肾脏癌肉瘤和肉瘤样癌的病理及临床特点  

Renal sarcomatoid carcinoma and carcinosarcoma

作　　者：田溪泉[1] 邢念增[1] 

机构地区：[1]首都医科大学附属北京朝阳医院泌尿外科,北京100020

出　　处：《临床泌尿外科杂志》2008年第8期584-586,共3页Journal of Clinical Urology

摘　　要：目的:总结肾脏癌肉瘤和肉瘤样癌的病理及临床特点。方法:回顾性分析1例肾脏癌肉瘤和1例肾脏肉瘤样癌的的临床资料,2例患者均为男性,年龄分别为60岁、64岁。1例以右腹部肿块伴体重减轻就诊,影像学检查发现右侧肾脏巨大占位性病变。另1例以右侧腰区间歇性疼痛伴全程肉眼血尿就诊,影像学检查提示右肾巨大占位性病变,侵及肾周筋膜外组织,有淋巴结转移,2例患者均行肿物根治性切除。结果:2例患者均成功进行根治性肾脏肿物切除术。病理诊断:第1例患者肿块存在癌与肉瘤两种成分,癌成分为嫌色细胞瘤,肉瘤为平滑肌以及纤维成分混合来源,诊断为肾脏实质癌肉瘤。术后3个月存活良好,目前在随访中。另1例诊断为肾脏肉瘤样癌,侵及肾周组织,术后未行任何辅助治疗,2个月后死亡。结论:肾脏癌肉瘤和肉瘤样癌临床少见,具有浸润性生长的生物学特性,恶性程度高,多数患者对放化疗不敏感,预后较差。免疫组织化学检查对于确诊有重要价值。根治性切除仍然是目前首选的治疗手段。Objective：To investigate the pathological and clinical characteristic of renal sarcomatoid carcinoma and carcinosarcoma. Methods： the data of a case of renal sarcomatoid carcinoma and a case of renal carcinosarcoma were reviewed. The first patient presented with giant abdominal lump and loss of body weight in three months, B type ultrasound and CT revealed a giant invasive tumor on the right renal. The second patient presented with intermittent low back pain and gross hematuria. CT discovered that right renal invasive tumor, with the swelling of lymph nodes in retroperitoneal space. Results： Radical nepbrectomy was successfully performed in two patients. The neoplasm of the first patient was proved to be renal carcinosarcoma by the pathological study and immunohisto-chemistry. The patient has lived for three months and was being follow up by now. The second patient was diagnosised as sarcomatoid carcinoma and died of multi organ metastatis two months after operation. Conclusions： Renal sarcomatoid carcinoma and carcinosarcoma have the biological behavior of invasive growth,often present with or develop metastases soon after the primary diagnosis. Most cases do not respond to immunotherapy or aggressive chemotherapy and have the poor prognosis. The immunohistochemical study are essential in pathological diagnosis and differentiation. Radical resection is still the first choice for treatment.

关 键 词：肾脏肿瘤 癌肉瘤 肉瘤样癌 

分 类 号：R737.11[医药卫生—肿瘤]