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。     

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.     

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。     

肾囊肿内肾癌(附四例报告)

目的 探讨肾囊肿内肾细胞癌的诊断和治疗。方法 总结６８例肾囊肿患者资料,对４例合并肾细胞癌者的资料进行分析。结果 ４例患者中术前明确诊断者２例,术中发现者２例。行肾癌根治切除术２例,行囊壁和肿物切除术２例,４例随访６～１２个月未见复发,结论 Ｂ超发现肾囊肿增长快或囊内有病变时应行ＣＴ平扫和增强扫描。怀疑肾囊肿内肾癌时应行手术探查。     

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。     

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。     

重复肾合并肾癌肾积水1例报告并文献复习

目的探讨重复肾合并肾癌肾积水的诊断和治疗,提高罕见病例的诊疗水平。方法回顾我院收治的1例重复肾合并肾癌肾积水患者的临床资料,结合文献讨论该病的临床特点以及诊断、治疗方法。结果患者明确诊断后行经腹左肾癌根治术,术后病理提示透明细胞癌伴淋巴结转移,给予辅助靶向治疗,随访6个月未见肿瘤复发及转移。结论重复肾合并肾癌肾积水临床上较为罕见,且影像学诊断容易误诊,CT尿路成像技术(CTU)应该成为诊断的首选。手术是首要治疗方法,一般认为早期确诊及治疗对疾病的预后有较大作用。     

高密度肾囊肿（附八例报告）

报告８例高密度肾囊肿，全部行Ｂ超、ＣＴ检查。其中６例ＣＴ误诊为肾癌，经手术、病理证实为肾囊肿。２例在ＣＴ引导下囊肿穿刺硬化剂治疗。就高密度肾囊肿的诊断标准、病因、ＣＴ与Ｂ超的诊断价值及处理意见进行讨论。提出高密度肾囊肿仅凭ＣＴ影象与肾癌难以区别，ＣＴ结合Ｂ超有助于提高诊断水平。     

小肾癌的影像学诊断(附43例报告)

目的 评价影像学检查在小肾癌诊断中的应用价值。方法 回顾性分析43例经手术及病理证实为小肾癌（直径≤3cm）患者的B超、IVU、CT、MRI等影像学资料。结果 43例小肾癌中，B超诊断恶性肿瘤28例，诊断准确率65．1％。29例行IVU，7例有间接征象（24．1％）。CT诊断恶性肿瘤42例，诊断准确率97．7％。14例MRI检查诊断恶性肿瘤13例，诊断准确率92．9％。结论 影像学检查中CT及CT增强扫描对小肾癌的定性、定位诊断有重要价值。     

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     

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.     

Sonographically detected malignant transformation of a simple renal cyst

The clinical course is reported of a simple renal cyst which developed into a septated renal cyst, and finally to a cystic renal cell carcinoma. A 49-year-old man, who had been diagnosed as having a renal cyst, was found by repeated ultrasonography over 6 years to have solid components developing within the cyst. Radical nephrectomy was performed, and pathological examination confirmed cystic renal cell carcinoma (RCC). This case clearly shows a natural history of malignant transformation from a simple renal cyst, and emphasizes that careful follow-up of renal cysts, especially of complicated renal cysts, is mandatory for successful treatment of RCC.     

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.     

Laparoscopic evaluation of indeterminate renal cysts: long-term follow-up

PURPOSE: We present our long-term follow-up of patients who have undergone laparoscopic evaluation for their indeterminate renal cysts, specifically reporting those patients who were found to have cystic renal-cell carcinoma (RCC) and assessing the safety and efficacy of the procedure. PATIENTS AND METHODS: Fifty-seven patients with indeterminate renal cysts (28 Bosniak category II and 29 Bosniak category III) underwent laparoscopic evaluation between July 1993 and July 2000. A transperitoneal laparoscopic localization and aspiration of the cyst, cytologic analysis, and biopsy of the cyst wall and base were performed. A total of 11 patients were found to have cystic RCC. Patients with malignancy have been followed for a mean of 40 months (range 6-70 months), and five patients had 5 years or more of follow-up. RESULTS: Eleven patients (19% of the total) were found to have cystic RCC. Three of these patients had Bosniak category II cysts, and eight had category III cysts. All tumors were low grade (I or II), and the stages were T1-2, Nx-0, M0. There has been no evidence of laparoscopic port site or renal fossa tumor recurrence, local recurrence, or metastatic disease to date in these patients. There is no cancer-specific mortality. CONCLUSIONS: Long-term follow-up indicates that laparoscopic evaluation of indeterminate renal cysts is not associated with an increased risk of port site or retroperitoneal or peritoneal recurrence of RCC. It may save a patient from undergoing open surgery and should be considered as a diagnostic option for patients with indeterminate renal cysts.     

Renal cell carcinoma- diagnosis by computed tomography

In approximately 10% of cases, renal cell carcinoma (RCC) could present as a fluid- filled cystic mass. There are three mechanisms by which RCC may become cystic: extensive cystic necrosis, intrinsic cystic growth and origin from the epithelium lining a simple renal cyst. Simple renal cysts are very common. Uncommonly these cysts are complicated by hemorrhage, infection and possibly ischemia. The goal of the radiologist in evaluating these cystic lesions is to distinguish malignant neoplastic cystic masses from non-neoplastic complicated cysts so that appropriate management can be undertaken: RCC is best treated by surgical excision while non-neoplastic complicated cysts do not require surgery. The radiologic findings in these cystic masses which must be carefully evaluated include calcification, abnormal density, septations, nodularity, wall thickening and enhancement.     

多房性囊性肾癌的诊治体会

目的:提高对多房性囊性肾癌(MCRCC)的诊治水平。方法:2006年1月～2011年3月我院共收治MCRCC患者12例,男8例,女4例,平均年龄50岁。该组患者均于体检时发现。术前均行B超、CT检查,其中有3例又行MRI检查,术前诊断囊实性占位10例,诊断肾囊肿2例,4例行根治性肾切除,6例行肾部分切除,1例术中病理为良性,行去顶减压术,术后病理为恶性而二次行肾切除术。1例患者术中取病理回报为恶性而行肾切除。结果:该组患者术后病理均证实为MCRCC,肿瘤最大直径为2.5～8.0cm,平均4.0cm。TNM分期均为T1N0M0期。病理分级G110例,G22例。随访3～62个月,平均36个月,均无瘤生存。结论:MCRCC恶性度低,预后好。术前诊断主要依赖于影像学检查,但影像学检查无特异性,不易与多房性肾囊肿鉴别,肾部分切除术是治疗的最佳选择。