肾嫌色细胞癌的临床研究

目的 探讨肾嫌色细胞癌的临床特点,提高肾嫌色细胞癌的诊断和治疗水平.方法 针对1例肾嫌色细胞癌的临床资料,结合相关文献进行分析.结果 病理结果示为肾嫌色细胞癌.免疫组化:CK部分细胞(+),CD10(-),CK8(+),RCC(-),vimentin(-),Ki-67(＜5%+),Hale胶状铁染色(+).结论 肾嫌色...     

肾嫌色细胞癌的诊断和治疗（附五例报告）

目的 提高肾嫌色细胞癌的诊治水平。方法 回顾性分析5例肾嫌色细胞癌资料,结合文献复习进行讨论。结果 3例肾部分切除术,2例行根治性肾切除术,随访个月至4年,4例无瘤存活,1例于术后1年死于中风。结论 肾嫌色细胞癌是一种低度恶性的肾细胞癌,确诊有赖于影像学检查及典型病理表现,治疗以手术为主。     

肾嫌色细胞癌影像学特点与外科治疗选择

目的 提高肾嫌色细胞癌的临床诊治水平. 方法 回顾性分析25例肾嫌色细胞癌患者临床资料.男13例、女12例,平均年龄51岁.左侧13例,右侧12例.无症状肾癌16例,有腰部不适、发热、肉眼血尿等症状9例.实验室检查发现肝功能异常1例、红细胞沉降率加快1例.结合文献复习讨论肾嫌色细胞癌的影像学特点与外科治疗选择. 结果 B超检查肿瘤主要表现为低回声、有包膜、血流信号不明显.CT及MRI扫描肿瘤特征为边界清楚、质地均匀(CT平扫为70%、MR为73%),出血、坏死和囊性变少见,增强扫描多为均匀强化(CT为65%、MR为67%)及轻度强化(CT为65%、MR为93%).肿瘤直径＞4.0 cm的22例患者行根治性肾切除术、≤4.0 cm且位于肾周边的3例行肾部分切除术.肿瘤平均直径7.6 cm,剖面质地多均匀、呈灰白色或暗红色,光镜下癌细胞呈板状或条索状排列、胞质苍白或呈嗜酸性,免疫组化染色Vimentin阴性、CK18阳性.TNM分期pT1a 8例、pT1b 9例、pT2 6例、pT3a 2例.23例获随访,平均随访28个月,无瘤生存22例,1例于术后58个月发现肺转移,经干扰素-α治疗、吉西他滨及氟尿嘧啶化疗3个月后死亡. 结论 肾嫌色纽胞癌患者多无症状、分期较早.MR和CT主要表现为边界清楚、质地均匀、强化不明显.手术方式选择应遵循肾癌的外科治疗原则.患者预后多良好,手术至出现转移的时间间隔较长,建议延长术后随访时间.     

肾脏嫌色细胞癌 (附3例报告)

肾脏嫌色细胞癌是一种较少见的肾细胞癌 ,对其临床特点、病理学特征了解不多。我院从 1 999年至今共收治肾脏嫌色细胞癌 3例 ,结合文献报告如下。1　病例报告例 1　女 ,45岁。 5年前体检时发现右肾占位性病变 ,约 3ｃｍ× 2ｃｍ大小 ,ＣＴ示错构瘤可能。近半个月前感腰酸 ,再次复查ＣＴ示肿块增大至 5ｃｍ× 4ｃｍ。入院后Ｂ超示右实质性占位病变。术中所见 :肾中极腹侧约 4ｃｍ× 4ｃｍ× 3ｃｍ肿块 ,突出肾外。行右肾肿瘤剜出术。肿块切面灰黄色 ,呈均质状。术中冷冻切片病理诊断为嗜酸细胞瘤。术后石蜡切片病理诊断为肾脏嫌色细胞癌。例 …     

