腺17例（58．6％）,肾上腺外12例（41．4％）。首次手术根据肿瘤结构破坏、浸润生长及淋巴结转移确诊恶性13例（44．8％）。病理检查28例,确诊恶性23例（82．1％）。术后随访24例,时间4个月～8年,肿瘤复发11例,其中9例行2次或多次手术。肺转移4例,肝转移4例,骨转移3例,局部淋巴结转移4例,广泛淋巴结转移2例,2个或多个脏器同时发生转移3例。死亡4例：其余存活至今。结论病理难以区分嗜铬细胞瘤的良恶性,需结合影像学检查、生化检查及术中所见。根治性肿瘤切除是治疗恶性嗜铬细胞瘤最有效的方法,肿瘤复发时再次手术仍然有效。长期随访观察肿瘤的转移情况对最终确诊疑似病例和及时治疗尤为重要。     

异位嗜铬细胞瘤的诊断和治疗

目的探讨异位嗜铬细胞瘤的诊断和治疗特点。方法回顾分析2005年6月～2009年3月收治并经病理证实的9位异位嗜铬细胞瘤患者的临床资料。结果24h尿香草扁桃酸（VMA）及血儿茶酚胺检测升高分别为7例（77．8％）和8例（88．9％）。9例均行B超检查,5例进一步行CT检查,4例行MR;下腔静脉与腹主动脉间3例、腹主动脉旁2例、腔静脉后2例、肾蒂后2例。其中为进一步明确肿瘤毗邻关系行血管造影和CTA各1例。肿瘤平均直径（4．5±2．2）cm。9例均手术切除,术后血压正常8例,口服降压药控制良好1例。结论手术切除目前仍是异位嗜铬细胞瘤最有效的治疗方法,因肿瘤和周围大血管和器官的关系复杂,腹腔镜下肿瘤切除仍不能代替开放手术。     

后腹腔镜肾上腺嗜铬细胞瘤切除术

目的：探讨后腹腔镜手术治疗肾上腺嗜铬细胞瘤的效果。方法：回顾性分析2002年2月～2004年1月采用后腹腔镜手术治疗12例。肾上腺嗜铬细胞瘤患者的临床资料。结果：12例手术全部成功。手术时间45～190mln,平均100min。平均出血量133ml,无需要输血者。平均术后住院时间为4．4（2～8）d。切除肿瘤平均直径为36（20～60）mm,术后并发血肿1例。病理检查报告均为嗜铬细胞瘤。随访2～24个月,患者血压均恢复正常,肿瘤局部无复发。结论：后腹腔镜手术具有微创、出血少、恢复快等特点,对切除直径〈5cm的嗜铬细胞瘤是安全的。     

腹腔镜保留肾单位手术治疗早期肾癌的临床研究（附32例报告）

目的探讨腹腔镜保留肾单位手术治疗早期肾癌的方法和疗效。方法采用腹腔镜技术，术中使用超声刀、电凝钩对32早期。肾癌患者行保留肾单位手术，患者年龄31～72岁，平均49±1．8岁。肿瘤平均直径1．5±4．5cm，平均（2．8±0．8）cm。25例行后腹腔镜保留肾单位手术，7例行经腹途径腹腔镜保留肾单位手术，影像学检查示32例肿瘤突出于肾脏表面，肾上极10例，肾下极13例，肾脏中部5例，近肾盂部位4例；偏背侧18例，腹侧14例。结果32例除1例转开放手术外，余31例为腹腔镜保留肾单位的肾肿瘤切除术。平均手术时间（105±15．4）min，平均出血量（120±21．6）ml，6例术中输血400ml。2例术后发生尿漏，予负压吸引15d后引流量小于20ml后拔出肾周引流管。术后住院时间平均7～17d，平均（9±2）d。术后病理报告：肾透明细胞癌28例，肾颗粒细胞癌3例，嗜酸性细胞癌1例。随访时间3-53个月，平均（21±4）个月，肿瘤无复发。结论腹腔镜保留肾单位术治疗早期肾癌安全、可行。     

