囊性肾癌的诊断和治疗(附7例报告)

目的：提高对囊性肾癌的认识。方法：对7例囊性肾癌的临床、超声及CT的特点，以及病理学特征、手术方式和预后进行回顾性分析。结果：术前超声诊断囊性肾癌4例，CT诊断囊性肾癌7例；术后病理诊断肾癌囊性坏死5例，多房性囊性肾癌1例，单纯性囊肿恶变1例。5例行根治性肾切除术，1例行肾部分楔形切除术，1例行肿瘤切除术。6例获随访，5例生存至今。结论：熟悉囊性肾癌的病理学特征及影像学的特点是提高囊性肾癌诊断率的关键。     

囊性肾癌15例分析

目的 提高对囊性肾癌的认识。方法 对１９８２～１９９７年收治的１５２列囊性肾癌的临床特点、影像学、病理学特征及治疗预后情况进行回顾性分析。结果 术前影像学检查提示囊肿相关肾占生病变１２例,其中伴钙化５例,单纯性囊肿３例;术中活检发现癌变２例,多房囊肿性肾癌１例。１５例均行根治性肾切除术。１３例获随访,存活时间３个月～８年,平均３．２年。结论 囊性肾癌有其独特的临床,影像及病理学特征,对不符合典型单     

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。     

囊性肾癌诊治体会

目的 提高囊性肾癌的诊治水平. 方法 回顾分析10例囊性肾癌患者术前影像学特点、病理特征和治疗方法.男7例,女3例.年龄38～74岁,平均56岁.患侧腰酸3例,体检偶然发现7例,有肾囊肿病史者2例.囊腔直径3.5～8.2 cm.术前B超检查诊断为肾癌6例,CT诊断为肾癌7例.8例术中行冰冻病理:肾细胞癌6例,未发现恶性倾向2例.10例均行根治性肾切除术. 结果 术后病理诊断:肾透明细胞癌9例,颗粒细胞癌1例.病理学分型:肾癌囊性坏死6例,多房囊性肾癌2例,肾囊肿恶变型2例.8例随访6个月～5年,6例无瘤存活,2例分别于术后13、20个月死于肿瘤转移. 结论 重视囊性肾癌独特的影像学特点、病理学特征,术中行冰冻病理检查,是提高囊性肾癌诊治水平的关键.     

多房囊性肾细胞癌诊治体会(附14例报告)

目的:加深对多房囊性肾细胞癌(MCRCC)的认识,提高术前诊断准确率并选择合适的治疗方法。方法:对我院2012年1月~2014年12月间14例囊性肾占位患者的临床表现、影像学、病理学及手术方式等临床资料进行研究与分析。结果:本研究共14例,男12例,女2例,年龄31~75岁。7例术前术后均诊断囊性肾癌,5例行肾部分切除术,2例行根治性肾切除。2例术前诊断为复杂性肾囊肿,行去顶减压术后病理结果为肾囊性透明细胞癌,1例术前诊断为双肾下极肾癌,术后病理结果为左肾透明细胞癌伴局部囊性透明细胞癌,右肾透明细胞癌;1例术前诊断为左肾多发囊肿,术后病理证实为囊性腺瘤,1例术前诊断囊性肾癌,术后病理结果为肾囊肿;1例术前诊断为双侧多囊肾伴部分囊壁钙化,术后病理为双侧多囊肾伴左肾乳头状肾细胞癌;1例术前诊断双侧多囊肾伴右肾下极占位,术后病理结果为右肾下极占位为囊性肾乳头状肾细胞癌伴有囊性肾透明细胞癌;14例患者术后随访3~12个月均未发现肿瘤复发。结论:MCRCC术前影像学容易误诊,最好的选择是保留肾单位手术,以尽量多保留肾功能以改善整体预后。     

囊性肾癌10例分析

目的：探讨提高囊性。肾癌的诊治水平的方法。方法：对10例囊性。肾癌的临床资料进行回顾性分析。术前CT诊断囊性。肾癌8例,复杂性。肾囊肿1例,单纯性。肾囊肿1例。10例均行根治性。肾切除术。结果：术后病理检查均为囊性。肾透明细胞癌,其中。肾癌囊性坏死5例,多房性囊性。肾癌2例,单纯性囊肿恶变3例。随访8例,7例术后生存至今,生存时间1个月～6年,1例术后6个月死于脑血管意外。结论：囊性。肾癌有其独特的临床、影像学及病理学特征,确诊者宜行根治性。肾切除。     

肾癌误诊为肾囊肿11例

目的 提高对囊肿相关性肾癌的诊治水平。方法 回顾性分析误诊为肾囊肿的11例肾癌的临床特点、影像学、病理学特征。结果 11例患者平均误诊3.0年,其中实质性肾癌3例,囊性肾癌8例,术中活检2例。均行根治性肾切除术。结论 肾癌影像学复杂多变,重视体检发现的肾囊肿的随访,警惕漏诊肾癌。     