肾嫌色细胞癌临床与病理学特点分析

目的探讨肾嫌色细胞癌的临床及病理学特点，提高对此病的诊治水平。方法总结19例肾嫌色细胞癌患者的临床及病理资料。男10例，女9例。平均年龄53岁。左侧9例，右侧10例。偶发12例，7例有肉眼血尿、腰痛不适和腹部包块等症状。结果B超主要表现为包膜完整的低回声肿块。CT扫描肿瘤多为均匀低密度，边界清晰。肿瘤平均直径8．2cm。TNM分期T1N0M0 8例，T2N0M0 11例。行根治性肾切除17例，肾部分切除2例。16例获得随访，随访时间3个月～16年，平均无瘤生存4．8年。病理特点：肿瘤大体标本多为均匀深棕色实体，1例瘤体中央有纤维瘢痕；光镜下瘤细胞由典型型和嗜酸型两种细胞组成，胞膜清晰；免疫组化检测CK8阳性、Vimentin阴性；Hale胶体铁染色阳性；电镜下胞质内有大量膜性小空泡。结论肾嫌色细胞癌具有独特的形态学特点。B超、CT检查缺乏特异性。多数病例瘤体较大，但TNM分期多为早期，预后良好。     

肾嫌色细胞癌临床特征分析

目的 探讨肾嫌色细胞癌的临床特点并分析其预后.方法 对1998年1月至2008年1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、Ptnm分期和生存期随访等,进行回顾性分析.结果 所有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.23例患者行根治性肾切除术,6例行保留肾单位手术(NSS),病理分期:Pt1n0m0 11例,Pt2n0m0 8例,pT3aN0M0 5例,Pt1nm0 3例,Pt2n1m0 2例.26例患者获得随访,随访24～144个月,平均90个月;3例死于心脑血管疾病,6例局部复发后4例再次手术,1例远处转移,21例无瘤生存.与同期肾透明细胞癌患者相比,累积5年生存率两者分别为83.9%和63.8%,差异无统计学意义(P＞0.05),累积10年生存率分别为77.9%和49.9%,差异具有统计学意义(P＜0.01).结论 肾嫌色细胞癌是一种少见的具有特殊形态的肾细胞癌病理亚型,主要通过病理学予以鉴别诊断,手术切除是治疗初发或复发的肾嫌色细胞癌的首选方法,其预后较好.

Abstract：

Objectives To explore the clinical, pathological features and prognosis of patients with chromophobe renal cell carcinoma. Methods From January 1998 to January 2008, clinical data of 29 patients with chromophobe renal cell carcinoma including clinical manifestations, imaging examinations,treatment models, pTNM stages and follow-up results, were summarized to investigate its features and prognosis. Results All cases had no obvious clinical and preoperative imaging presentation. There were 23 patients underwent radical nephrectomy, and 6 cases underwent nephron sparing surgery. Postoperative pathological findings confirmed the diagnosis of chromophobe renal cell carcinoma. Macroscopically, the cut surface of the tumors were generally beige in color. Histologically, it showed polygonal chromophobe cells and small round eosinophilic cells with eccentric hyaline degeneration. These tumor cells had a clear and sharp membrane, lightly stained abundant cytoplasm with a fine reticular translucent pattern and irregular nuclei. And a perinuclear halo was often seen in these cells. Histochemically, the tumor cells generally show a diffuse and strong reaction for CK-8 with a negative expression of Vimentin. The pTNM stages of the tumor were as follows, pT1N0M0 in 11 cases, pT2N0M0 in 8 cases, pT3aN0M0 in 5 cases, pT1N1M0 in 3 cases,pT2N1M0 in 2 cases. Twenty-six cases of patients were followed up (24 to 144 months, with an average of 90 months), 3 cases died of cardio-cerebrovascular disease, and local recurrence involved in 6 cases with reoperation in 4 cases, as well as distant metastasis in 1 case. Twenty-one cases survived with tumor-free.The statistical results indicated that the survival rates of the patients with chromophobe renal cell carcinoma in five years and ten years were 83.9%, 77.9%, respectively, compared with renal cell carcinoma of the same stage 63. 8% and 49. 9% at the same periods, and there is no difference in the survival rate of five years( P ＞ 0. 05 ) but significant difference in that of ten years ( P ＜ 0. 01 ). Conclusions Chromophobe renal cell carcinoma is a morphologically uncommon subtype of renal cell carcinoma with the good prognosis. Definite diagnosis depends on its typical pathological feature. Radical nephrectomy is the first choice for the treatment of chromophobe renal cell carcinoma.     

