肾脂肪肉瘤3例报告及文献复习

报告３例肾脂肪肉瘤，均采用手术切除，１例未行放，化疗仅存活３个月；２例术后行放，化疗一个疗程，但仍于１４个月和２次手术后９个月死于全身转移和肠瘘。并结合文献复习，就其病理及临床表现，影像学特征、诊断和治疗进行讨论，认为此病以疼痛、体重下降、低热、白细胞增多等为主要临床表现；ＣＴ检查在术前是能够明确诊断的；其治疗以手术切除为主，术后辅以放疗和化疗，可提高生存率。     

肾脂肪肉瘤五例报告

肾原发性肉瘤临床少见 ,我们于1988年 5月～ 1999年 12月收治 5例 ,报告如下。资料与方法　本组 5例。男 2例 ,女 3例。年龄 36～ 5 5岁。左侧 3例 ,右侧 2例。 5例均有患侧腰部胀痛 ,3例伴有间歇性血尿。病程 1ｄ～ 2个月 ,平均2周。其中 1例 36岁男性患者于外伤后觉右腰部及右上腹胀痛伴血尿 1ｄ收住院。 5例均无发热及其他不适感。体格检查 :患侧上腹部触及包块 3例 ,肾区叩击痛阳性 ,所有病例全身浅表淋巴结未触及。实验室检查 :尿常规镜下血尿3例。ＩＶＵ示患肾外形增大 ,其中 4例功能丧失 ,另 1例示肾盂充盈缺损 ,上极肾盏积水 ,术前…     

原发性肾肉瘤的诊治及预后(附6例报告及文献复习)

目的：探讨原发性肾肉瘤的诊断方法、病理学特点、治疗手段及影响预后的因素。方法：回顾性分析1998～2007年期间收治的6例原发性肾肉瘤患者的临床资料：男5例,女1例,年龄39～72岁,平均58岁。左肾肿瘤3例,右肾肿瘤3例。表现为腹痛3例,腹部包块1例,阴囊坠胀1例,无症状1例。肿瘤直径2．5～13cm·平均8．1cm。T1N0M0期2例,T2T0M0期1例,L3bN1M0期1例,T4NxM1期2例。6例患者术前影像学资料均诊断为肾脏恶性肿瘤。2例T1N0M0期、1例T2N0M0期及2例T1N0M1期患者均行肾癌根治术,1例T3bN1M0期患者行肾脏姑息性切除术。4例术后实施化疗。结果：术后病理检查示平滑肌肉瘤5例,癌肉瘤1例。术后3例随访6个月～3年,其中1例（T2N0M0）于术后2年发现腹膜后转移,并于术后3年死亡,1例（T4NxM1）于术后2个月发现双肺转移,1例（T1N0M0）无瘤存活。结论：腹痛及包块是肾肉瘤的常见症状,其恶性程度高,预后差。病理分期是影响预后的重要因素。手术是其主要治疗方式,术后是否化疗尚存在争议。     

肾周围脂肪肉瘤四例报告

肾周围脂肪肉瘤临床罕见。我科近９年来收治４例。报告如下。例１,女。４２岁。因腹胀、腹部肿块１个月入院。体检：腹部左侧可扪及二个直径分别约２０ｃｍ、７ｃｍ大小肿物。Ｂ超示腹腔左侧８４ｃｍ×５．０ｃｍ、１３０ｃｍ×８．４ｃｍ大小肿物。ＣＴ示左侧腹部巨...     

肾周硬化性脂肪肉瘤的临床特点及腹腔镜治疗(附1例报告并文献复习)

目的:探讨肾周硬化性脂肪肉瘤的临床特点及腹腔镜治疗的安全性。方法:回顾性分析1例经本院收治的肾周硬化性脂肪肉瘤患者的临床资料,探讨其临床特点及其腹腔镜治疗方法。患者年龄72岁,无特征性临床表现。B超发现左侧脾肾间有低回声,大小约8.1cm×4.6cm,内部见血流信号。CT检查提示左肾上极后腹膜内软组织密度影,CT值-11~45HU,增强后不均匀轻度强化,动脉期CT值22~69HU。术前B超引导下行穿刺活检提示为梭形细胞间叶源性肿瘤可能。在全麻下行腹腔镜腹膜后肿物切除术,成功切除病灶,保留肾脏。结果:经病理检查诊断为肾周硬化性脂肪肉瘤。术后随访2个月,未发现肿瘤复发。结论:肾周硬化性脂肪肉瘤临床上少见,多无特征性临床表现,CT检查对协助术前诊断及手术均有重要指导意义。腹腔镜手术治疗肾周硬化性脂肪肉瘤安全有效。     

