肾黏液性小管状和梭形细胞癌临床病理特点分析

目的:分析肾脏黏液性小管状和梭形细胞癌的临床病理特点,提高对肾黏液性小管状和梭形细胞癌的认识。方法:回顾性分析8例肾黏液性小管状和梭形细胞癌患者的临床资料。女5例,男3例,平均年龄48.4(25～80)岁。肿瘤最大直径平均4.2(2.5～10.0)cm。3例行开放性肾癌根治术,3例行腹腔镜肾癌根治术,2例行腹腔镜肾脏部分切除术。结果:手术顺利,术中术后未出现明显并发症,术后病理检查均诊断为肾黏液性小管状和梭形细胞癌。平均住院7(5～10)天,术后平均随访30(7～45)个月,均未见肿瘤复发及转移。结论:肾黏液性小管状和梭形细胞癌是一种极为罕见的低度恶性的肾脏肿瘤,临床症状、影像学表现与肾癌类似,需依靠病理组织学确诊。早期手术治疗是首选治疗方法,预后良好,需长期密切随访,对最大直径<4.0cm患者,推荐行腹腔镜下保留肾单位手术。     

两种不同临床类型的肾黏液性小管状和梭形细胞癌

目的:探讨两种不同临床类型肾黏液性小管状和梭形细胞癌的临床特点。方法:报告2例不同临床类型肾黏液性小管状和梭形细胞癌患者的临床资料,进行对比分析,并复习有关文献。结果:例1为体检发现,无局部及远处转移,无病理性核分裂像,异型性小。例2以持续高热就诊,有局部及远处转移,病理性核分裂像常见,异型性明显。2例均行肾癌根治术,例1术后随访未见复发。例2患者于术后3个月死亡,此为国内首例报道因肾黏液性小管状和梭形细胞癌死亡者。结论:肾黏液性小管状和梭形细胞癌有两种不同临床类型,多数为低度恶性,亦存在恶性程度较高的病例,需区别对待。     

左肾巨大黏液样小管状和梭形细胞癌1例报告

我院2019年11月收治1例左肾黏液样小管状和梭形细胞癌(MTSCC)患者, 女, 75岁。肿瘤位于左肾上极, 大小约23.3 cm×18.0 cm×21.8 cm, 行经腹根治性左肾切除术, 术后随访3年2个月, 未见肿瘤复发和转移。发生在肾的MTSCC是罕见的低度恶性肿瘤, 发展缓慢, 边界清楚, 很少发生浸润和转移, 确诊依靠病理检查, 手术是治疗本病的唯一有效方法。     

肾脏黏液性管状和梭形细胞癌一例报告并文献复习

目的 探讨肾脏黏液性管状和梭形细胞癌患者的临床病理特点。方法 分析1例肾脏黏液性管状和梭形细胞癌患者临床资料，结合文献复习讨论。患者，男，27岁。查体发现右肾占位性病变6d，CT及MRI示右肾上极囊实性占位，术前诊断良性病变。行右肾根治性切除术。结果 术中见肿瘤对肾组织有推挤样边界，位于右肾上极，冰冻切片诊断低度恶性黏液性上皮性肿瘤。病理检查：大体标本见右肾上极6cm×5cm×4cm类球形肿物，边界清楚，切面实性、灰白色。肿瘤细胞排列成管状、实性梁索状漂浮于黏液性基质中，Alcianblue染色（＋）。免疫组化：上皮细胞CK（＋）、CK7（＋）、EMA（＋）、Vimentin（＋）、34βE12（＋）。病理诊断：肾脏黏液性管状和梭性细胞癌。术后随访5个月未见肿瘤复发和转移。结论 肾脏黏液性管状和梭形细胞癌是一种罕见的低度恶性上皮性肿瘤，具有潜在远处转移的可能，应与其他肾脏良恶性肿瘤相鉴别。     