肾嗜酸细胞瘤4例临床分析

目的:探讨肾嗜酸细胞瘤的临床、影像学及病理学特点,提高对肾嗜酸细胞瘤的诊疗水平。方法:回顾性分析4例肾嗜酸细胞瘤患者的临床资料:临床表现为右上腹痛2例,另2例体检发现。2例静脉尿路造影(IVU)检查提示占位性病变,超声、CT及肾动脉造影诊断为肾癌。4例均行肾癌根治性切除术,其中2例行腹腔镜手术,2例行开放性手术。结果:术后病理检查均诊断为肾嗜酸细胞瘤。术后B超随访6～15个月,4例均未出现复发和转移。结论:肾嗜酸细胞瘤是良性肿瘤,但临床症状、影像学表现与肾癌类似,需病理检查确诊。治疗上首选保留肾单位手术,术中冷冻切片活检可对手术提供重要信息。     

肾平滑肌肉瘤1例报告并文献复习

目的：探讨肾平滑肌肉瘤（LMSK）的临床特点和诊治方法.方法：回顾性分析1例LMSK患者的临床资料,并结合文献复习讨论LMSK的临床表现、病理特点、诊治方法和预后.患者为女性,主要表现为腰部阵发性疼痛8天,B超和CT提示左肾占位性病变.行根治性肾切除术.结果：病理检查肿瘤直径6 cm,光镜下见肿瘤细胞主要为平行束状或交织束状排列的嗜酸性梭形细胞,胞核钝圆,胞浆嗜酸性.免疫组织化学染色α-平滑肌肌动蛋白（α-SMA）和结蛋白（Des）阳性,细胞角蛋白（CK）和黑色素瘤抗体（HMB-45）阴性.TNM分期为T2b N0M0,分级为G2.患者术后5个月死于局部肿瘤复发和肺转移.结论：LMSK临床少见,恶性程度高,预后差.临床表现和影像学检查无特异性表现,通常为术后病理检查确诊.手术为主要治疗手段,辅助化疗和放疗效果尚有争议.     

原发性肾上腺节细胞神经瘤的诊治分析

目的：总结肾上腺节细胞瘤的诊治方法。方法：回顾性分析1992年10月～2011年1月诊治19例肾上腺节细胞瘤患者的临床资料,并复习相关文献资料。结果：19例患者中12例经开放手术切除肾上腺肿瘤,7例行腹腔镜肾上腺肿瘤切除术,术后病理均证实为肾上腺节细胞神经瘤,术后随访2个月～14年,因心脏疾病死亡4例,脑出血死亡1例,车祸伤死亡1例,无一例患者因原发性肾上腺节细胞神经瘤死亡,随访期间肿瘤无复发和转移,预后良好。结论：肾上腺节细胞神经瘤为神经源性良性肿瘤,临床主要与静息型嗜铬细胞瘤相鉴别,对伴有疑似嗜铬细胞瘤临床表现的患者,且实验室检查与嗜铬细胞瘤相关的指标有异常时,术前准备需按嗜铬细胞瘤的要求。腹腔镜肿瘤切除可作为一线治疗方法,对于伴有周围血管脏器界限不清的肿瘤,建议行开放手术治疗。     

肾嗜酸性细胞腺瘤临床诊治及文献复习：附5例报告

目的探讨肾嗜酸性细胞腺瘤（RO）的临床诊治方法，加深对其认识，提高诊治水平。方法回顾2007年至2010年我们收治的5例RO患者的临床资料，结合文献分析。患者4男1女，年龄39～77岁，平均50．8岁。结果术前均诊断为肾癌。2例行“肾癌根治术”。3例行肾部分切或肿瘤剜除术。送检标本均证实为RO。术后恢复顺利，随访中位数15个月（9～48个月）无复发转移。结论RO是一种良性肿瘤，预后良好。术前仅靠临床症状和影像特征难以与肾细胞癌区分达到正确诊断。     

肾嗜酸细胞瘤术前诊断与治疗(附13例报告)

