孤立性肾髓外浆细胞瘤1例报告并文献复习  

Isolated extramedullary plasmacytoma of the kidney:a case report and literature review

作　　者：刘志飞[1,2] 乔磊[2] 张志宏[2] 徐勇[2] 

机构地区：[1]唐山市人民医院泌尿外科,河北唐山063000 [2]天津医科大学第二医院泌尿外科,天津市泌尿外科研究所

出　　处：《临床泌尿外科杂志》2013年第7期489-491,共3页Journal of Clinical Urology

摘　　要：目的:提高肾脏浆细胞瘤的诊治水平。方法:肾脏浆细胞瘤患者1例,女,55岁。体检B超偶然发现左肾前唇实质内可见一范围约4.7cm×2.6cm的低回声包块;CT检查左肾见一大小约3.0cm×4.0cm×3.5cm低密度影;增强CT示左侧肾脏占位性病变,考虑肾肿瘤性病变不除外。行后腹腔镜左肾根治性切除术。结果:病理报告示左肾上极可见囊实性肿物,大小约4.0cm×3.0cm,腔内含淡黄色的浆液性液体,切面淡黄色,其余肾脏皮髓质分界清楚。镜下肿瘤细胞有大片浆细胞样改变,密集成片,细胞大小不一,多为单核,也可见双核细胞,细胞核为圆形或椭圆形,位于细胞一端,染色质粗糙,呈"车辐"状排列,胞浆成双嗜性,核与胞浆之间可见"月牙状"淡染区。病理诊断:髓外浆细胞瘤。术后随访6个月未见复发和转移。结论:髓外浆细胞瘤是一种发生于骨髓之外的恶性肿瘤,此类患者没有多发骨髓瘤的临床表现,发病率低,组织活检发现单片状浆细胞并且未发现任何多发性骨髓瘤的迹象是诊断的惟一途径;浆细胞瘤对放疗相对敏感,外科手术和放疗联合治疗效果最好。Objective： To optimize the diagnosis and treatment of plasmacytoma of the kidney. Method： The clinical data of 1 case of plasmacytoma of the kidney including manifestation, imaging, pathology and therapy were reviewed. The female patient aged 55 was incidentally found that a low-echo mass measuring 4.7 cm× 2.6 cm was in left kidney by ultrasound detection. Computer tomography （CT） and enhanced CT examination revealed an occupying lesion measuring with low density 3.0 cm×4.0 cm× 3.5 cm in left kidney. The patient then underwent radical nephrectomy. Result： The pathological characteristics were seen as follows. A solid-cystic mass measuring 4.0 cm×3.0 cm was detected at the upper pole of left kidney, with yellow serous fluid inside and yellowish cross section of the mass. The boundary between cortex and medullary is clear. Microscopically, intense arrangement of plasmocyte-like tumor cells with varying size was seen. These cells presented mono or binucleated, with round or oval nucleus locating in the cell at one end. The rough chromatin demonstrated spoke-like arrangement, and the cytoplasm exhibited dual tropism. Crescent-shaped olistherozone were seen between nucleus and cytoplasm. The pathological diagnosis was extramedullary plasmacytoma. A 6-month follow-up displayed no sign of relapse or me- tastasis. Conclusion： Extramedullary plasmacytoma is a rare malignant neoplasm typically arising outside bone mar row. Patient with this kind of disease show no clinical manifestation of multiplemyeloma. The diagnosis relies on the finding of single-sheet like plasma cells in biopsy detection as well as no sign of multiple myeloma. Due to its sensitivity to radiotherapy, a combination of surgery and radiotherapy could be a promising treatment for extr amedullary plasmacytoma.

关 键 词：肾脏浆细胞瘤 临床研究 免疫组织化学 

分 类 号：R737.11[医药卫生—肿瘤]