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。

Clinical Analysis of Papillary Renal Cell Carcinoma (Report of 7 Cases)

Objective： To study the clinical feature of papillary renal cell carcinoma（PRCC） and to improve the recognization of diagnosis, treatment and prognosis of PRCC. Methods： A retrospective study was done including reviewing the clinical data of 7 cases of PRCC and review relative literature. All cases were followed up. Results： 7 cases were proved to be PRCC by pathology, and 1 case existed adrenal adrenoma. Fisrt symptoms mainly were pain, hematuria, emaciation, low fever. CT image showed the density of tumor in renal medulla phase was strengthened weaker than that in renal cor tex phase obviously , and that in the renal medulla phase and the excretory phase were both strengthened. 6 patients per formed transventral radical nephrectomy, and 1 patuents performed lumbar radical nephrectomy. All patients performed adjuvant therapy of immunotherapy. Radiotherapy and chemotherapy were not performed. 6 patients had been followed up from 3 months to 2 years, one case died 6 month after operation due to renal failure, one case died 12 month after operation due to live and lyphy node metastasis, other 4 patients survived without recurrence and metastasis by now. Conclusions： PRCC is similar to other renal cell carcinoma（RCC） in clinical manifestation, but differs from other RCC in radiographic, pathologic morphology and biologic behavior. Diagnosis depends on CT image, pathology and Immunohistochemical methods. Early radical surgery is the optimal treatment by now. The prognosis was associated with the stage and metastatic status of PRCC.