目的:通过对嗜酸细胞瘤的临床特点和术前影像学诊断的分析,探讨肾嗜酸细胞瘤的诊断与治疗方法。方法:回顾性分析2003~2013年我院收治的13例(男9例,女4例)肾嗜酸细胞瘤患者的临床特点、诊疗经过以及术后随访结果。结果:所有患者均接受手术治疗,其中2例行肾部分切除术,11例行肾根治性切除术,肿瘤平均直径(4.2±1.5)cm。术中均未见淋巴结转移,肿瘤位于肾实质内,呈圆形或椭圆形,与周围组织界限清晰,术前临床诊断均为肾癌,术后病理均诊断为肾嗜酸细胞瘤。患者平均随访43(7~68)个月,均无复发、进展或死亡。结论:肾嗜酸细胞瘤是一种少见的良性肿瘤,临床表现无特异性,术前容易误诊为肾癌。考虑肾嗜酸细胞瘤与肾癌相比预后良好,对于疑似病例,术前诊断应慎重,仔细分析影像学检查资料,必要时行术中冷冻病理学检查以避免不必要的肾切除。     

肾脏嗜酸细胞腺瘤6例报告

目的：探讨肾脏嗜酸细胞腺瘤的临床特征。方法：报告6例本病患者的临床资料，5例无临床表现，经B超体检偶然发现“肾脏占位”；1例腰痛、腰部不适、触及腹部包块。CT、IVU等影像学检查均有阳性发现。行肾脏部分切除术2例，根治性肾脏切除术4例。术中快速冷冻病理检查确诊。结果：6例术后均痊愈。随访13～96个月，平均78．6个月，2例随访时间未满5年，4例已超过5年（60个月），均未见肿瘤复发和转移。结论：肾脏嗜酸细胞腺瘤是一种少见的良性肿瘤，多无临床表现；影像学检查均有阳性发现；确诊有赖于病理检查，术中快速冷冻病理检查对确定术式有帮助。     

RENAL ONCOCYTOMA: MULTIFOCALITY, BILATERALISM, METACHRONOUS TUMOR DEVELOPMENT AND COEXISTENT RENAL CELL CARCINOMA

PURPOSE: We analyzed a large series of cases of renal oncocytoma to define the incidence of coexistent renal cell carcinoma, multifocality, bilateralism and metachronous tumor development. MATERIALS AND METHODS: Between 1980 and 1997, 100 men and 38 women with a mean age of 68 years with oncocytoma, were treated surgically at our institution. We analyzed tumor characteristics and reviewed specimens for coexistent renal cell carcinoma. RESULTS: Tumors were discovered incidentally in 58% of the cases. Specimens were obtained from 84 radical and 70 partial nephrectomies. Tumor size ranged from 0.3 to 14.5 cm. (median 3.2). Oncocytoma was unilateral in 131 cases (95%) and bilateral in 7 (5%), while there were multiple oncocytomas in 8 (6%). Mean followup was 41 months (range 0 to 200). The disease specific survival rate was 100% and no patient had metastasis. In 6 patients (4%) metachronous oncocytoma developed during followup. No patient had locally recurrent oncocytoma after partial nephrectomy for a solitary renal oncocytoma. Renal cell carcinoma and oncocytoma were found in 14 patients (10%), including unilateral synchronous disease in 9 and bilateral synchronous disease in 5. CONCLUSIONS: Our data support the benign nature of renal oncocytoma. Multifocality, bilateralism and metachronous tumor develop in approximately 4 to 6% of all cases. Renal cell carcinoma coexisted in 10% of oncocytoma cases.     

肾嗜酸细胞腺瘤的临床诊治分析

目的提高肾嗜酸细胞腺瘤(renal oncocytoma,RO)的诊疗水平。方法回顾分析13例RO患者临床资料。13例患者中,男4例,女9例;肿瘤单发12例,单侧多发1例;肿瘤最大直径为1.0～6.9cm,平均3.3cm;肿瘤位于左肾上极2例,左肾中极2例,左肾下极3例,右肾上极4例,右肾中极1例,右肾下极1例。所有患者术前均行B超、IVU检查,12例行CT检查,3例行MRI检查。结果 12例术前诊断为肾癌,1例考虑为RO。13例中8例行根治性肾切除术,5例行肾部分切除术。术后病理均证实为RO。随访1～183个月无肿瘤复发或转移。结论 RO是一种临床少见的良性肿瘤,术前确诊较困难,与肾癌较难鉴别,诊断有赖于病理组织学和免疫组化检查,保留肾单位手术为首选治疗方法。     