127例肾嫌色细胞癌免疫组化分析

目的研究肾嫌色细胞癌(Renal chromophobe cell carcinom)的免疫组化特点,并从病理学角度探讨诊断肾嫌色细胞癌的分子标记物特点,以提高肾嫌色细胞癌的诊治水平。方法回顾性分析郑州大学第一附属医院收治的127例病理确诊为肾嫌色细胞癌的病理资料,分析其免疫组化特点,并复习相关文献。结果 127例病理确诊为肾嫌色细胞癌的免疫组化表达如下:S-100(11/98,11.2%),CK(111/113,98.2%),CK7(84/108,77.8%),CD10(52/109,47.7),CD117(105/111,94.6%),PAX-2(30/109,27.5%),PAX-8(79/96,82.3%),Vim(26/103,25.2%),EMA(103/104,99.0%),RCC(22/98,22.4%),Ki-67(6/111,5.4%),E-caderin(94/100,94.0%)。结论免疫标志物CK,CK7,EMA,E-caderin阳性及Vim,S-100阴性是肾嫌色细胞癌诊断的良好标记物。S-100A1的阴性表现还预示着肾嫌色细胞癌可能预后较好。CD117在肾嫌色细胞癌的细胞膜上的过表达可能是激酶抑制剂的潜在靶标,不过疗效仍需更多的研究证实。     

肾嫌色细胞癌(附15例报告)

目的　提高肾嫌色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15例肾嫌色细胞癌的临床资料。男 10例 ,女 5例。年龄 4 7～ 74岁 ,平均 5 7岁。均行根治性肾切除术。　结果　术后病理证实为肾嫌色细胞癌。病理分期 :pT1N0 M0 6例 ,pT2 N0 M0 5例 ,pT3bN0 M0 2例 ,pT1N2 M0 1例 ,pT2 N2 M0 1例。病理分级 :G2 10例 ,G3 5例。 11例获随访 ,随访 2～ 31个月 ,平均19个月 ,1例死于心脏病 ,1例局部复发 ,9例无瘤生存。　结论　肾嫌色细胞癌是一种具有特殊形态的少见肾癌类型。肾根治性切除术是治疗肾嫌色细胞癌的首选方法。与同期、同级的其他类型肾癌相比 ,肾嫌色细胞癌预后较好。     

肾嫌色细胞癌的超声造影表现

目的 分析肾嫌色细胞癌的超声造影特征,提高对该肿瘤的识别.方法 分析经手术病理证实的28例嫌色细胞癌超声造影资料,分析血供情况及造影特征,并进行时间-强度曲线参数分析.结果 28例嫌色细胞癌与肾皮质作参照均呈乏血供造影表现,且肿块呈不均匀增强,肿块局部呈"快进快出"造影表现,强化程度低于周围肾皮质,其中15例(54%)病灶内可出现辐射样分布的强回声带.时间-强度曲线显示嫌色细胞癌组曲线达峰绝对值、曲线下面积低于肾皮质(P＜0.05),造影剂到达时间、达峰时间、曲线上升支斜率高于肾髓质组(P＜0.05).结论 超声造影检查中,肾嫌色细胞癌瘤体内辐射状增强和瘤体呈乏血供型增强为诊断提供了依据.

