肾嫌色细胞癌的诊断和治疗（附五例报告）

目的 提高肾嫌色细胞癌的诊治水平。方法 回顾性分析5例肾嫌色细胞癌资料,结合文献复习进行讨论。结果 3例肾部分切除术,2例行根治性肾切除术,随访个月至4年,4例无瘤存活,1例于术后1年死于中风。结论 肾嫌色细胞癌是一种低度恶性的肾细胞癌,确诊有赖于影像学检查及典型病理表现,治疗以手术为主。     

肾脏嫌色细胞癌 (附3例报告)

肾脏嫌色细胞癌是一种较少见的肾细胞癌 ,对其临床特点、病理学特征了解不多。我院从 1 999年至今共收治肾脏嫌色细胞癌 3例 ,结合文献报告如下。1　病例报告例 1　女 ,45岁。 5年前体检时发现右肾占位性病变 ,约 3ｃｍ× 2ｃｍ大小 ,ＣＴ示错构瘤可能。近半个月前感腰酸 ,再次复查ＣＴ示肿块增大至 5ｃｍ× 4ｃｍ。入院后Ｂ超示右实质性占位病变。术中所见 :肾中极腹侧约 4ｃｍ× 4ｃｍ× 3ｃｍ肿块 ,突出肾外。行右肾肿瘤剜出术。肿块切面灰黄色 ,呈均质状。术中冷冻切片病理诊断为嗜酸细胞瘤。术后石蜡切片病理诊断为肾脏嫌色细胞癌。例 …     

肾嫌色细胞癌(附15例报告)

目的　提高肾嫌色细胞癌的诊治水平和对此类型肾癌的认识。　方法　回顾性分析15例肾嫌色细胞癌的临床资料。男 10例 ,女 5例。年龄 4 7～ 74岁 ,平均 5 7岁。均行根治性肾切除术。　结果　术后病理证实为肾嫌色细胞癌。病理分期 :pT1N0 M0 6例 ,pT2 N0 M0 5例 ,pT3bN0 M0 2例 ,pT1N2 M0 1例 ,pT2 N2 M0 1例。病理分级 :G2 10例 ,G3 5例。 11例获随访 ,随访 2～ 31个月 ,平均19个月 ,1例死于心脏病 ,1例局部复发 ,9例无瘤生存。　结论　肾嫌色细胞癌是一种具有特殊形态的少见肾癌类型。肾根治性切除术是治疗肾嫌色细胞癌的首选方法。与同期、同级的其他类型肾癌相比 ,肾嫌色细胞癌预后较好。     

肾嫌色细胞癌的临床研究

目的 探讨肾嫌色细胞癌的临床特点,提高肾嫌色细胞癌的诊断和治疗水平.方法 针对1例肾嫌色细胞癌的临床资料,结合相关文献进行分析.结果 病理结果示为肾嫌色细胞癌.免疫组化:CK部分细胞(+),CD10(-),CK8(+),RCC(-),vimentin(-),Ki-67(＜5%+),Hale胶状铁染色(+).结论 肾嫌色...     

127例肾嫌色细胞癌免疫组化分析

目的研究肾嫌色细胞癌(Renal chromophobe cell carcinom)的免疫组化特点,并从病理学角度探讨诊断肾嫌色细胞癌的分子标记物特点,以提高肾嫌色细胞癌的诊治水平。方法回顾性分析郑州大学第一附属医院收治的127例病理确诊为肾嫌色细胞癌的病理资料,分析其免疫组化特点,并复习相关文献。结果 127例病理确诊为肾嫌色细胞癌的免疫组化表达如下:S-100(11/98,11.2%),CK(111/113,98.2%),CK7(84/108,77.8%),CD10(52/109,47.7),CD117(105/111,94.6%),PAX-2(30/109,27.5%),PAX-8(79/96,82.3%),Vim(26/103,25.2%),EMA(103/104,99.0%),RCC(22/98,22.4%),Ki-67(6/111,5.4%),E-caderin(94/100,94.0%)。结论免疫标志物CK,CK7,EMA,E-caderin阳性及Vim,S-100阴性是肾嫌色细胞癌诊断的良好标记物。S-100A1的阴性表现还预示着肾嫌色细胞癌可能预后较好。CD117在肾嫌色细胞癌的细胞膜上的过表达可能是激酶抑制剂的潜在靶标,不过疗效仍需更多的研究证实。     

