肾集合管癌10例分析

目的：研究肾集合管癌的临床病理特征。方法：回顾性研究肾集合管癌的临床及病理资料并进行随访。结果10例肾集合管癌占肾癌的2．1％，主要症状为血尿、腰腹痛。9例行肾癌根治术，1例行肿瘤剜除术。肿瘤主要位于肾髓质，呈灰白色或淡黄色，侵袭性生长；以腺管乳头状结构为主，部分混有肉瘤样癌，腺样囊性癌、条索及巢状癌。Fuhrman病理分级；G2，1例；G3,4例；G4，5例，TNM综合病理分期：Ⅰ期4例，Ⅱ2例，Ⅲ期1例，Ⅳ期3例，6例死于肾癌转移，其中1例术后19个月死于心脏病；2例无瘤生存，1例失访。平均生存时间13．3个月。结论肾集合管癌临床症状19个月死于心脏病；2例无瘤生存；1例失访。平均生存时间13．3个月。结论肾集合管癌临床症状明显，临床病理分期高，进展快，主要治疗方法为肾癌根治术，多数病例于术后数月发生转移或死亡。

Carcinoma of kidney collecting duct: an analysis of 10 cases

OBJECTIVE: To study the clinicopathologic characteristics of renal collecting duct carcinoma (CDC). METHODS: A retrospective study was done in 10 cases of CDC. RESULTS: Among 466 cases of renal cell carcinoma admitted in our Institute between January 1989 and June 30, 1999, 10(2.1%) cases of CDC were identified. Seven presented with gross hematuria and 3 with abdominal pain. Radical nephrectomy was done in 9 patients, enucleation of tumor in one. The primary tumor was located predominantly in the renal medulla. Histologic examination showed prominent tubular or tubulopapillary structures. Sarcomatoid carcinoma, cystadenocarcinoma, nests and cords of tumor cells in desmoplastic stroma were identified in some cases. High molecular weight cytokeratin 34 beta E12 was positive in 8 cases and peanut agglutinin in 7 cases. According to Fuhrman's nuclear grade, one was in G2, 4 were in G3 and 5 in G4. Six patients died of metastases within 3 to 23 months (mean 13.3 months), one died of heart disease with tumor free after 19 months, two survived with tumor free for 14 months and 39 months, respectively, one lost from follow-up. CONCLUSION: CDC is a distinctive renal cell carcinoma with prominent clinical appearance and progressive clinical course.