肾炎性肌纤维母细胞瘤2例报告并文献复习  

Renal inflammatory myofibroblastic tumor:report of two cases and review of literature

作　　者：张爱丽[1] 王爱香[2] 畅继武[2] 

机构地区：[1]天津港口医院病理科,天津300456 [2]天津市泌尿外科研究所,天津医科大学第二医院病理科

出　　处：《临床泌尿外科杂志》2016年第5期437-441,共5页Journal of Clinical Urology

摘　　要：目的:探讨肾炎性肌纤维母细胞瘤(IMT)的临床病理特征。方法:回顾性分析2014年6月及2015年8月收治的2例肾IMT患者的临床资料。例1,女,69岁。主诉左腰部酸胀30d。B超检查示左肾中部一直径约5.5cm液性暗区,囊壁较厚,可见钙化。强化CT检查示左肾中部低密度病变并可见强化,边缘欠光滑,病变内低密度区CT值约为23HU,病变与肾实质边界欠清晰。初步诊断为左肾囊性占位病变,考虑继发感染。行后腹腔镜左肾肿物切除术。例2,男,58岁。主诉左侧腰痛6个月。B超造影检查示左肾窦低回声结构,超声造影低增强。CT检查示左肾盂占位病变,考虑肾盂癌。MRI检查示左肾窦内软组织肿块影,T1WI、T2WI均呈中等信号表现,病变与肾盂分界不清。诊断为左肾窦肿瘤,行根治性左肾切除术。结果:例1术后病理诊断:肾炎性肌纤维母细胞瘤(浆细胞亚型)伴囊性变及感染,免疫组织化学:CD68+,Lambda+,Kappa+。术后随访14个月,未见复发。例2术后病理诊断:肾脏炎性肌纤维母细胞瘤(浆细胞亚型),免疫组织化学:CD68局部+,Vimentin+,bcl2+,SMA+,S100+,Lambda+,Kappa+,Ki-67<1%瘤细胞阳性,CD117-,Desmin-,CK-,ALK-,P53-。术后随访4个月,未见复发。结论:IMT是一种罕见的交界性肿瘤,临床及影像学表现无特异性,容易误诊;病理学检查是诊断该病的主要依据,需与其他肾区肿瘤相鉴别;手术切除为主要治疗方法,通常预后较好。Objective：To study the clinicopathologic features of renal inflammatory myofibroblastic tumor（IMT）.Method：The clinical and pathological data of two cases of IMT were reviewed from June 2014 to August2015.One case was a 69-year-old female who was admitted to the urology department due to left flank pain for one month.The serologic examination and chest X-ray were normal.The abdomen B-ultrasonography and CT found a renal cystic neoplasm.The patient was diagnosed as renal cystic neoplasm accompanying with infection.Then laparoscopic left kidney neoplasm resection was performed.The other case was a 58-year-old male who visited the urology department for complaining of left flank pain for six months.The abdomen B-ultrasonography,CT and MRI found a tumor of renal pelvis.The patient accepted radical resection of the left kidney.Result：The first case was diagnosed as renal IMT with infection.Immunohistochemical staining was positive for CD68,Lambda,Kappa.Over the follow-up period of 14 months after surgery,the patient recovered and did not have recurrence or metastasis.The second case was also diagnosed as renal IMT.Immunohistochemical staining was positive for CD68,Vimentin,bcl2,SMA,S100,Lambda,Kappa and Ki67（〈1%）,and negative for CD117,Desmin,CK,ALK and P53.Over the follow-up period of four months after surgery,the patient didn＇t recur.Conclusion：Renal IMT is a rare borderline tumor with nonspecific clinical signs and symptoms,which leads to misdiagnosis.The diagnosis bases on pathological examination heavily and differential diagnosis is necessary.Surgical resection is the primary option of treatment with a good prognosis.

关 键 词：炎性肌纤维母细胞瘤 肾脏 病理学 临床 

分 类 号：R737.11[医药卫生—肿瘤]