肾嫌色细胞癌临床与病理学特点分析

目的探讨肾嫌色细胞癌的临床及病理学特点，提高对此病的诊治水平。方法总结19例肾嫌色细胞癌患者的临床及病理资料。男10例，女9例。平均年龄53岁。左侧9例，右侧10例。偶发12例，7例有肉眼血尿、腰痛不适和腹部包块等症状。结果B超主要表现为包膜完整的低回声肿块。CT扫描肿瘤多为均匀低密度，边界清晰。肿瘤平均直径8．2cm。TNM分期T1N0M0 8例，T2N0M0 11例。行根治性肾切除17例，肾部分切除2例。16例获得随访，随访时间3个月～16年，平均无瘤生存4．8年。病理特点：肿瘤大体标本多为均匀深棕色实体，1例瘤体中央有纤维瘢痕；光镜下瘤细胞由典型型和嗜酸型两种细胞组成，胞膜清晰；免疫组化检测CK8阳性、Vimentin阴性；Hale胶体铁染色阳性；电镜下胞质内有大量膜性小空泡。结论肾嫌色细胞癌具有独特的形态学特点。B超、CT检查缺乏特异性。多数病例瘤体较大，但TNM分期多为早期，预后良好。     

肾嫌色细胞癌临床特征分析

目的 探讨肾嫌色细胞癌的临床特点并分析其预后.方法 对1998年1月至2008年1月期间收治的29例肾嫌色细胞癌患者的临床资料包括临床表现、影像学检查、治疗方法、Ptnm分期和生存期随访等,进行回顾性分析.结果 所有29例患者均缺乏典型的临床症状,术前影像学检查亦未发现特异性表现.23例患者行根治性肾切除术,6例行保留肾单位手术(NSS),病理分期:Pt1n0m0 11例,Pt2n0m0 8例,pT3aN0M0 5例,Pt1nm0 3例,Pt2n1m0 2例.26例患者获得随访,随访24～144个月,平均90个月;3例死于心脑血管疾病,6例局部复发后4例再次手术,1例远处转移,21例无瘤生存.与同期肾透明细胞癌患者相比,累积5年生存率两者分别为83.9%和63.8%,差异无统计学意义(P＞0.05),累积10年生存率分别为77.9%和49.9%,差异具有统计学意义(P＜0.01).结论 肾嫌色细胞癌是一种少见的具有特殊形态的肾细胞癌病理亚型,主要通过病理学予以鉴别诊断,手术切除是治疗初发或复发的肾嫌色细胞癌的首选方法,其预后较好.

Abstract：

Objectives To explore the clinical, pathological features and prognosis of patients with chromophobe renal cell carcinoma. Methods From January 1998 to January 2008, clinical data of 29 patients with chromophobe renal cell carcinoma including clinical manifestations, imaging examinations,treatment models, pTNM stages and follow-up results, were summarized to investigate its features and prognosis. Results All cases had no obvious clinical and preoperative imaging presentation. There were 23 patients underwent radical nephrectomy, and 6 cases underwent nephron sparing surgery. Postoperative pathological findings confirmed the diagnosis of chromophobe renal cell carcinoma. Macroscopically, the cut surface of the tumors were generally beige in color. Histologically, it showed polygonal chromophobe cells and small round eosinophilic cells with eccentric hyaline degeneration. These tumor cells had a clear and sharp membrane, lightly stained abundant cytoplasm with a fine reticular translucent pattern and irregular nuclei. And a perinuclear halo was often seen in these cells. Histochemically, the tumor cells generally show a diffuse and strong reaction for CK-8 with a negative expression of Vimentin. The pTNM stages of the tumor were as follows, pT1N0M0 in 11 cases, pT2N0M0 in 8 cases, pT3aN0M0 in 5 cases, pT1N1M0 in 3 cases,pT2N1M0 in 2 cases. Twenty-six cases of patients were followed up (24 to 144 months, with an average of 90 months), 3 cases died of cardio-cerebrovascular disease, and local recurrence involved in 6 cases with reoperation in 4 cases, as well as distant metastasis in 1 case. Twenty-one cases survived with tumor-free.The statistical results indicated that the survival rates of the patients with chromophobe renal cell carcinoma in five years and ten years were 83.9%, 77.9%, respectively, compared with renal cell carcinoma of the same stage 63. 8% and 49. 9% at the same periods, and there is no difference in the survival rate of five years( P ＞ 0. 05 ) but significant difference in that of ten years ( P ＜ 0. 01 ). Conclusions Chromophobe renal cell carcinoma is a morphologically uncommon subtype of renal cell carcinoma with the good prognosis. Definite diagnosis depends on its typical pathological feature. Radical nephrectomy is the first choice for the treatment of chromophobe renal cell carcinoma.     

