肾脏和前列腺恶性纤维组织细胞瘤三例报告  

Malignant fibrous histiocytoma of the kidney and the prostate（report of 3 cases）

作　　者：戚晓平[1] 蔡松良[2] 王华[3] 阎利[1] 

机构地区：[1]解放军第一一七医院泌尿外科,杭州310013 [2]浙江大学医学院附属第一医院泌尿外科 [3]嘉兴市第一人民医院泌尿外科

出　　处：《中华泌尿外科杂志》2007年第4期235-238,共4页Chinese Journal of Urology

摘　　要：目的 提高对肾脏、前列腺恶性纤维组织细胞瘤（malignant fibrous histiocytoma，MFH）的认识。方法 MFH患者3例，均为男性。2例原发性肾脏MFH者年龄为69、73岁，临床表现为低热或腰部疼痛、消瘦，B超及CT示肾脏实性占位性病变，分别为8．0cm×7．0cm、7．4cm×6．6cm。1例原发性前列腺MFH患者年龄39岁，临床表现为排便困难，B超及CT示前列腺内囊实性占位性病变18．1cm×14．5cm。结果 3例分别行根治性左肾切除术、左肾切除加局部浸润组织切除、膀胱前列腺切除术加直肠切除术加乙状结肠造瘘术。首次手术均完整切除肿瘤。光镜下见肿瘤细胞常排列成席纹状，形态多样，主要由梭形的纤维母细胞样细胞和圆形、卵圆形组织细胞样细胞组成，并有不等量的多形性巨细胞及炎细胞。免疫组化染色示vimentin、-AAT、α1—ACT、CD68（＋），EMA、Desmin、S-100（-）。2例肾脏MFH患者分别于首次术后16、21个月因纵隔广泛转移或局部复发伴腹腔转移死亡，前列腺MFH患者术后3个月因肿瘤肺转移死亡。结论 原发性肾脏和前列腺MFH是一类罕见的、高度恶性的肿瘤，预后差，确诊需依赖组织病理学及免疫组织化学检查，早期诊断及原发病灶的彻底切除是治疗的关键。Objective To discuss the diagnosis and therapeutic methods of malignant fibrous histiocytoma（MFH） of the kidney and the prostate. Methods Three cases of MFH of the urinary system （all male） were reviewed. The age of the 2 renal MFH was 69 and 73 years. The clinical symptoms were low fever or left lumbar pain, emaciation. B-ultrasound and CT showed solid massws both （all on the left kidney）which were 8.0 cm× 7.0 cm or 7.4 cm× 6.6 cm in size, respectively. The prostate MFH （39-year-old） presented with difficulty defecation. B-ultrasound and CT showed a cystic and solid mass which was 18.1 cm× 14.5 cm in size. Results All three cases underwent total tumor resection after the diagnosis. Pathology examination of the tumor showed spindle-shaped fibroblast- like cells arranged in a storiform pattern with fibrous stroma and clusters of rounded histiocyte-like cells, pleomorphic giant cells and inflammatory cells. Immunohistochchemical staining showed the tumor cell was positive for vimentin, α1-AAT, CD68 and α1-ACT, and negative for EMA, Desmin, S- 100. Two cases of renal MFH died 16, 21 months after first operation due to metastasis. The prostate MFH died of lung metastasis 3 months after operation. Conclusions Primary MFH of the kidney and the prostate is rare with high malignancy. The specific survival for adult with MFH is short. Diagnosis of MFH depends on pathologic and immunohistochchemical examination. Early diagnosis and complete surgical resection primary lesion offer patients the best chance for survival.

关 键 词：肾肿瘤 前列腺肿瘤 恶性纤维组织细胞瘤 

分 类 号：R686[医药卫生—骨科学]