肾嫌色细胞癌诊治分析  

The clinical analysis of chromophobe renal cell carcinoma

作　　者：杨斌[1] 程伟[1] 张明聪[1] Yang Bin;Cheng Wei;Zhang Mingcong(Department of Urology,the Second People's Hospital of Lianyungang,Jiangsu Lianyungang 222006,China)

机构地区：[1]江苏省连云港市第二人民医院泌尿外科,222006

出　　处：《中国医师进修杂志》2019年第10期927-931,共5页Chinese Journal of Postgraduates of Medicine

摘　　要：目的探讨肾嫌色细胞癌(chRCC)的临床特点,提高对其诊治水平.方法回顾性分析江苏省连云港市第二人民医院2012年7月至2019年2月收治的8例chRCC患者的临床资料,其中男3例,女5例,年龄34~71(52.1±11.2)岁.肿瘤位于左肾3例,右肾5例.临床表现无症状5例,腰痛3例.肿瘤最大径2.0~8.5(5.6±2.2)cm.所有患者均行超声、CT检查.超声检查主要表现为低回声、有包膜、血流信号不明显的实性肿块.CT检查主要表现为边界清楚、质地均匀的实性肿块,增强多为轻度强化,其中钙化1例,囊性变、坏死1例,明显强化1例,中央瘢痕1例.7例患者行根治性肾切除术,其中经腰开放手术2例,后腹腔镜下手术5例.1例行后腹腔镜下肾部分切除术.结果术后病理回报均为chRCC.肿瘤剖面质地多均匀,呈灰黄灰红或灰黄灰白.免疫组织化学染色CK7、CD117阳性.肿瘤分期:pT1aN0M02例,pT1bN0M02例,pT1bN0M转移)1例,pT2N0M0 3例.所有患者均获得随访,随访时间3~79(26.8±24.1)个月.伴有骨转移的患者给予阿帕替尼靶向治疗,术后9个月出现双肺转移,术后19个月死亡.1例随访24个月后出现肺转移,拒绝靶向治疗,随访至2019年3月仍存活.其余患者无肿瘤复发、转移.结论chRCC临床少见,临床表现及影像学检查无特异性,主要依靠病理检查确诊,根据肾癌外科治疗原则选择肾切除手术方式,为惰性肿瘤,较少发生转移及复发,预后良好.Objective To explore the clinical features of chromophobe renal cell carcinoma(chRCC) in order to improve its diagnosis and treatment. Methods Clinical data of 8 patients with chRCC treated from July 2012 to February 2019 in the Second People′s Hospital of Lianyungang were retrospectively analyzed. There were 3 males and 5 females. Their age ranged from 34 to 71 years, with a mean age of (52.1 ± 11.2) years. All tumors were located unilaterally, with 3 cases in left kidney and 5 cases in right kidney. Five patients were asymptomatic and back pain occurred in other 3 patients. The maximum diameter of the tumor was 2.0 to 8.5 cm and the mean value was (5.6 ± 2.2) cm. Ultrasonography and CT scan were performed on all patients. Ultrasonography was mainly characterized by low echo renal mass with intact capsule and low blood flow signals. The CT appearances were typically well circumscribed and homogeneous solid mass, with mild enhanced. One case had calcification, 1 case had necrosis and cystic degeneration, and 1 case had central scar 1 case had significant enhancement. All patients underwent surgery. Five cases underwent retroperitoneal laparoscopic radical nephrectomy, 2 cases underwent open radical nephrectomy and 1 case underwent retroperitoneal laparoscopic partial nephrectomy. Results Postoperative pathologic findings confirmed the diagnosis of chRCC. The cross section of the tumors was grossly homogeneous, gray and yellow or gray and red. Immunohistochemical assay was positive of CK7 and CD117. The pathologic TNM stage of chRCC was as follows: pT1aN0M0 in 2 cases, pT1bN0M0 in 2 cases, pT1bN0M1(with bone metastasis) in 1 case and pT2N0M0 in 3 cases. All cases were followed-up. The follow-up time was 3 to 79 months, and the mean time was (26.8 ± 24.1) months. One case with bone metastasis was treated with apatinib and had pulmonary metastasis 9 months after operation and died 19 months after operation. One case had pulmonary metastasis 24 months after operation and survived up to March 2019 refusing to acc

关 键 词：肾细胞癌 嫌色细胞癌 诊断 治疗结果 

分 类 号：R737.11[医药卫生—肿瘤]