Does the finding of a indeterminate mass lesion in screening CT result in kidney loss and is postoperative follow-up necessary in renal encocytomas? A retrospective study

OBJECTIVE: Sixteen patients who were operated on with a preoperative diagnosis of renal tumor were diagnosed with renal oncocytoma between 1991 and 2004. The reliability of preoperative diagnosis, the role of screening CT in organ preservation and the need for follow-up for renal oncocytomas are discussed in the light of literature findings. MATERIAL AND METHODS: Among 345 patients diagnosed with renal tumors in the previous 13 years, the clinical and radiological features of the 16 patients with renal oncocytomas and the results during the postoperative follow-up period were evaluated in this retrospective study. The female:male ratio was 4.3. Two of the patients complained of hematuria whereas the other 14 experienced lumbocostal pain. The mean dimensions of the tumors on CT scans were 5.7+/-2.88 cm. Central fibrous scarring existed in three patients. Two patients underwent tumor enucleation, three underwent partial nephrectomy and 11 underwent radical nephrectomy. RESULTS: Screening CT could not achieve a precise preoperative differential diagnosis from malignant renal mass. The organ preservation ratio was approximately 1:3 based on the radiological diagnosis. Screening CT scans showed oncocytomas with diameters greater than those reported in the literature, indicating a need for urgent nephrectomy. No recurrences, metastases or deaths due to renal oncocytoma were observed in the postoperative follow-up period (mean 6.7+/-4 years; range 1-13 years). CONCLUSIONS: Preoperative diagnosis of renal oncocytoma is very difficult. The postoperative follow-up period in our series was 13 years, which is significantly longer than the duration proposed in the literature.     

Renal cancer in adults. Review of 68 cases

The authors report a series of 68 cases of renal cancer observed over a 9-year period. Patients consisted of 33 women (49%) and 35 men (51%), with a mean age of 53 years (range: 23-85 years). The clinical features were polymorphic, dominated by loin pain (44%), haematuria (37%), a lumbar mass (19%), alteration of the general state (7%). The diagnosis was established by ultrasonography in 59 patients and CT-scan in 63 patients. The mean tumour diameter was 11 cm (4-22 cm) and two cases presented bilateral tumours. The time to diagnosis ranged from 1 month to 7 years. Staging reflected the advanced stage of the cancer. Treatment was surgical for 58 patients (58%). A lumbar incision was performed, in 40% of cases. Radical nephrectomy was performed in 82%, and partial nephrectomy was performed in 3% of patients. Histological examination of the specimen showed renal cell carcinoma in 75% of cases. The lymph nodes removed were invaded in 20% of cases. The mean follow-up was 29 months (6 to 84 months), normal at one year for 44 patients (86%) and at 5 years for 16 patients (31%). Tumour recurrence in the renal compartment was observed in 2 patients (4%). Asynchronous metastases occurred in 11 patients (21.5%) after 21 months. (range: 12-48 months). The overall 5-year survival was 100% T1, 69% T2 and 50% T3.     

肾嗜酸细胞腺瘤国内外平均发病年龄比较及文献分析（附24例报告）

目的：掌握我国肾嗜酸细胞腺瘤患者的平均发病年龄,提高其诊治水平。方法：回顾性分析24例肾嗜酸细胞腺瘤患者临床资料：发病年龄22-84岁,其中〈40岁2例,40～49岁10例,50-59岁3例,60-69岁5例,70～79岁2例,80-89岁2例。同时复习相关文献,比较国内外该病的平均发病年龄。结果：本组24例平均发病年龄为54．5岁,术后病理检查证实均为肾嗜酸细胞腺瘤。统计国内肾嗜酸细胞腺瘤224例平均发病年龄为52岁,国外397例平均发病年龄为66岁,国内发病年龄较欧美早14年。结论：肾嗜酸细胞腺瘤平均发病年龄国内与国外报道有明显差别,应引起临床重视。     

