肾盂鳞状细胞癌的诊治分析  

Clinical analysis of squamous cell carcinoma of renal pelvis

作　　者：黄吉炜[1] 蔡兴韫 王早宇 蔡文[1] 钱宏阳 陈勇辉[1] 张进[1] 陈海戈[1] 曹明[1] 薛蔚[1] 黄翼然[1] Huang Jiwei;Cai Xingyun;Wang Zaoyu;Cai wen;Qian Hongyang;Chen Yonghui;Zhang Jin;Chen Haige;Cao Ming;Xue Wei;Huang Yiran(Department of Urology,Renji Hospital,School of Medicine,Shanghai Jiaotong University,Shanghai 200127,China;Department of Pathology,Renji Hospital,School of Medicine,Shanghai Jiaotong University,Shanghai 200127,China)

机构地区：[1]上海交通大学附属仁济医院泌尿外科,上海200127 [2]上海交通大学附属仁济医院病理科,上海200127

出　　处：《中华泌尿外科杂志》2020年第5期348-351,共4页Chinese Journal of Urology

基　　金：上海市自然科学基金(18ZR1423200)。

摘　　要：目的探讨肾盂鳞状细胞癌的诊治特点及预后。方法回顾性分析2007年6月至2019年9月上海仁济医院收治的28例病理检查确诊为肾盂鳞状细胞癌患者的临床资料。男19例,女9例。中位年龄56岁。临床表现为肉眼血尿18例,腰背痛11例,腹部包块1例。28例均行CT或MRI检查,发现肾盂或肾占位26例,肾内大量积液2例。2例行PET-CT检查,发现骨转移1例。术前诊断为肾盂肿瘤13例,肾肿瘤13例,肾脓肿2例。合并肾结石或肾盂结石19例。28例均行手术治疗,根治性肾切除术13例,根治性肾输尿管切除术12例,姑息性切除术1例,脓肾切除术2例。术中发现肿大淋巴结9例,行局部淋巴结清扫术。结果病理检查结果显示,肿瘤平均直径8.5 cm;高分化9例,中分化11例,低分化8例;pT2期1例,pT3期15例,pT4期12例;淋巴结转移9例;合并肾静脉癌栓5例。免疫组化染色检查共同特征为CK5(+),34βE12(+),p63(+),CK20(-),GATA3(-)。术后12例行放疗、化疗或免疫治疗。中位随访时间6(1~80)个月,中位生存时间为10个月。15例死亡,均死于肿瘤进展。结论肾盂鳞状细胞癌是一种罕见且高度恶性的肿瘤,与长期肾结石、尿路积水、慢性炎症等因素有关,诊断基于术后病理检查,免疫组化染色检查CK5、34βE12和p63(+)有助于鳞状细胞癌的诊断。本病确诊时常处于进展期,手术是首选治疗方式,但是复发和转移风险高,预后极差。Objective To investigate the diagnosis,treatment and prognosis of squamous cell carcinoma of renal pelvis.Methods The clinic data of 28 cases with squamous cell carcinoma of renal pelvis confirmed by pathologic examination treated during June 2007 and September 2019 was retrospectively analyzed.There were 19 male and 9 female patients,with a median age of 56 years.Hematuria was present in 18 cases,flank pain was present in 11 cases,and abdominal mass was present in 1 case.All 28 cases accepted CT or MRI examination.Renal pelvis or renal tumors were found in 26 cases,and severe hydronephrosis was observed in 2 cases.2 cases underwent PET/CT,and bone metastasis was found in 1 case.Preoperative diagnoses were renal pelvic tumor in 13 cases,renal tumor in 13 cases and renal abscess in 2 cases.Coexisting renal calculi or renal pelvic calculus was detected in 19 cases.All 28 cases underwent surgical excision,including radical nephroureterectomy in 13 cases,radical nephrectomy in 12 cases,palliative resection in 1 case,and pyonephrenectomy in 2 cases.Enlarged lymph nodes were found in 9 cases during the surgery,and local lymph node dissection was performed in these cases.Results The mean diameter of the tumors was 8.5 cm.Histopathological examination revealed that 9 cases were well differentiated,11 cases were moderately differentiated,and 8 case was poorly differentiated.1 case had pT2 stage,15 cases had pT3 stage and 12 cases had pT4 stage.9 cases had lymph node metastasis.5 cases had renal vein thrombosis.Immunohistochemistry staining exhibited consistent characteristics including CK5(+),34βE12(+),p63(+),CK20(-)and GATA3(-).Postoperatively,12 cases received adjuvant therapy including chemotherapy,radiotherapy and/or immunotherapy.Within a median follow-up of 6.0 months(ranging 1-80 months),median overall survival was 10.0 months.15 cases died of tumor progression.Conclusion Squamous cell carcinoma is a rare and highly aggressive neoplasm,typically associated with long-lasting renal calculi,hydronephrosis and chronic

关 键 词：癌 鳞状细胞 肾盂 病理学 临床 预后 

分 类 号：R737.11[医药卫生—肿瘤]