原发性肾窦肿瘤三例报告

目的 总结原发性肾窦肿瘤的临床特点及治疗方法.方法 原发性肾窦肿瘤患者3例.女2例,男1例.平均年龄40(33～55)岁.临床表现为腰痛伴血尿1例,单纯腰部疼痛2例.肿瘤位于右侧2例,左侧1例.直径平均5.5(3.5～8.5)cm.3例均经行手术治疗. 结果行右肾窦肿瘤探查术1例,术中病理提示良性肿瘤,单纯切除肿瘤,病理报告为血管平滑肌瘤,随访3年未见复发.1例术中因肿瘤出血及肾盂破坏严重,行右肾切除,病理报告为血管平滑肌脂肪瘤,随访10个月未见复发.1例因肿瘤包绕肾动静脉,局部严重黏连,行左肾切除术,病理报告为脂肪瘤,随访4年未见肿瘤复发.结论 原发性肾窦肿瘤临床罕见,多为良性,易误诊为肾盂肿瘤,CT、MRI、IVU检查有助于鉴别;良性肿瘤直径<4 cm且无症状者可密切随访,有症状或直径>4 cm者可行肿瘤切除;肿瘤累及肾蒂并严重破坏肾盂者可行单纯肾切除;恶性肿瘤应行根治性肾切除.

Diagnosis and management of tumors primary in renal sinus

Objectlve To discuss the characters and management of renal sinus tumors. Methods The clinical data of 3 tumors occurring in tenal sinus were reviewed.The first patient was a 33-year-old man with the chief complaint of lumbago in the right side for 6 months.B-ultrasound showed low echo in the right pelvis and CT scan showed that a mass measured about 3.5 cm in diameter in the right kidney collective system.Intravenous urography showed the upper collective system was tompressed.He was diagnosed for renal sinus tumor.The second case was a 34-year-old woman with the chief complaint of sudden lumbago in the right for 3 d.Color ultrasonography found hyperechoic in the right kidney.CT scan showed a mass measured 8 cm×6 cm × 8 cm in the right renal sinus,its CT value was about-70 HU.Intravenous urography showed the lower collective system was compressed.She was diagnosed for renal angiomyolipoma of right kidney.The third case was a 55+year-old woman with the chief complaint of lumbago for 1 year.B ultrasound showed hyperechoic in the leftrenal hilum.CT scan showed a nlass of 8 cm×5 cm×5 am in the left renal sinus with CT value of 50 HU.Intravenous urography showed the collective system of the left kidney was compressed.Mag-netic resonance imaging showed high signal on T1 WI and T2WI but low signal in fat suppression ima-ging.She was diagnosed for lipoma of the left renal sinus. Results All the 3 cases had undergone surgical approaches.The first case underwent surgical exploration of renal sinus tumor.Fast pathologic diagnosis was benign tumor,only the tumor was resected.Postoperative pathology confirmed the diagnosis of angioleiomyoma.There was no recurrence during follow-up of 3 years.The second case was scheduled for tumor enucleating,but nephrectomy was perform because of serious bleeding and damaged renal pelvis.Pathological report was angiomyolipoma.The third case was scheduled for lipoma enucleating but nephrectomy was performed because of tumor encapsulated renal pedicle vascular.Pathological report was lipoma.During the follow-up for 4 years there was no relapse. ConclusionsTumors occurred in renal sinus are rare, most of which are benign.CT scan, MRI and intravenous urography are the best imaging examination methods for differential diagnosis.Surgical operation is the major approach, while for the tumor radical nephrectomy less than 4 cm watchful waiting could be a choice.Tumor resection with nephron sparing is feasible while tumor is larger than 4 cm.Radical nephrectomy should performed for the malignant tumor.