精索多形性脂肪肉瘤1例报告并文献复习

目的：分析并总结精索脂肪肉瘤患者的临床表现及其诊断及治疗方法。方法：回顾性分析我院收治的1例精索脂肪肉瘤患者的临床资料：左侧阴囊内有-9．0cm×9．4cm×6．7cm肿块,B超检查示左侧阴囊内存在一非均质实性包块;MRI显示左侧阴囊内有实质性肿瘤,未见肿大淋巴结。血清肿瘤标志物13-HCG、CEA、PSA和AFP检查均无异常。手术切除肿瘤的同时行左侧阴囊部分切除术。结果：术后病理检查提示为多形性混合型脂肪肉瘤。患者术后恢复顺利。结论：精索脂肪肉瘤是一种罕见的泌尿生殖系肿瘤,诊断主要依据病理检查结果确定;治疗以根治性睾丸切除术为主要方式,辅助放疗、化疗疗效不确切;预后与肿瘤组织病理类型密切相关,局部复发很常见,需长期随访。     

肾及肾周脂肪肉瘤9例临床分析

目的:总结肾及肾周脂肪肉瘤的临床表现、治疗及预后特点,以提高对该病的诊治水平。方法:回顾性分析2009年8月～2017年12月上海交通大学医学院附属仁济医院泌尿外科诊治的9例经手术和病理检查证实的肾及肾周脂肪肉瘤患者的临床资料及随访结果。结果:男7例,女2例;平均年龄59.4(50～74)岁,平均肿瘤直径21.6(13～33)cm,患者均行根治性切除术。其中来源于肾脏者6例,来源于肾周者3例;累及肾上腺者2例,侵犯脾脏者1例,侵犯患侧小肠者1例,侵犯肝脏者1例。结论:肾及肾周脂肪肉瘤属罕见类型,患者确诊依赖于术后病检,患者早期往往缺乏典型临床症状,发现时多属疾病中晚期,手术根治难度较大。手术治疗的关键在于肿瘤切除的完整性,而早期诊断及根治性治疗有望降低肿瘤复发率,提高患者的生存率。     

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.     

精索脂肪肉瘤1例报告并文献复习

目的:探讨精索脂肪肉瘤的临床特点及诊治方法。方法:回顾性分析1例精索脂肪肉瘤临床资料,结合相关文献对其临床诊治进行讨论。结果:患者行左侧精索肿瘤根治性切除术。术后病理诊断为精索脂肪肉瘤。随访5个月无复发及转移。结论:精索脂肪肉瘤是一种罕见的疾病,影像学及实验室检查无特异性。推荐的治疗方法为根治性睾丸切除术及局部肿瘤广泛性切除术;对于中、高级分化的肿瘤可以辅助放疗。化疗效果尚未明确。     

Liposarcoma of the colon: A case report and review of the literature

Liposarcoma is a malignant mesenchymal tumor frequently located in the retroperitoneum and rarely presents as an isolated lesion in the colon. To our knowledge, only three cases of primary colon liposarcoma have been reported in the world literature to date. In this article, we report a case of liposarcoma of the colon in a 46-year-old man. The patient presented with abdominal pain and a palpable mass. Abdominal ultrasonography and computed tomogram confirmed the presence of a large intra-abdominal fatty tissue mass, but the colon origin of the tumor was revealed only on laparotomy. During surgery, a voluminous (12 cm × 11 cm × 10 cm) lesion situated in the subserosa of the ascending colon was found, and a right hemicolectomy with radical lymph node dissection was performed. The pathological diagnosis of the resected tumor revealed primary colon liposarcoma (myxoid subtype). The postoperative course was uneventful, and the patient remained free of disease for 12 months. No adjuvant therapy was performed. Diagnostic and therapeutic problems related to this type of neoplasm as well as literature reviews are reported. Curative R0 resection remains the main treatment for primary and recurrent liposarcomas.     

Liposarcoma of the breast,review of the literature and a report of a case

A case of gigantic liposarcoma of the breast in a 52-year-old woman was reported. She had a small indolent mass in the left breast for twenty years. The mass grew rapidly from the summer of 1979 and became gigantic and penetrated the skin over the mass. Her general condition on admission was poor but resection, of the tumor was carried out. She suddenly died of cardiac failure with electrolytes imbalance 13 days after the operation. The diagnoses of liposarcoma, predominantly myxoid, was made on the basis of light and electron microscopic findings. Forty cases of liposarcoma of the breast were collected from the literature. The possibility of malignant trans-formation of a benign tumor was suggested.     