乳头状肾细胞癌的临床特征分析（附7例报告）

目的：观察乳头状肾细胞癌的临床特点,提高对其诊断要点、治疗及预后的认识。方法：回顾性分析7例乳头状肾细胞癌患者的临床资料,复习相关文献,并对患者进行随访。结果：7例患者均经病理证实为乳头状肾细胞癌,1例并发肾上腺腺瘤;首发症状主要以腰痛、血尿、消瘦、低热为主;CT影像均提示肿瘤密度在肾髓质期强化程度明显弱于肾皮质,且在肾髓质期和排泄期呈均匀强化;6例经腹行根治性肾切除,1例经腰行根治性肾切除,术后均辅以免疫治疗,未行放化疗;6例获随访,随访时间为3个月～2年,1例于术后6个月出现急性肾衰死亡,1例于12个月因肝及淋巴结转移死亡,其余4例在随访期间未出现复发和转移,无瘤生存至今。结论：乳头状肾细胞癌与其它肾细胞癌在临床表现上基本相同,但在影像学表现,病理形态及生物学行为上均与其他类型的肾细胞癌不同,诊断主要依靠CT影像,确诊有赖于病理和免疫组织化学检查,早期手术是首选治疗方式,其预后可能与分期及转移有关。     

原发性肾小细胞癌1例报告及文献复习

目的探讨原发性肾小细胞癌的病理诊断和临床病理特点。方法对1例肾小细胞癌进行光镜、电镜观察和免疫组化标记并行相关文献复习。结杲结节状肿瘤位于肾下部近肾门处,瘤组织由短梭形与小圆形细胞构成,呈片巢状、小梁状排列。瘤细胞胞质较少,核深染,核分裂像多见。瘤组织浸润肾皮质、肾盂和肾门周围脂肪组织。肾门处与腹主动脉旁淋巴结可见转移。电镜见瘤细胞胞质内较多神经内分泌颗粒。免疫组化示多种上皮与神经内分泌标志物表达阳性,全身其他脏器未发现肿瘤。随访21个月无复发转移。站论肾脏小细胞癌具有小细胞癌的一般病理形态学特征。依据光镜、电镜变化和免疫组化标记并除外转移,可确诊为肾原发性小细胞癌。     

肺多形性癌的临床处理及文献分析

目的探讨肺多形性癌(pleomorphic carcinoma,PC)的临床表现、手术方法及预后,以提高其诊断和治疗的有效性。方法回顾性分析四川大学华西医院自2006年1月至2011年8月期间收治7例肺多形性癌患者的临床资料,男5例,女2例,男女比例为2.5∶1.0;平均年龄58.85(43～69)岁。并使用PubMed检索系统,检索关键词为Pulmonary pleomorphic carcinoma surgery,复习2005～2011年报道有完整资料的8例患者的文献,其中男7例,女1例,男女比例7︰1;平均年龄70.25(51～79)岁。15例患者均行手术治疗并行系统淋巴结清扫术。结果本组资料平均发病年龄64.93(43～79)岁;15例患者中,男12例,女3例,男女比例为4∶1;主要症状多为咳嗽,痰中带血及咯血,胸痛;病理诊断均为多形性癌。本院7例患者中,梭形细胞癌伴鳞癌3例,梭形细胞癌伴腺癌2例,梭形细胞癌伴大细胞癌和腺癌2例;截至随访时有3例术后死亡,最长生存时间49个月,4例恢复良好。检索文献资料的8例患者中,梭形细胞癌伴鳞癌4例,梭形细胞癌伴腺癌1例,梭形细胞癌伴大细胞癌和鳞癌1例,梭形细胞癌伴腺癌和鳞癌2例;截至随访时有5例术后死亡,最长生存时间22个月,3例恢复良好。结论肺多形性癌极为少见,积极手术治疗可取得较好的疗效。     

肾透明细胞癌胆囊转移2例报告并文献复习

目的提高对肾透明细胞癌胆囊转移的认识,探讨其临床及病理特点。方法报告2例经本院收治的肾透明细胞癌胆囊转移患者的临床资料,回顾性分析其临床特征以及影像学表现。2例均为男性,年龄分别为56岁及61岁。患者均无特征性临床表现。其中1例患者行腹腔镜根治性肾切除术后6个月复查B超发现胆囊腔内肿物增大,遂在全麻下行腹腔镜胆囊切除术。另1例发现肾脏及胆囊病变后同期在全麻下行腹腔镜根治性肾切除术及胆囊切除术。检索Pubmed和CBM数据库,对该疾病相关文献进行复习。结果2例术后病理诊断为肾透明细胞癌胆囊转移。术后随访3个月及25个月未见肿瘤复发。结论肾透明细胞癌胆囊转移临床罕见,对于肾癌患者或既往有肾癌病史的患者,应该关注其胆囊上存在的病变性质,PET／CT对诊断该病有一定帮助,同时比较原发灶和转移灶二者病理的异同能更准确地进行病理诊断。     