Abstract：

Objective To discuss the imaging characteristics of chromophobic cell renal carcinoma (CCRC) and study the features on the contrast-enhanced ultrasound (CEUS). Methods The CEUS features of CCRC in 28 cases identified by pathology were reviewed. The blood supply and enhancement characteristic were observed and analyzed on time intensity curve parameters. Results The 28 cases of CCRC showed poor blood supply in contrast with the renal cortex. The CCRC presented with heterogeneity enhancement, part of the tumor took on a high wash-in and wash-out, and enhanced less intense than the surrounding renal cortex. The actinomorphous strong echo of the tumors might be revealed with CEUS in 15 cases (54%). The time intensity curve analysis demonstrated that the CCRCs' difference of peak intensity and area under the curve were lower than the renal cortex (P＜0.05), but arrival time, time-to-peak and slope of ascending curve were higher than the renal medulla (P＜0.05). Conclusion The actinomorphous enhancement and poor blood supply in the tumor of CEUS could provide diagnostic evidence for CRCC.     

肾嫌色细胞癌临床病理特征及预后分析

目的 分析肾嫌色细胞癌的临床病理特征及预后,提高对肾嫌色细胞癌的认识. 方法 对1998年2月至2009年7月行根治性肾切除术后病理诊断为嫌色细胞癌的75例患者资料进行回顾性研究.男42例,女33例.平均年龄56(25～74)岁.均为单发肿瘤,左肾36例,右肾39例.比较患者性别、年龄、肿瘤大小、分级、分期与预后的关系,Kaplan-Meier生存曲线分析生存关系.结果 肿瘤平均直径7.3(2.5～17.0)cm,大体切面以灰黄、灰红色为主(50/75例),肿瘤细胞多为体积较大的多角形嫌色细胞和小圆形嗜酸细胞.T1N0M0 30例,T1N0M11例,T2N0M0 26例,T2N0M11例,T3N0M0 11例,T3N0M1 3例,T3N1M0 1例,T4N0M1 1例,T4N1M11例.依照Fuhrman分级系统,Ⅰ级3例,Ⅱ级24例,Ⅲ级46例,Ⅳ级2例.平均随访44(9～93)个月,死亡7例,其余均无瘤生存.3、5年生存率分别为93.3%和90.7%.单因素分析示肿瘤大小(P=0.028)、TNM分期(P=0.000)和肿瘤侵袭、预后有关;多因素分析显示,TNM分期可作为肾嫌色细胞癌独立的预后因素.结论 肾嫌色细胞癌是一种具有特殊形态的少见肾癌类型,多数瘤体较大,预后较好;细胞核分级较高,不适用Fuhrman分级系统;TNM分期可作为肾嫌色细胞癌预后的独立因素.     

肾盂鳞状细胞癌的诊断与治疗(附16例报告)

目的：探讨肾盂鳞状细胞癌的术前诊断及治疗效果。方法：回顾性分析16例肾盂鳞状细胞癌患者的诊断和治疗等临床资料。所有患者术前均行IVU检查，13例行B超检查，4例行CT和MRI检查；11例行根治性肾切除加局部淋巴结清扫术。结果：行IVU检查者仅提示4例有占位性变病，13例行B超检查者仅显示2例有占位性病变，4例行CT或MRI检查者均提示有肿瘤改变。近50％的患者术后1年内死亡。结论：术前诊断肾盂鳞状细胞癌的敏感方法为CT和MRI，其治疗方法首选根治性肾切除术，但预后差。     

乳头状肾细胞癌的诊断和治疗

目的；提高乳头状肾细胞癌的诊治水平。方法：8例均作影像学检查，IVU示患侧肾脏外形增大；CT示患侧肾脏有类圆形，界限清楚，中心有肿瘤坏死引起的代密度灶。8例患者均接受肾癌根治术，其中2例经腹腔途径，6例经11肋间切口。结果：随访4-60个月。除1例于术后13个月死于颅内转移外，其余均生存。结论：乳头状肾细胞癌是较罕见的肾细胞肿瘤，其形态学和遗传学与非乳头状肾细胞癌有明显不同；其确诊有赖于影像学检查，典型病理检查及分子遗传学特征分析；治疗仍以手术为主。     