肾血管瘤3例报告并文献复习

目的提高肾血管瘤的诊断准确率及治疗效果。方法对3例肾血管瘤患者病例进行回顾性分析。结果1例术前明确诊断,行肾部分切除术;2例行肾切除术,手术后诊断明确;3例均治愈,疗效满意,无并发症,术后随访10个月~9年,未发现血管瘤复发。结论B超、CT对肾血管瘤术前明确诊断缺乏特异性,DSA有助于诊断;该病肾切除率较高,但选择性肾动脉栓塞术是良好的治疗手段。     

肾素瘤的诊断和治疗(附3例报告)

目的提高肾素瘤的诊治和治疗水平。方法回顾分析3例肾素瘤患者的临床资料,结合文献复习进行讨论。3例患者均表现有高血压、高肾素和高醛固酮血症。2例临床表现有低血钾。结果2例患者行保留肾单位的肾肿瘤切除术,1例行肾切除术,术后病理示:肾素瘤。3例患者术后血压、血浆肾素、醛固酮和血钾等恢复正常,随访3～12年未见肿瘤复发及高血压再发。结论肾素瘤为罕见的良性肾脏肿瘤,肿瘤根治性切除效果满意,预后良好。     

Well-Differentiated Liposarcoma of the Hypopharynx Exhibiting Myxoid Liposarcoma-like Morphology with MDM2 and DDIT3 Co-Amplification

Well-differentiated liposarcoma (WDL) is one of the most common soft tissue sarcomas in adults. It has a predilection for middle-aged males and arises in deep-seated locations such as retroperitoneum, mediastinum, and spermatic cord. Its occurrence in young individuals at the hypopharyngeal region is an exceedingly rare event. Myxoid liposarcoma (ML)-like changes can seldom occur in some cases of WDL, which makes the diagnosis of WDL more challenging. Amplification of DDIT3 gene in a subset of cases of WDL has shown to be associated with such unique morphology. Herein, we present a case of a 36-year-old gentleman who presented with difficulty in breathing and swallowing for 3 months duration. CT scan of the neck revealed a lesion along the posterior wall of the hypopharynx measuring 3.5 cm. Histopathologic examination revealed a tumor composed of lobules of oval to spindle cells in a prominent myxoid stroma with delicate chicken-wire vasculature. In the vicinity, there were lobules composed of variably sized adipocytes separated by thick fibrous septa that contains atypical hyperchromatic spindle cells. By immunohistochemistry, the tumor cells in both components were immunoreactive for CDK4, but negative for MDM2. Fluorescence in-situ hybridization (FISH) confirmed the presence of MDM2 gene amplification. There was no evidence of FUS-DDIT3 gene rearrangement, however, DDIT3 gene was also amplified. The diagnosis of well-differentiated liposarcoma with prominent myxoid stroma was rendered. This is the first documentation of WDL with ML-like morphology harboring co-amplification of MDM2 and DDIT3 in the hypopharynx.     

原发性肾脏恶性淋巴瘤（附3例报告）

目的 探讨肾脏原发性恶性淋巴瘤的临床特点。方法 总结3例肾脏原发性恶性淋巴瘤患者临床资料，结合文献复习讨论其发病特点、影像学特征、治疗及预后。结果 3例患者中手术活检加化疗1例，手术切除加化疗1例，术前化疗加手术切除加术后化疗1例。3例均诊断为非何杰金淋巴瘤，1例死于肾衰，另2例分别存活38个月和8个月，仍在随访中。结论 肾脏原发性恶性淋巴瘤影像学征象与肾细胞癌相似，肾脏包膜或包膜下弥漫浸润被认为是原发性肾恶性淋巴瘤的特征性表现，通过经皮穿刺活检可明确诊断，治疗应根据组织学分型、分期及肿瘤大小，采取手术联合化疗及放疗。     

后腹腔镜肾脏切除术35例报告

目的探讨后腹腔镜肾脏切除术的手术方法及临床效果。方法2005年1月至2008年12月行后腹腔镜肾切除术35例,其中肾癌根治术11例,肾盂癌根治术1例,单纯肾切除术23例。站果35例均顺利完成腹腔镜手术。手术时间45-305min,平均（72.3±24.0）min,出血50-500mL,平均（102±56）mL,术后平均住院（7.2±3.1）d。术后随访3-51个月,患者均生存。结论腹腔镜肾切除术具有创伤小、术中出血少、术后恢复快等优点,是一种安全、有效的治疗方法。     

Liposarcoma of the Mesocolon — Case Report of a Rare Lesion

A middle-aged man with a 2-imonth history of lower abdominal pain was found to have a large left-sided abdominal lump. Radiological investigations (barium enema, ultrasound, and computed tomography scan) revealed a mass lesion in the area of the descending colon, the sigmoid colon, and the rectum. Flexible sigmoidoscopy showed only mucosal edema and luminal narrowing. At laparotomy, a diffuse thickening of both the descending and sigmoid mesocolon extending into the mesorectum was seen, which suggested an inflammatory pathology. A left hemicolectomy with Hartmann's procedure was performed. After obtaining a histopathological diagnosis of liposarcoma of the mesocolon, an abdominoperineal resection of the rectum was done. The patient was advised to undergo postoperative radiotherapy but he did not comply and was thereafter lost to follow-up.