肾嗜酸细胞腺瘤12例临床诊治分析并文献复习  

Diagnosis and treatment of 12 renal oncocytoma patients and literature review

作　　者：高德轩[1] 宁豪[1] 丁克家[1] 吕家驹[1] 王法成[1] 李善军[1] 尉立京[1] 

机构地区：[1]山东大学附属省立医院泌尿外科,山东济南250021

出　　处：《中华肿瘤防治杂志》2010年第17期1374-1376,共3页Chinese Journal of Cancer Prevention and Treatment

摘　　要：目的:探讨肾嗜酸细胞瘤的诊断和治疗。方法:回顾性分析12例肾嗜酸细胞腺瘤患者临床资料,并复习相关文献,总结临床特征、影像及病理表现、治疗和预后。结果:肿瘤均为单发,直径1.5～11.0cm,平均(4.4±3.1)cm。CT平扫显示,肿瘤包膜完整,密度均匀一致;增强扫描成中等强化,2例瘤体中央可见星芒状瘢痕。术前B超、CT诊断2例为肾嗜酸性细胞腺瘤,10例为肾癌。行肾癌根治术者7例,肾部分切除者5例。术后观察肿瘤包膜完整,切面呈棕色或棕黄色,质地均匀。光镜下瘤细胞胞质内含丰富的嗜酸性颗粒,细胞无明显异形性和核分裂像。免疫组织化学染色显示,cytokera-tin8/18(+),CD10(-),EMA(+),vimen-tin(-),Hale胶体铁染色(-)。随访2～102个月,平均(19.4±27.3)个月,均无瘤生存。复习国内文献70篇,病例211例,英文文献19篇,病例92例。结论:肿瘤较小肾嗜酸细胞腺瘤在影像学上极易被诊断为肾癌;直径>4.0cm肿瘤星芒状瘢痕改变多见,CT或磁共振多可作出正确诊断,保留肾单位手术应尽量考虑。对于<4cm肿瘤不论是术前影像学是否诊断正确,均应该以保留肾单位手术为主。OBJECTIVE：To investigate and improve the diagnostic and therapeutic feature of renal adenoma. METHODS：The clinical data of 12 cases of patients with renal oncocytoma were retrospectively analyzed. The literature of renal oncocytoma was reviewed. RESULTS：All the renal masses were solitary,with the mean diameter ranged （4.4±3.1） cm （1.5-11.0 cm）. Renal oncocytoma was characterized by homogenous attenuation on CT scan,and a central,margined satellites area on CT scan could be found in 2/12 cases. On ultrasound-B and CT,2 cases were suggested as adenoma and 10 cases were misdiagnosed as renal carcinoma. Seven cases underwent radical nephrectomy and 5 nephron-sparing surgery. On light microscopy,there was strong eosinophilic cytoplasm with granules,the tumor cells being adenoid or laminar in pattern with no necrosis. The immunohistochemical stain was positive for cytokeratin 8/18 and EMA,whereas it was negative for vimentin,CD10 and Hale＇s colloidal iron stain. With 2-102 months 〔mean （19.4±27.3） months〕 follow up. Seventy Chinese literatures （211 cases） and 19 English literatures （92 cases） were reviewed.CONCLUSIONS：Renal oncocytoma is easy to misdiagnose as carcinoma on ultrasound-B and CT. The central satellite area of oncocytoma is usually found in 4 cm tumors on CT or MR. The diagnosis can be established on imaging,histopathologic and immunohistochemical studies. Surgery is the optimal treatment,and nephron-sparing surgery （NSS） should be the first choice.

关 键 词：肾肿瘤 嗜酸细胞 腺瘤 诊断 治疗 

分 类 号：R737.11[医药卫生—肿瘤]