腹腔镜手术治疗囊性肾癌的临床分析与体会

目的:总结腹腔镜手术治疗囊性肾癌(CRCC)的临床经验,提高临床诊治水平。方法:回顾性分析2014年10月～2018年5月我院收治的14例术前影像学诊断为CRCC并接受腹腔镜手术治疗的患者的临床资料,并定期随访。14例肾脏囊性疾病通过螺旋CT、超声检查或MRI初步诊断为CRCC,其中Bosniak分级Ⅱ、ⅡF、Ⅲ、Ⅳ级肾脏囊性疾病分别为4、2、6、2例。9例行腹腔镜保留肾单位手术(LNSS);3例行腹腔镜根治性肾切除术(LRN);1例行腹腔镜肾囊肿去顶减压术;1例行腹腔镜肾囊肿去顶减压术,术后病理考虑恶性病变再次行LNSS。结果:14例患者术后均恢复良好。术后病理检查结果显示,6例诊断为低度恶性潜能多房囊性肾癌(MCRNLMP),4例诊断为肾细胞癌囊性变(RCCC),3例诊断为单纯性肾囊肿,1例诊断为多房囊性肾瘤(MLCN)。其中11例CRCC中,T_(1a)N_0M_0期4例,T_(1b)N_0M_0期3例,T_(2a)N_0M_0期3例,T_(2b)N_0M_0期1例。随访2～46个月,其中1例RCCC患者术后9个月复发,其余均无复发和转移。结论:术前影像学诊断的CRCC病理类型多样,诊断较为困难,但Bosniak分级可以作为肾囊性肿瘤的诊断与治疗的重要依据。LNSS可作为治疗CRCC的优先选择方案,MCRNLMP预后良好,与临床分期及肿瘤体积无关,但RCCC预后不良,应根据术后病理个体化管理随访。     

囊性肾癌的诊治

目的：提高囊性肾癌的诊治水平。方法：回顾性分析我院2002～2008年间诊治的13例囊性肾癌患者临床资料,分析其影像学特点、病理检查结果及预后情况。结果：术前B超诊断为囊性。肾癌6例,CT诊断为囊性肾癌9例,其余4例依术中冷冻切片和术后病理检查结果确诊。5例为多囊性肾癌,8例为单囊性。肾癌。11例获得随访,随访3～60个月,7例存活,因癌死亡3例,1例因其他原因死亡。结论：囊性。肾癌诊断较为困难,应结合术前影像学检查、术中冷冻切片以及术后病理检查结果确诊,以免漏诊。     

囊性肾癌的临床特征(附2例报告并文献复习)

目的:总结囊性肾癌的临床特征,提高诊治水平。方法:回顾性分析2例囊性肾癌患者的临床资料,并结合相关文献就其临床特征进行讨论。结果:1例术前超声及CT诊断为囊性肾癌,经腹腔行根治性肾切除术;1例术前超声及CT诊断为肾囊肿,术后病理检查为囊性肾癌,再次经腹腔行根治性肾切除术。结论:熟悉囊性肾癌的病理学及影像学特点,是提高囊性肾癌诊断率的关键。     

囊性肾癌27例诊治分析

目的:探讨囊性肾癌(CRCC)的临床特点,提高其诊治水平。方法:回顾性分析27例CRCC患者的症状与体征、影像学表现、手术方式、病理检查及随访结果。结果:综合B超、CT、MRI、超声造影等检查诊断CRCC 24例,疑似肾癌2例,误诊为肾囊肿1例。行保留肾单位手术15例,根治性肾切除11例,肾囊肿去顶减压后再行根治性肾切除1例。病理检查报告为透明细胞癌26例,乳头状肾细胞癌1例;临床分期T1aN0M08例,T1bN0M012例,T2aN0M05例,T2bN0M02例;组织分级G16例,G221例。27例随访6~78个月,平均21个月,除1例术后3个月局部复发外,其余26例均无复发和转移。结论:综合多种影像学检查能提高CRCC的诊断率,部分患者保留肾单位手术能达到与根治性肾切除术同样的治疗效果。除肾癌囊性坏死型外,其余类型预后较好。     

肾嫌色细胞癌29例临床分析简

目的 探讨肾嫌色细胞癌的临床特点,提高其临床诊治水平。方法 回顾性分析2006年6月至2012年4月期间收治的29例肾嫌色细胞癌患者的临床资料,包括临床表现、影像学检查、治疗方法、病理分期和随访等。结果 29例患者均缺乏典型的临床症状,术前影像学检查亦未发现特异性表现。16例行根治性肾切除术,其余13例行保留肾单位手术,病理分期： pT 1 N 0 M 0 27例,pT 2 N 0 M 0 2 例。29例患者均获得随访,随访13-72个月,平均（35.0±7.2）个月,29例均无瘤生存。结论 肾嫌色细胞癌是肾细胞癌的一个独立类型,CT和B超检查缺乏特异性表现,主要通过病理学进行诊断,但CT表现与常见的肾透明细胞癌有所不同,手术切除是治疗肾嫌色细胞癌的首选方法,其预后较好。     