A rare case of synchronous association of chromophobe renal cell carcinoma with urothelial carcinoma of urinary bladder

Introduction

Chromophobe renal cell carcinoma accounts for 3–5% of all RCCs. However, its association with urothelial carcinoma of urinary bladder has never been reported. We report a case of synchronous association of chromophobe RCC with low grade urothelial carcinoma of urinary bladder.

Sarcomatoid renal cell carcinoma with a chromophobe component producing beta-human chorionic gonadotropin

We report a case of sarcomatoid renal cell carcinoma with a chromophobe component showing significant elevation of beta-human chorionic gonadotropin (beta-HCG) in the peripheral blood. A 35-year-old man was hospitalized because of a large tumor of the left kidney and elevated serum levels of beta-HCG. Extended nephrectomy was performed, after which the serum beta-HCG level decreased. However, 3 months later, masses were discovered in the left renal bed and in the lung in association with elevated serum levels of beta-HCG. The patient was rehospitalized and received combination therapy with interferon-alpha and doxorubicin-based multiple chemotherapy (cyclophosphamide, vincristine, doxorubicin, and dacarbazine). The recurrent mass responded extremely well to treatment, and beta-HCG normalized. However, the patient died 14 months after nephrectomy because of eventual resistance to chemotherapy. Sarcomatoid renal cell carcinoma containing beta-HCG positive cells were pathologically diagnosed with immunohistochemical staining in the left kidney. Sarcomatoid renal cell carcinoma is a variant of renal adenocarcinoma which has a poor prognosis. This patient had an extremely rare sarcomatoid renal cell carcinoma associated with serum levels of beta-HCG which were elevated and strongly correlated with morphologic cancer activity. beta-HCG might be a useful serum marker for detecting and monitoring this renal cell carcinoma.     

Molecular pathology of chromophobe renal cell carcinoma: A review

The recognition of chromophobe renal cell carcinoma (RCC) among other distinct types of renal cell tumors (RCT) based on light‐microscopic features, such as cytoplasmic and nuclear characteristics, might pose a dilemma in some cases because of morphological pattern overlapping with renal oncocytoma or conventional RCC. The present article reviews chromophobe RCC with focus on aspects of its molecular pathology, which was shown using ancillary modern microarray‐based technology that can distinguish it from its mimics and therefore be helpful for its correct diagnosis. Although the high resolution DNA‐microarray analyses excluded with all certainty the occurrence of small specific alterations, the loss of entire chromosomes 2, 10, 13, 17 and 21 occurs exclusively in chromophobe RCC and therefore probes localized at these chromosomes might be used to establish the diagnosis of chromophobe RCC in cases with uncertain histology. The usefulness of proposed candidate genes selected by the global gene expression analyses in the diagnostic pathology is far below expectations. The conflicting staining patterns, together with the poor specificity of used antibodies, leads us to believe that these candidate immunomarkers might not help in the separation of chromophobe RCC, with the exception of CD82, which has recently been suggested to be used for routine histological diagnosis.     

双侧肾细胞癌的诊断与治疗(附3例报告)

报告近年收治的肾细胞癌（肾癌）患者3例，均经B超、CT等检查确诊，分别施行部分肾切除术、肾动脉栓塞术、孤立转移灶切除术、根治性肾切除术及Bench手术治疗，并配合免疫及透析治疗。经随访，1例死于急性肾功能衰竭，1例7个月后死于全身衰竭，1例无瘤生存已3年。同时就双侧肾癌发病情况、诊断方法及治疗措施进行讨论，认为双侧肾癌患者无特殊临床表现，其诊断主要依靠影像学检查；手术切除仍是其主要的治疗方法。