Renal oncocytoma in Taiwan

BACKGROUND: Renal oncocytoma has been repeatedly reported in Western countries, but only a few cases have been reported in Eastern countries. This study aims to review the clinical course of renal oncocytoma in an Eastern country such as Taiwan. MATERIALS AND METHODS: Sixteen cases of renal oncocytoma seen between 1987 and 2002 at Chang Gung Memorial Hospital, Taipei, Taiwan, were studied. RESULTS: Preoperatively, all patients were diagnosed to have renal cell carcinoma, following various radiologic studies. Perioperatively, frozen sections of three patients indicated renal oncocytoma in two and renal cell carcinoma in one. Renal oncocytoma has marked similarities to renal cell carcinoma, according to various radiologic, cytologic, and pathological investigations, so an accurate diagnosis is difficult to achieve, either preoperatively or perioperatively. Therefore, rather than being treated with partial nephrectomy, all patients were treated aggressively with unilateral radical nephrectomy. Postoperatively, all 16 patients were followed up, from 12 to 189 months, with a mean of 58.7 months. Notably, all patients survived with no evidence of tumor recurrence. CONCLUSIONS: The experience in Taiwan is generally that renal oncocytoma behaves benignly, as reported in other areas. The excellent prognosis associated with this tumor appears to indicate that partial nephrectomy may suffice for removing the tumor, while sparing other unaffected renal parenchyma.     

腹腔镜肾部分切除术(附15例报告)

目的 评价腹腔镜肾部分切除术治疗肾脏肿痛的临床效果。方法 2004年1月至2005年4月采用腹腔镜经腹腔或后腹腔途径对15例肾肿瘤患者行肾部分切除术。男11例，女4例。平均年龄52岁（29～70岁）。局限性肾透明细胞癌12例，平均肿瘤直径3．0cm（2．0～4，0cm）；肾血管平滑肌脂肪瘤3例，平均肿瘤直径4．5cm（3．5～6．0cm）。观察手术时间、术中出血量、住院天数、并发症及手术效果。结果 15例手术顺利。平均手术时间120min（80～150min），术中平均出血量150ml（100～220ml），无输血、中转开放手术病例。术后无并发症，平均住院时间8d（7～9d）。随访2～16个月肿瘤无复发。结论 腹腔镜肾部分切除术安全有效，但需长期随访以确定其远期疗效。     

肾嗜酸细胞瘤的诊治（附12例报道）

目的 探讨肾嗜酸细胞瘤的诊断和治疗。方法 回顾分析12例肾嗜酸细胞瘤患者的临床资料,结合文献资料复习讨论。结果 男9例,女3例,年龄46～78岁,平均62岁。肿瘤直径2.0 ～9.2cm,平均5.4cm。1例以无痛肉眼血尿2周入院,余11例均为体检发现。CT扫描2例可见中央星芒状低密度影。肿瘤边界清楚,切面呈棕黄色,...     

Partial nephrectomy for renal tumours: the Singapore General Hospital experience.

From January 1991 to August 1998, 220 radical nephrectomies were performed for renal cell carcinoma (RCC). During the same period, 27 patients underwent partial nephrectomy for their renal tumours. These included 19 male and 8 female (mean age, 54; range, 35-75). Their clinical presentation, diagnostic modalities and surgical outcome were evaluated. The lesions included 18 RCCs, 7 angiomyolipomas (AMLs), 1 oncocytoma and 1 dysoncogenetic renal tumour. Only 8 patients had specific urological symptoms. Computerised tomography (CT) scan was diagnostic in 78% of cases. Tumour size ranged from 15-50 mm for RCC and 30-190 mm for AML, respectively. Operative time averaged 92 minutes (range: 35-145). The hospital stay ranged from 3 to 25 days (mean 11). Complications occurred in four cases (14.8%); there was one death (3.7%). No tumour recurrence was detected during a mean follow up of 20 months. None of the patients developed significant renal impairment. Partial nephrectomy is feasible in small RCC and some large AML, and can be offered in selected patients.