乳头状肾细胞癌的临床病理表现

目的 探讨乳头状肾细胞癌的临床病理表现，提高对此类型肾癌的认识。方法 回顾性分析9例乳头状肾细胞癌患者临床病理资料并进行随访。结果 9例乳头状肾细胞癌占同肾癌的1.9％，平均发病年龄52岁。无自觉症状者5例，血尿4例。7例行肾癌根治术，1例行肾输尿管全长切除术，1例保留肾单位的肿瘤切除术。肿瘤最大径4－15cm，多位于肾皮质，淡黄色到金黄色，单灶或多灶性结节性长。均以乳头或乳头管状结构为主，乳头轴心可见泡沫细胞。9例均有细胞角蛋白CK7表达。Fuhrman病理分级G13例、G24例、 G32例。TNM病理分期pT27例、pT3a1例、pT3bN1V1b1例。随访7例无瘤生存36－134个月，1例G2pT3b者无瘤生存11个月，1例G3pT3a者13个月后死于肾癌转移。结论 乳头状肾细胞癌是少见的肾癌，表现为低分期，预后好。

The clinical and pathological manifestations of papillary renal cell carcinoma

Objective　To study the clinical and patholo gical manifestations of papillary renal cell carcinoma(PRCC) and to improve the recognization of this subtype of renal cell carcinoma(RCC).　Metho ds　A retrospective study was done including revewing the clinical do cuments and the pathological sections of 9 cases of PRCC.Follow-up was made in all cases.　Results　466 cases of RCC were encountered in our institute between January 1989 and June 30,1999. 9 (1.9%) cases of PRCC were identified.The patients were seven men and two women whose age ranged from 33 to 69 years(mean age 52 years).Four presented with gross hematuria and 5 without any symptom being detected on ultrasound exam in a routine physical examination .Radical nephrectomy was done in 7 patients,resection of kidney and whole ureter was done in one patient,nephron-sparing surgery was done in one patient.The tu mor ranged from 4 to 15 cm in the greatest dimension.Most tumors located in the cortex of kidney with straw yellow or golden yellow appearance.Multifocality was found in five cases.Microscopically,PRCCs were predominantly papillary or tubul opapillary,often with a thick fibrous capsule and foam cells.Cytokeratin 7 was e xpressed in all cases.The Fuhrman's nuclear grade of the PRCC was grade 1 in 3 c ases,grade 2 in 4 and grade 3 in 2.The TNM stage was pT2 in 7 cases,pT3a in one and pT3bN1V1b in one.Seven patients were alive and tumor f ree for 36 months to 134 months with a mean of 85.4 months.One with G3 pT3 b has been alive and tumor free for 11 months.One with G3 pT3a died of metastasis.　Conclusions　PRCC is an uncommon subtype of RCC in China,it tends to present at an earlier stage and ha s a better prognosis.