原发性肾脏类癌2例报告并文献复习

目的：探讨原发性肾脏类癌的临床特征及诊治方法。方法：总结2例原发性肾脏类癌患者的临床资料结合文献复习讨论。例1，女，48岁。因右腰酸痛1个月入院。B超示右肾中上极中等回声占位，边界清楚，内有血流信号。CT示右肾中上极10．0cm×7．5cm实性占位，增强后病灶均匀轻度强化。例2，男，44岁。体检发现左肾占岱40天入院。B超示左肾门处中等回声占位，边界清楚，内有血流信号。CT示左肾中极肾门处3．7cm×3．5cm实性占位，增强后病灶均匀轻度强化；其内伴-钙化点。结果：2例均行根治性肾切除术。病理检查镜下肿瘤细胞形态为多边形，嗜酸性颗粒状细胞质，边界不清，呈柱状或缎带状排列混合有实性巢状排列；细胞核呈园形大小一致，核分裂像难见。免疫组化：突触素、波形蛋白均为阳性。病理诊断为肾脏类癌伴淋巴结转移。例1术后30个月死于肝骨转移；例2术后随访26个月，未见肿瘤复发转移。结论：原发性肾脏类癌临床罕见，易发生淋巴结转移，确诊依靠病理学检查，根治性肾切除应为治疗原发性肾类癌的首选方法。

Primary Carcinoid Tumors of the Kidney (Report of 2 Cases and Review of Literature)

Objective：To discuss the diagnosis and treatment of primary renal carcinoid tumor Methods： Two cases of primary renal carcinoid tumor were reported and the relevant literature was reviewed. Case 1, a 48-year-old woman, complained of intermittent right back pain for 1 month. B-ultrasound examination showed large patchs with middle-strong echo, well defined regions in upper pole of the right kidney with blood flow signals. CT scan revealed a 10 cm × 7.5 cm mass with uneven enhancement by contrast in the right kidney. Case 2, a 44-year-old man, presented with a solid mass in the left kidney for 40 days. B-ultrasound and CT scan revealed a 3.7 cm ×3. 5 cm mass with calcification and minimal enhancement by contrast in the mid pole of the left kidney. Results： Radical nephrectomy was performed in two patients. Microscopica 11 y, the tumors consisted of tightly packed cords and trabeculae of polygonal neoplastic cells which showed a trabecular or ribbon-like arrangement admixed with solid nests. Nuclei are round to oval and uniform in size with rare mitotic events. Immunohistochemically, neoplas- tic cells were stained positively for Synaptophysin and Vimentin. The pathological diagnosis for both patients was the renal carcinoid tumor with regional lymph nodes metastases. Case 1 was dead of liver and bone metastases at 30 months after the surgery. Case 2 was alive without disease at 26 months. Conclusions： Primary renal carcinoid tumor is a rare disease and has an aggressive clinical course with lymph node metastases early. Surgical resection of these tumors accompanied by lymph node dissection should be the primary therapy.