104例肾嫌色细胞癌的临床分析

目的 探讨肾嫌色细胞癌的临床特点、治疗方式的选择及患者预后生存情况。方法回顾性分析陆军军医大学第二附属医院2012年1月至2022年1月收治的104例经术后病理诊断为肾嫌色细胞癌(chRCC)的患者临床资料。所有患者均行手术治疗,对患者的影像学资料、病理资料及术后生存情况进行分析和总结。结果 104例患者中有67例行CT检查,报告显示平扫期多数呈等密度或稍高密度软组织影,肿瘤内若存在坏死灶,则可能出现混杂密度影,部分肿瘤内有钙化,增强期大多呈现轻度或中度不均匀强化;4例行MRI检查,强化时均呈不均匀强化,静脉期强化均减退;病理结果示chRCC主要包括两种细胞类型,一种为体积较大的多角形半透明细胞,另一种为小圆形的嗜酸性细胞。8例患者失访,3例患者因非肾肿瘤性疾病死亡,2例因转移死亡,其余患者均长期生存,预后良好。结论 chRCC临床症状不典型,超声可作为首选体检筛查手段,CT和MRI检查在chRCC诊断上也具有一定优势。手术为早期chRCC首选治疗方案,多数患者预后良好,极少数患者术后出现转移或复发。晚期chRCC目前尚无统一治疗方案。     

肾嫌色细胞癌影像学特点与外科治疗选择

目的 提高肾嫌色细胞癌的临床诊治水平. 方法 回顾性分析25例肾嫌色细胞癌患者临床资料.男13例、女12例,平均年龄51岁.左侧13例,右侧12例.无症状肾癌16例,有腰部不适、发热、肉眼血尿等症状9例.实验室检查发现肝功能异常1例、红细胞沉降率加快1例.结合文献复习讨论肾嫌色细胞癌的影像学特点与外科治疗选择. 结果 B超检查肿瘤主要表现为低回声、有包膜、血流信号不明显.CT及MRI扫描肿瘤特征为边界清楚、质地均匀(CT平扫为70%、MR为73%),出血、坏死和囊性变少见,增强扫描多为均匀强化(CT为65%、MR为67%)及轻度强化(CT为65%、MR为93%).肿瘤直径＞4.0 cm的22例患者行根治性肾切除术、≤4.0 cm且位于肾周边的3例行肾部分切除术.肿瘤平均直径7.6 cm,剖面质地多均匀、呈灰白色或暗红色,光镜下癌细胞呈板状或条索状排列、胞质苍白或呈嗜酸性,免疫组化染色Vimentin阴性、CK18阳性.TNM分期pT1a 8例、pT1b 9例、pT2 6例、pT3a 2例.23例获随访,平均随访28个月,无瘤生存22例,1例于术后58个月发现肺转移,经干扰素-α治疗、吉西他滨及氟尿嘧啶化疗3个月后死亡. 结论 肾嫌色纽胞癌患者多无症状、分期较早.MR和CT主要表现为边界清楚、质地均匀、强化不明显.手术方式选择应遵循肾癌的外科治疗原则.患者预后多良好,手术至出现转移的时间间隔较长,建议延长术后随访时间.     

肾嫌色细胞癌的超声造影表现

目的 分析肾嫌色细胞癌的超声造影特征,提高对该肿瘤的识别.方法 分析经手术病理证实的28例嫌色细胞癌超声造影资料,分析血供情况及造影特征,并进行时间-强度曲线参数分析.结果 28例嫌色细胞癌与肾皮质作参照均呈乏血供造影表现,且肿块呈不均匀增强,肿块局部呈"快进快出"造影表现,强化程度低于周围肾皮质,其中15例(54%)病灶内可出现辐射样分布的强回声带.时间-强度曲线显示嫌色细胞癌组曲线达峰绝对值、曲线下面积低于肾皮质(P＜0.05),造影剂到达时间、达峰时间、曲线上升支斜率高于肾髓质组(P＜0.05).结论 超声造影检查中,肾嫌色细胞癌瘤体内辐射状增强和瘤体呈乏血供型增强为诊断提供了依据.

Abstract：

Objective To discuss the imaging characteristics of chromophobic cell renal carcinoma (CCRC) and study the features on the contrast-enhanced ultrasound (CEUS). Methods The CEUS features of CCRC in 28 cases identified by pathology were reviewed. The blood supply and enhancement characteristic were observed and analyzed on time intensity curve parameters. Results The 28 cases of CCRC showed poor blood supply in contrast with the renal cortex. The CCRC presented with heterogeneity enhancement, part of the tumor took on a high wash-in and wash-out, and enhanced less intense than the surrounding renal cortex. The actinomorphous strong echo of the tumors might be revealed with CEUS in 15 cases (54%). The time intensity curve analysis demonstrated that the CCRCs' difference of peak intensity and area under the curve were lower than the renal cortex (P＜0.05), but arrival time, time-to-peak and slope of ascending curve were higher than the renal medulla (P＜0.05). Conclusion The actinomorphous enhancement and poor blood supply in the tumor of CEUS could provide diagnostic evidence for CRCC.     