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。     

肾嫌色细胞癌的诊治（附4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4例肾嫌色细胞癌患者的临床资料。男3例，女1例，年龄34—76岁，平均52岁。结果 3例患者行肾癌根治术，1例行肾部分切除术。术后病理诊断为肾嫌色细胞癌，病理分期：pT1aNxMo 1例，pT1bNoMo3例。病理分级：G1 3例，G2 1例。免疫组织化学染色：CK8（低分子量细胞角蛋白）阳性，Vimentin（波型蛋白）阴性，Hale胶体铁阳性。随访4个月至8年，平均4年。4例患者均健在，无肿瘤复发或转移。结论 肾嫌色细胞癌是一种低度恶性的肾细胞癌，影像学检查对其诊断有重要帮助，确诊有赖于组织病理学检查，手术治疗后预后较好。     

Analysis of renal cell carcinoma with tumorous legion in the liver

We presented 3 cases of renal cell carcinoma with hepatic lesion, for which it was difficult to make a diagnosis preoperatively. The hepatic lesion was cavernous hemangioma of the liver, liver metastasis of renal cell carcinoma or hepatocellular carcinoma. To discuss the strategy of treatment for liver metastasis of renal cell carcinoma at the time of nephrectomy, or in the follow-up period after nephrectomy, we reviewed the 188 cases of renal cell carcinoma which were nephrectomized from December, 1962 to June, 1988. At the time of nephrectomy, there was only 1 case that had concurrent liver metastasis. In 4 cases, liver metastasis was found at autopsy, and in 15 cases, in the follow-up period after nephrectomy. We analysed these 15 cases and classified them into 2 groups. One was "early metastasis group", i.e., liver metastasis was found within 18 months after nephrectomy, and the other was "late metastasis group", i.e., liver metastasis detected more than 6 years after nephrectomy. In the "early metastasis group", 2 lived 10 months or 57 months, but 5 died within 1 month after the appearance of liver metastasis. In the "late metastasis group", 4 of 7 lived more than 2 years after the appearance of liver metastasis and the median survival was 21 months. In both groups, when liver metastasis was found, there were metastases in multiple organs and the hepatic lesions were multiple.(ABSTRACT TRUNCATED AT 250 WORDS)     

囊性肾癌的诊治(附12例报告)

目的　提高对囊性肾癌的认识。　方法　总结 12例囊性肾癌患者的诊断、治疗、预后等资料。术前诊断为复杂性囊肿 10例 ,9例术中行病理检查 ,8例报告为恶性。 12例中行根治性肾切除 7例 ,肾切除 3例 ,部分肾切除和囊肿去顶各 1例。　结果　 12例术后病理均为囊性肾透明细胞癌 ,平均随访 39.5个月 ,无肿瘤复发和转移。　结论　对可疑囊性肾癌者 ,术中须行病理检查 ;确诊者宜行根治性肾切除或部分肾切除。囊性肾癌预后较好     

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。     

A case of bladder metastasis of renal cell carcinoma: a case report and literature review

The patient was a 74-year-old man. Computed tomography (CT) detected a right renal tumor with paraaortic lymph node swelling. Radical nephrectomy and left lymphadenectomy were performed in September 2008. Interferon-alpha (6 million international units three times per week) was administered as adjuvant therapy. Due to the development of side effects, including fatigue, the patient's immunotherapy was discontinued after 6 months. Radiofrequency ablation for pulmonary metastasis was performed 9 months after surgery. A nodular pedunculated tumor was detected on the posterior wall of the urinary bladder by CT, and transurethral resection was performed 18 months after nephrectomy/lymphadenectomy. Since the pathological diagnosis of the bladder tumor was clear cell carcinoma, that tumor was thought to have originated from the renal cell carcinoma. We have summarized 43 cases of bladder metastasis of renal cell carcinoma in Japanese patients, including ours.     

