乳头状肾细胞癌的临床病理表现  

The clinical and pathological manifestations of papillary renal cell carcinoma

作　　者：孔祥田[1] 曾荔[1] 宓培[1] 潘柏年[1] 夏同礼[1] 那彦群[1] 郭应禄[1] 

机构地区：[1]北京大学泌尿外科研究所,北京大学第一医院100034

出　　处：《中华泌尿外科杂志》2001年第2期77-80,共4页Chinese Journal of Urology

摘　　要：目的　探讨乳头状肾细胞癌的临床病理表现 ,提高对此类型肾癌的认识。　方法　回顾性分析 9例乳头状肾细胞癌患者临床病理资料并进行随访　结果　 9例乳头状肾细胞癌占同期肾癌的 1.9% ,平均发病年龄 5 2岁。无自觉症状者 5例 ,血尿 4例。 7例行肾癌根治术 ,1例行肾输尿管全长切除术 ,1例行保留肾单位的肿瘤切除术。肿瘤最大径 4～ 15cm ,多位于肾皮质 ,淡黄色到金黄色 ,单灶或多灶性结节状生长。均以乳头或乳头管状结构为主 ,乳头轴心可见泡沫细胞。 9例均有细胞角蛋白CK7表达。Fuhrman病理分级G13例、G2 4例、G32例。TNM病理分期 pT2 7例、pT3a1例、pT3bN1V1b1例。随访 7例无瘤生存 36～ 134个月 ,1例G2 pT3b者无瘤生存 11个月 ,1例G3pT3a者 13个月后死于肾癌转移。　结论　乳头状肾细胞癌是少见的肾癌 ,表现为低分期 ,预后好。Objective To study the clinical and pathological manifestations of papillary renal cell carcinoma(PRCC) and to improve the recognization of this subtype of renal cell carcinoma(RCC). Methods A retrospective study was done including revewing the clinical documents and the pathological sections of 9 cases of PRCC.Follow up was made in all cases. Results 466 cases of RCC were encountered in our institute between January 1989 and June 30,1999. 9 (1.9%) cases of PRCC were identified.The patients were seven men and two women whose age ranged from 33 to 69 years(mean age 52 years).Four presented with gross hematuria and 5 without any symptom being detected on ultrasound exam in a routine physical examination.Radical nephrectomy was done in 7 patients,resection of kidney and whole ureter was done in one patient,nephron sparing surgery was done in one patient.The tumor ranged from 4 to 15 cm in the greatest dimension.Most tumors located in the cortex of kidney with straw yellow or golden yellow appearance.Multifocality was found in five cases.Microscopically,PRCCs were predominantly papillary or tubulopapillary,often with a thick fibrous capsule and foam cells.Cytokeratin 7 was expressed in all cases.The Fuhrman's nuclear grade of the PRCC was grade 1 in 3 cases,grade 2 in 4 and grade 3 in 2.The TNM stage was pT 2 in 7 cases,pT 3a in one and pT 3b N 1V 1b in one.Seven patients were alive and tumor free for 36 months to 134 months with a mean of 85.4 months.One with G 3 pT 3b has been alive and tumor free for 11 months.One with G 3 pT 3a died of metastasis. Conclusions PRCC is an uncommon subtype of RCC in China,it tends to present at an earlier stage and has a better prognosis.

关 键 词：肾肿瘤 癌 乳头状 病理学 

分 类 号：R737.11[医药卫生—肿瘤] R730.231[医药卫生—临床医学]