Molecular pathology of chromophobe renal cell carcinoma: A review

The recognition of chromophobe renal cell carcinoma (RCC) among other distinct types of renal cell tumors (RCT) based on light‐microscopic features, such as cytoplasmic and nuclear characteristics, might pose a dilemma in some cases because of morphological pattern overlapping with renal oncocytoma or conventional RCC. The present article reviews chromophobe RCC with focus on aspects of its molecular pathology, which was shown using ancillary modern microarray‐based technology that can distinguish it from its mimics and therefore be helpful for its correct diagnosis. Although the high resolution DNA‐microarray analyses excluded with all certainty the occurrence of small specific alterations, the loss of entire chromosomes 2, 10, 13, 17 and 21 occurs exclusively in chromophobe RCC and therefore probes localized at these chromosomes might be used to establish the diagnosis of chromophobe RCC in cases with uncertain histology. The usefulness of proposed candidate genes selected by the global gene expression analyses in the diagnostic pathology is far below expectations. The conflicting staining patterns, together with the poor specificity of used antibodies, leads us to believe that these candidate immunomarkers might not help in the separation of chromophobe RCC, with the exception of CD82, which has recently been suggested to be used for routine histological diagnosis.     

囊性肾癌的诊治及预后(附31例报告)

目的提高囊性肾癌的诊治水平，提高对于囊性肾癌的认识。方法回顾性分析1994年6月-2004年6月收治的31例囊性肾癌患者的流行病学、病理学、临床表现、影像学特征及临床治疗资料，并与TNM分期构成与囊性肾癌组相同的21例非囊性肾癌比较预后。结果囊性肾癌无特征性的临床表现，术前影像学检查可以提供诊断线索，经病理确诊肾癌囊性变19例，多囊性肾癌9例，单纯性囊肿癌变3例。17例行根治性肾切除术，14例行单纯性肾切除术。术后21例获得随访，生存时间平均38个月。总体上与非囊性肾癌的预后尤统计学差异。站论囊性肾癌是一类在影像学和大体病理上具有囊性改变的肾癌的统称，由3种病理学类型构成，术前正确鉴别各亚型是选择手术方式和判断预后的关键。     

原发性输尿管癌的诊断与治疗（附13例报告）

目的探讨原发性输尿管癌的早期诊断及手术治疗方法，以提高治愈率。方法回顾性分析13例经病理证实的原发性输尿管癌患者的临床资料，并对诊疗问题进行讨论。结果肉眼血尿、腰痛和肾积水是其主要临床表现，彩超、CT、MRI、IVU、膀胱镜检及逆行输尿管插管造影是本病的基本诊断方法；12例患者获得随访，随访时间10个月-7年，死于输尿管癌转移5例，存活7例。结论患侧肾输尿管全长及膀胱袖状切除术是治疗原发性输尿管癌的首选方法，取腰腹部弧形切口先行输尿管及膀胱袖状切除后再向上延长切口作肾切除术，具有成功率高、创伤性小、简便易行、安全可靠等优点。     

Hybrid tumour ‘oncocytoma‐chromophobe renal cell carcinoma’ of the kidney: a report of seven sporadic cases

OBJECTIVES

To determine whether renal hybrid tumours (HT) appear as a specific clinical and radiological entity, as HT are characterized by the association of both oncocytes and chromophobe cells within the same tumour, and have been described in patients with oncocytosis and Birt‐Hogg‐Dube syndrome.

PATIENTS AND METHODS

We reviewed the medical charts of 67 patients who had a partial or radical nephrectomy in our institution for renal oncocytoma (RO, 24), chromophobe renal cell carcinoma (CRCC, 36) and HT (seven), from January 2006 to October 2007. We report the clinical, radiological and pathological characteristics of the seven cases of HT.

RESULTS

The mean (range) age of the patients was 56 (41–68) year. None of the seven patients had any suspicion of RO, based on computed tomography (CT). Two patients had a history of kidney cancer. Five patients had partial and two a radical nephrectomy. The mean (range) maximum tumour diameter was 5.5 (1.8–9) cm. Two tumours were pT1a, two were pT1b and three were pT2. Pathological analysis showed RO‐like and CRCC‐like cells intermixed (six patients) or distinct (one). After a median (range) follow‐up of 20 (8–25) months, none of the patients had any evidence of disease recurrence.

