混合性肾细胞癌行腹腔镜下肾部分切除术1例报告及文献复习  

Laparoscopic partial nephrectomy for mixed renal cell carcinoma:A case report and literature review

作　　者：赵群 王寅春 王旭[1] 惠鹏祥 汤高文 孙梦鸽 段思宇 李然伟[1] ZHAO Qun;WANG Yinchun;WANG Xu;HUI Pengxiang;TANG Gaowen;SUN Mengge;DUAN Siyu;LI Ranwei(Department of Urinany Surgery,Second Hospital,Jilin University,Changchun 130041,China)

机构地区：[1]吉林大学第二医院泌尿外科,吉林长春130041

出　　处：《吉林大学学报（医学版）》2023年第3期789-794,共6页Journal of Jilin University：Medicine Edition

基　　金：吉林省科技厅发展计划项目(20191102012YY);吉林省科技厅面上项目(YDZJ202201ZYTS059);吉林省财政厅卫生人才项目(2020SCZT056)。

摘　　要：目的:分析单侧肾脏嗜酸细胞性乳头状肾细胞癌(OPRCC)和肾透明细胞癌(CCRCC)并存的混合性肾细胞癌(RCC)患者的临床及病理特点,以提高对该疾病的认识。方法:回顾性分析1例OPRCC和CCRCC并存的混合性RCC患者的临床资料。患者,男性,52岁,因体检发现右肾肿物入院。双肾平扫和增强CT显示右肾占位性病变,考虑恶性肿瘤的可能性大。行腹腔镜下右肾部分切除术。结果:术后病理回报显示:(右肾下极)混合性RCC。免疫组织化学染色检测,CK(AE/AE3)(部分+)、Vimentin(部分+)、EMA(部分+)、CK7(+)、CD10(+)、CAIX(局部+)、P504s(+)、PAX-8(弱+)、TFE3(-)、HMB45(-)、MelanA(-)、SDHB(+)和Ki-67(阳性率为2%)。确诊为右肾混合性RCC。患者术后恢复快,术后未接受任何辅助治疗,术后3个月CT检查,未见肿瘤局部复发及转移,术后6个月随访无不适症状。结论:OPRCC和CCRCC并存的混合性RCC患者无特异性临床表现,确诊主要依靠病理组织学检查,治疗方法首选手术治疗;肿瘤恶性程度较低,进展较慢,预后较好,术后仍需长期密切随访。Objective:To analyze the clinical and pathological characteristics of the mixed renal cell carcinoma(RCC)patient with co-existence of unilateral renal eosinophilic papillary renal cell carcinoma(OPRCC)and renal clear cell carcinoma(CCRCC),and to improve the understandings of this disease.Methods:The clinical data of one RCC patient with co-existence of OPRCC and CCRCC were retrospectively analyzed,and the diagnosis,treatment,and prognosis of the patient were analyzed in combination with the literature review.A 52-year-old male patient was admitted to the hospital due to a right renal mass detected by physical examination.The results of plain scan and enhancement CT of both kidneys showed space-occupying lesions of the right kidney,which was highly likely considered to be malignant.The laparoscopic partial nephrectomy was performed.Results:The postoperative pathological results showed mixed RCC(lower pole of right kidney).The results of immunohistochemical staining showed CK(AE/AE3)(partial+),Vimentin(partial+),EMA(partial+),CK7(+),CD10(+),CAIX(partial+),P504s(+),PAX-8(weak+),TFE3(-),HMB45(-),MelanA(-),SDHB(+)and Ki-67(the positive rate was 2%).The mixed RCC of the right kidney was diagnosed.The patient recovered quickly after operation and did not receive any adjuvant therapy.The CT examination results showed no local tumor recurrence and metastasis 3 months after operation,and no discomfort symptoms were found during the follow-up 6 months after operation.Conclusion:The RCC patient with co-existence of OPRCC and CCRCC has no specific clinical manifestations,and the diagnosis mainly depends on the histopathological examination.Surgery is the first choice for the treatment;the malignant degree of the tumor is low,the progression is slow,the prognosis is good,and the long-term and close follow-up is still needed after operation.

关 键 词：混合性肾细胞癌 嗜酸性乳头状肾细胞癌 肾透明细胞癌 肾部分切除术 

分 类 号：R737.11[医药卫生—肿瘤]