Cyst-associated renal cell carcinoma: Clinicopathologic characteristics and evaluation of prognosis in 27 cases

BACKGROUND: No consistent clinicopathologic characteristics of cyst-associated renal cell carcinoma (CRCC) have previously been determined. METHODS: In total, 768 patients with renal cell carcinoma (RCC) underwent radical or partial nephrectomy. Renal cell carcinoma was classified as CRCC in 27 of these patients (3.5%, subdivided into RCC originating in a cyst and cystic RCC), clear-cell RCC in 662 patients (86.2%), chromophobe cell renal carcinoma in 36 patients (4.7%) and papillary RCC in 43 patients (5.6%) according to the criteria of the World Health Organization. RESULTS: The pathologic stage and nuclear grade were usually lower in those with CRCC (low stage/low grade; 89%/96%) or chromophobe cell renal carcinoma (low stage/low grade; 89%/80%) than in those with clear-cell RCC (low stage/low grade; 59%/65%) or papillary RCC (low stage/low grade; 53%/69%). Of the 27 CRCC patients, only 19 (70%) could be diagnosed through preoperative imaging studies. Patients with CRCC showed a favorable prognosis (survival rate: 95% at 1 year, 89.7% at 3 years and 84.4% thereafter) and, especially among the patients with RCC originating in a cyst, no cancer-related death was observed. Comparing the survival among four types of RCC, a favorable outcome was observed in cases of CRCC or chromophobe cell renal carcinoma compared with clear-cell RCC or papillary RCC (clear vs chromophobe: P = 0.002; chromophobe vs papillary: P = 0.019; clear vs cyst-associated: P = 0.001; papillary vs cyst-associated: P = 0.00079). CONCLUSIONS: In cases of CRCC, the disease was usually detected at lower stages and grades and therefore the prognosis was better than in cases of other types of RCC. Preoperative diagnosis of this disease was very difficult, especially in cases of RCC originating in a cyst.     

囊性肾癌5例报告并文献复习

目的:探讨囊性肾癌的早期诊断及治疗方法。方法:回顾性分析2008年1月~2012年8月间收治的5例囊性肾癌患者的临床资料,1例术前影像学检查提示双侧肾脏占位病变,一侧为囊性占位病变;4例显示单侧肾脏单发囊性占位病变,左肾3例,右肾1例;其中男3例,女2例;年龄46~68岁,平均56.4岁;肿瘤体积21.84~208ml,平均101.96ml。按照Bosniak分类,Ⅱ类1例,Ⅲ类2例,Ⅳ类2例;T1期2例,T2期2例,T3期1例。3例术前诊断为囊性肾癌,1例为肾脏囊肿,1例为肾嗜酸性细胞瘤合并囊性肾癌。2例行肾癌根治术,2例行肾部分切除术,1例行囊肿去顶减压术后2周行肾癌根治术。并结合相关文献复习进行分析讨论。结果:5例患者术后病理检查报告证实为透明细胞癌2例,乳头状细胞癌1例,多房囊性肾癌1例,嗜酸细胞腺瘤伴囊性变1例。平均随访34.4个月(10~66个月),1例发生骨骼及肺部转移,余4例均无复发转移。结论:囊性肾癌是一种广义上的肾癌分类,有四种分型;与其他类型肾癌相比,大部分恶性程度较低。囊性肾癌的术前诊断主要依赖于影像学检查,对于可疑病例,术中需行快速冷冻病理检查。对此类肿瘤,建议行保留肾单位手术。     

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。     

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.     

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.     

多房性囊性肾癌一例报告及文献复习

目的 提高多房性囊性肾癌的诊治水平.方法多房性囊性肾癌患者1例,男,49岁.体检B超偶然发现右肾下极多囊性肿物1个月.囊内无回声区,其间混杂低回声区;CT检查右肾下极见多囊性低密度病变,边界清楚、光整,内见薄壁分隔,增强扫描分隔可见强化;MRI检查示右肾下极多囊性病变,增强扫描囊壁可见强化.行右肾部分切除术,完整切除肿瘤.结果 病理报告:肾被膜下见多房状肿物,大小约3.0 cm×2.0 cm×2.0 cm,囊壁光滑,腔内含清亮的浆液性及血性液体,囊壁厚约0.1～0.2 cm,与肾周脂肪粘连.镜下多数囊腔内衬单层或复层立方状透明细胞,细胞核小而圆,位于细胞中央,无明显核仁;有的囊腔内衬扁平上皮细胞或无内衬上皮,偶见由透明细胞覆盖的小乳头;囊腔间隔由胶原纤维组成,部分间隔内可见灶状透明细胞,但未形成肉眼可见的结节.病理诊断:多房性囊性肾癌.术后随访20个月未见复发和转移.结论 多房性囊性肾癌是肾癌的一种罕见亚型,发病率低,是一种完全由囊腔构成的肿瘤;影像学检查可提供直接依据,确诊需依靠病理学检查;外科手术治疗预后良好.