根治性肾切除术治疗小肾癌的远期疗效观察

目的总结根治性肾切除术治疗小肾癌的远期疗效.方法回顾性分析1992年1月至2004年6月采用根治性肾切除术治疗56例小肾癌患者的临床资料和长期随访结果.56例患者中男41例,女15例.平均年龄54岁.设计术后随访表进行追踪随访,采用Kaplan-Meier法计算5年、10年生存率.结果56例患者术前均未发现转移灶.术后组织病理学结果示肾透明细胞癌44例,颗粒细胞癌7例,混合性细胞癌5例;癌组织浸润同侧肾上腺1例,浸润肾周脂肪4例,局部淋巴结转移2例.术后49例（87.5%）获随访,随访时间11～155个月,平均随访71个月.5年、10年生存率分别为81.7%、66.9%.5例术后死于肾癌转移.结论根治性肾切除术治疗小肾癌的远期疗效较好,是治疗小肾癌较理想的术式.     

Results of surgical treatment of renal cell carcinoma with solitary metastasis

To determine the effect on survival of excision of a solitary metastasis from renal cell carcinoma, the records of 29 patients seen at our institute within the last 15 years (1972 to 1986) who underwent such an operation were reviewed. Metastasis was present at diagnosis in 11 of the 29 patients, while 18 had metastasis 2 months to 11 years after nephrectomy, with an average interval free of disease of 38 months. There were 13 pulmonary metastases, 6 bone lesions and 10 other lesions. The estimated over-all survival rate for this group was 41 per cent at 2 years and 13 per cent at 5 years after excision of the metastasis. Only 2 of the 29 patients currently are alive with no evidence of disease 42 and 53 months since excision of the metastasis. Neither the presence nor absence of a metastasis at diagnosis nor the interval between nephrectomy and the development of a metastasis in patients without metastatic disease at diagnosis appeared to influence survival after excision of the metastasis. Unlike previous reports, these results suggest that the beneficial effects of excision of metastatic renal cell carcinoma are limited to improved short-term survival postoperatively and that surgical cure of patients with metastatic renal cell carcinoma is a relatively uncommon event.     

Squamous cell carcinoma of renal pelvis: a case report and review of the Japanese literature

Squamous cell carcinoma of renal pelvis is relatively rare and its prognosis is very poor. A 72-year-old man was introduced to our institute because of macroscopic hematuria. He had no history of urolithiasis or urinary tract infection. Excretory urography showed a nonfunctioning right kidney. Cytologic examination of urine was positive for malignant cell from squamous cell carcinoma. Preoperative diagnosis was made as right renal pelvic tumor, but it appeared to be renal tumor on the roentgenogram. Right radical nephrectomy and transurethral ureterectomy was performed. Radiation therapy was done after operation. Pathological diagnosis was squamous cell carcinoma of renal pelvis extensively infiltrating to the renal parenchyma. The patient is alive with no recurrence or metastasis for eight months after operation. Statistical analysis was made on 136 cases of squamous cell carcinoma of renal pelvis reported in the Japanese literature including our case, and this disease is also briefly reviewed.     

双侧原发性肾癌5例报告

目的:探讨双侧原发性肾癌的诊断、治疗和预后。方法:回顾性分析2001年3月~2005年6月诊治的5例双侧同期原发性肾癌患者的临床资料。5例均经B超、CT等检查确诊,施行保留肾单位手术联合对侧肾癌根治术。结果:术后恢复顺利,无外科并发症,4例为双侧肾透明细胞癌,1例为双侧肾乳头状腺癌。随访5~51个月(平均20.4个月),无局部复发、转移及肾功能不良。结论:双侧原发性肾癌早期无特殊临床表现,主要依靠影像学检查诊断。外科手术为主要治疗方法,保留肾单位手术联合对侧肾癌根治术既能有效治疗恶性肿瘤,又能确实保存肾功能,预后良好。