肾脏替代性脂肪瘤病一例报告并文献复习  

Renal replacement lipomatosis（a case report and review of the literature）

作　　者：刘冉录[1] 徐勇[1] 张志宏[1] 赵维明[1] 杨全成[1] 齐士勇[1] 李靖[1] 滕志刚[1] 

机构地区：[1]天津医科大学第二医院泌尿外科天津市泌尿外科研究所,300211

出　　处：《中华泌尿外科杂志》2007年第3期165-167,共3页Chinese Journal of Urology

摘　　要：目的探讨肾脏替代性脂肪瘤病的发生机理、病理特点、临床表现、诊断和鉴别诊断。方法患者，女，62岁。发现右腹部肿物4年，有20年右肾结石病史。CT示右肾区一低密度为主直径约15cm的类圆形肿块影，其内显示不规则软组织影、高密度钙化影及大量低密度脂肪影。术前拟诊为肾脏鳞状细胞癌、畸胎瘤或血管平滑肌脂肪瘤。行经腹切口肿物探查术。结果术中发现约10cm下腔静脉受压呈扁平状，后侧与腰肌粘连紧密。切除肿物约20cm×15cm×10cm。纵行剖开可见肾脏萎缩，仅残留厚度约2mm肾盂包绕多个结石，肾脏几乎被脂肪完全替代。病理检查：肾窦、肾门及肾周大量增生的成熟脂肪细胞，伴炎性细胞浸润；肾小球玻璃样变，大量炎性细胞浸润。随访5个月未见复发。结论肾脏替代性脂肪瘤病是一种少见的良性肾脏疾病，需与其他肾脏的良恶件肺瘤鉴别，以便正确诊断与治疗。Objective To review the pathogenesis, pathology, clinical manifestations, diagnosis and differential diagnosis of renal replacement lipomatosis with 1 case report. Methods A 62-yearold female patient with a 20-year history of right renal calculus found a mass in her right abdomen for 4 years. CT revealed a 15 cm in size, mainly low-density and round-like mass with irregular parenchyma, high-density calcification and abundant low-density fat. The possible diagnosis before operation was squamous cell carcinoma, teratoma or angiomyolipoma of kidney. The surgery exploration was performed via abdomen. Results About 10cm-long vena cava inferior was found oppressed by the mass and the mass was severely adhesive with the lumbar muscles at the back. Grossly, the tumor exhibited a 20 cm×15 cm×10 cm solid mass. Longitudinal section showed that the kidney was extremely atrophic and only about 2mm renal pelvis wrapping some stones left. The kidney was almost replaced by fatty tissues. Pathological examination indicated that the hyperplastic fatty tissues at the renal sinus and hilus and periphery were mature fatty cells with infiltration of inflammation cells. All glomeruli were hyaline with infiltration of large amount of inflammation cells. The patient was free of signs of recurrence 5 months after operation. Conclusions Renal replacement lipomatosis is a rare benign disease of kidney. It is necessary to distinguish it from any other benign and malignant tumors in the kidney in order to diagnose and treat it correctly.

关 键 词：肾肿瘤 脂肪瘤病 诊断 黄色肉芽肿 

分 类 号：R686[医药卫生—骨科学]