肾脏巨大黏液样小管状梭形细胞癌一例并文献复习

目的分析并探讨肾脏黏液样小管状和梭形细胞癌的临床、影像及病理学特点。方法对1例肾脏巨大黏液样小管状和梭形细胞癌患者的临床资料进行回顾性报道并相关文献复习分析,其早期发现由6 cm发展5年至18 cm巨大肿块出现腹腔挤压情况方行治疗,640排CT检查与其他肾脏肿瘤无特异性区别,行肾癌根治性切除术,术后病理确诊。结果病理检查示:镜下见肿瘤组织由狭长的小管组成,小管间见黏液间质,肿瘤细胞呈卵圆形及杆状,中度异性,间质内见多灶性浆细胞浸润,伴大片坏死。免疫组化:CD10(-),VIM(+),EMA(+),低分子量CK(-),CD15(-),Ki-67<5%肿瘤细胞,CK(-),CR(-),MC(-),CD34(-),CD31(-),S-100(-),诊断为肾黏液样小管状梭形细胞癌。术后恢复良好,随访3个月复查CT无复发,日常中度活动无不适反应,目前继续追踪随访中。结论肾脏黏液样小管状梭形细胞癌是一种罕见的低度恶性肾上皮肿瘤,术前诊断无特异性,最终依赖术后病理确诊,治疗仍以根治性切除术为主,预后相对较好。

Giant renal mucinous tubular and spindle cell carcinoma-a case report and review of literature

Objective To analyze the character of clinical manifestation, imaging and pathology of renal mucinous tubular and spindle cell carcinoma. Methods Clinical data of a giant renal mucinous tubular and spindle cell carcinoma（MTSCC） were reported and literatures were reviewed. The neoplasm was discovered at the size of 6 cm but was not treated until symptoms of compression occurred at the size of 18 cm 5 years later. The CT findings of MTSCC were not different from other renal neoplasms. The patient had radical nephrectomy and the pathology had confirmed the diagnosis. Results Histological appearance showed bland small tubules with mucinous stroma. The tumor cells showed spindle shape with moderate atypia. Multiple plasma cell infiltration was found in the stroma with massive necrosis. Immunohistochemical staining showed CD10（-）, VIM（＋）, EMA（＋）, low molecular CK（-）, CD15（-）, Ki-675% tumor cell, CK（-）, CR（-）, MC（-）, CD34（-）, CD31（-）, S-100（-）. The pathology diagnosis was MTSCC. CT imaging found no recurrence 3 months after surgery. The patient was well recovering and under follow up. Conclusion Mucinous tubular and spindle cell carcinoma is a rare renal neoplasm with low malignancy. Final diagnosis is made by post-operation pathology. The treatment is radical surger and good prognosis can be respected.