CONCLUSIONS

In a large series of patients with sporadic RO and CRCC, 10% of the tumours had hybrid morphological features, as described in oncocytosis and Birt‐Hogg‐Dube syndrome. We were unable to identify any specific clinical characteristic. Most importantly, none of these HT showed any of the radiological characteristics of RO.     

肾梭形细胞癌的诊断和治疗(附8例报告)

目的提高肾梭形细胞癌的诊治水平和对此类型肾癌的认识。方法回顾性分析8例肾梭形细胞癌的临床资料,结合文献复习进行讨论。结果8例均行根治性肾切除术,术后病理证实为肾梭形细胞癌;随访6-17个月,7例死于术后肿瘤复发或转移,1例随访9月出现肺转移。结论肾梭形细胞癌是一种高度恶性少见的肾细胞癌,确诊有赖于影像学检查及典型病理表现,治疗以手术为主,预后不良。     

Characteristics and prognosis of chromophobe non‐metastatic renal cell carcinoma: A multicenter study

Objectives: To analyze the characteristics and the prognostic significance of chromophobe renal cell carcinomas (chRCC). Methods: Data about 2981 patients with non‐metastatic renal cell carcinomas (RCC) at the time of surgery were retrospectively collected from 26 institutions between 1998 and 2008. All patients had undergone partial or radical nephrectomies. Of the 2981 patients, 2602 patients with conventional RCC (cRCC) and 148 with chRCC were studied. Clinical and pathological parameters were determined in all patients. Recurrence‐free survival (RFS) and cancer‐specific survival (CSS) were assessed. Results: Patients with chRCC differed significantly from those with cRCC on the following parameters: younger age (P = 0.026), greater female ratio (P < 0.001), and larger tumor diameter (P < 0.001). Both groups were alike with respect to body mass index (P = 0.943), Eastern Cooperative Oncology Group performance status (P = 0.163), T stage (P = 0.375), and Fuhrman's grade (P = 0.134). The 5‐year RFS rates in patients with chRCC and cRCC were 82.7% and 83.3%, respectively (P = 0.762). The 5‐year CSS rates in patients with chRCC and cRCC were 88.8% and 92.2%, respectively (P = 0.980). Both groups showed equivalent oncological outcomes in terms of RFS and CSS for cases stratified by T stage and Fuhrman's grade. In multivariate analysis, the histological subtype was not retained as an independent prognostic variable (RFS: P = 0.893; CSS: P = 0.729). Conclusions: Despite being significantly different from cRCC in terms of several clinical and pathological parameters, chRCC shows equivalent oncological outcomes.     

膀胱肉瘤样癌的诊断与治疗（附2例报告）

目的 提高对膀胱肉瘤样癌的认识和诊治水平。方法 分析2例膀胱肉瘤样癌患者的临床资料并结合文献进行讨论。2例患者均有肉眼血尿或伴有膀胱刺激症，膀胱镜检查为实体瘤，表面有坏死组织；病理表现，肿瘤主要由移行上皮癌细胞和恶性间叶细胞（梭形或多形性细胞）组成，之间可见移行过渡；免疫组化CK（＋）、CEA（＋）、SMA（＋）。结果 2例Ⅰ期治疗均行经尿道膀胱肿瘤电切，术后常规膀胱灌注，1例术后5个月死于肿瘤复发及多处转移；1例半年后复发改行部分膀胱切除，至今健在。结论 膀胱肉瘤样癌是一种高度恶性、预后差的肿瘤。确诊需依赖病理和免疫组织化学检查，早期诊断和采用膀胱部分切除或根治性切除，是改善预后的关键。     

Resection of bulky chromophobe renal cell carcinoma resolved severe idiopathic thrombocytopenic purpura: A case report

Idiopathic thrombocytopenic purpura associated with renal cell carcinoma is relatively rare. We report the case of a 48‐year‐old woman with massive renal cell carcinoma, measuring approximately 20 × 14 × 14 cm, who presented with severe thrombocytopenia: platelet count, 2000 cells/μL. After confirming normal bone marrow, she received high‐dose dexamethasone and intravenous gamma globulin, which raised the platelet count to normal levels. She then underwent left radical nephrectomy. The pathological examination showed chromophobe renal cell carcinoma. After the resection, the platelet count was maintained within the normal range without any treatment. The current case is the first report of chromophobe renal cell carcinoma causative of severe idiopathic thrombocytopenic purpura.