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肾黏液性小管和梭形细胞癌合并骨转移1例及文献回顾
引用本文:黄子雄,张晓鹏,董森,刘士军,杨荣利,周宇石,马伟国.肾黏液性小管和梭形细胞癌合并骨转移1例及文献回顾[J].北京大学学报(医学版),2018,50(4):732-735.
作者姓名:黄子雄  张晓鹏  董森  刘士军  杨荣利  周宇石  马伟国
作者单位:(北京大学人民医院1.泌尿外科,2.骨肿瘤科,3.胃肠外科, 北京100044; 4. 新疆克拉玛依市中心医院泌尿外科, 新疆克拉玛依834000)
摘    要:黏液性小管和梭形细胞癌(mucinous tubular and spindle cell carcinoma,MTSCC)是肾细胞癌中一种十分罕见的病理亚型。一般认为该亚型的恶性肿瘤具有高分化/低级别、侵袭能力较弱、预后较好等“惰性”肿瘤行为。本例MTSCC展现出了较为特异的临床表现,现报告如下。

关 键 词:肾肿瘤  黏液性小管和梭形细胞癌  肿瘤转移  骨肿瘤  

Renal mucinous tubular and spindle cell carcinoma combined with multiple bone metastasis: a case report and literature review
HUANG Zi-xiong,ZHANG Xiao-peng,DONG Sen,LIU Shi-jun,YANG Rong-li,ZHOU Yu-shi,MA Wei-guo.Renal mucinous tubular and spindle cell carcinoma combined with multiple bone metastasis: a case report and literature review[J].Journal of Peking University:Health Sciences,2018,50(4):732-735.
Authors:HUANG Zi-xiong  ZHANG Xiao-peng  DONG Sen  LIU Shi-jun  YANG Rong-li  ZHOU Yu-shi  MA Wei-guo
Institution:(1.Department of Urology, 2. Musculoskeletal Tumor Center, 3. Department of Gastroenterological Surgery, Peking University People’s Hospital, Beijing 100044, China; 4. Department of Urology, Karamay Central Hospital of Xinjiang, Karamay 834000, Xinjiang, China)
Abstract:Mucinous tubular and spindle cell carcinoma (MTSCC) is a rare sub-type of renal cell carcinoma (RCC). It has been considered to be a kind of “indolent” tumor with low grade fashion, weak invasive capacity and relatively favorable prognosis. However, in the current case, a 3.7 cm×2.8 cm spherical mass with contrast enhancement was found in the left kidney incidentally by computed tomography (CT) in a 60-year-old male patient. A lesion in the right humerus (2.1 cm×1.6 cm×3.1 cm) was found at the same time without any symptoms or sign of pathological fracture by magnetic resonance (MR) imaging. Further positron emission tomography (PET)/CT scan which was ordered immediately after admission suggested multiple bone destruction including skull, pelvis, sternum, right humerus and femur, left scapula, multiple vertebrae and libs. Pathological examination after radical nephrectomy and palliative resection with internal fixation of the lesion in the right humerus indicated that both renal (3.0 cm×3.0 cm×2.5 cm) and bone lesions were MTSCC with the features of high-grade ovoid epithelioid cells, cord-like spindle cells and mucinous matrix under light microscope. The diagnosis of renal MTSCC concurrent with multiple bone metastasis was made. This case report suggested the necessity of general evaluation, especially bone scan for possible distant metastasis, as MTSCC might present unexpected advanced behaviors without any orthopedic symptoms. The behavior of bone metastasis might be associated with male and elderly age. MTSCC has similar enhancement features to papillary RCC on CT scan. As results, attentions are needed to differentiate MTSCC from papillary RCC as they both tend to show lesser enhancement degrees than cortex. Rather than exhibiting a dedifferentiating appearance, the pathological characteristics of bone metastasis lesion were close to those of primary renal lesion. The reason of distant metastasis to the bone remained unclear, negative expression of cytokeratin (CK) 7 might be attributed to. Though immunotherapy, chemotherapy and target therapy could all be methods for systematic therapies, procedures to remove renal lesions and prevent skeletal related events are still highly recommended.
Keywords:Kidney neoplasms  Mucinous tubular and spindle cell carcinoma  Neoplasm metastasis  Bone neoplasms  
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