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肾颗粒细胞癌的诊断与治疗(附20报告)

The diagnosis and treatment of granular renal cell carcinoma(report of 20 cases)
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摘要 目的总结对肾颗粒细胞癌的诊治经验,提高对此类型肾癌的认识。方法对20例肾颗粒细胞癌的临床资料回顾分析。男13例,女7例,其中合并肾静脉、下腔静脉瘤栓3例,合并肺转移1例,肝、骨转移2例,年龄20~74岁,平均(53.7±5.4)岁,15例行根治性肾切除术+系统性淋巴清扫术,1例在深低温停循环技术行根治性肾癌切除+腔静脉瘤栓取除术,1例行肿瘤剜除术。3例远处转移者均为外院手术后患者,入院后给予行生物治疗。结果 20例术后病理证实为肾颗粒细胞癌。病理分期:pT1aN0M0 2例,pT1bN0M0 4例,pT2N0M0 5例,pT3aN0M0 1例,pT3aN1M0 2例,pT3bN1M0 2例,pT3cN1M0 1例,pT4NxM1 3例,Fuhrman病理分级:G17,例,G2,10例;G3~4,3例。15例获随访,随访6~40月,平均24个月,1例术后7个月死于脑血管意外,4例死于肿瘤复发或转移,10例无瘤生存超过3年。结论肾颗粒细胞癌临床表现与透明细胞相似,CT及MRI特殊表现可与透明细胞癌相鉴别;免疫组化染色Vimentin阳性,CK8及CK18同时阳性,光镜表现为癌细胞胞浆含大量嗜酸性细颗粒,电镜下为丰富的线粒体;根治性肾切除术+腹膜后系统性淋巴结清扫术是治愈和延长生命的首选方法。 Objective To summarize the treatment experiences of granular renal cell carcinoma(GRCC) and to improve the knowledge of this type of renal cell carcinoma.Methods The clinical data of 20 cases of GRCC(13 men and 7 women) were analyzed.Their age ranged from 20 to 74years,with a mean age of(53.7±5.4) years.Among the cases,there were 3 cases of renal vein tumor thrombus complicated with inferior vena cava tumor thrombus,1 cases was complicated with pulmonary metastasis and 2 cases of hepatic、bone metastasis.Radical nephrectomy + retroperitoneal lymph node dissection of systemic was performed in 15 cases among of them.1 cases of renal carcinoma with thrombosis involving the inferior vena cava were completely resected with cardiopulmonary bypass and deep hypothermic circulatory arrest.1 case were performed with nephron-sparing surgery,another 3 cases were treated with biological treatment.Results Postoperative pathological findings confirmed the diagnosis of GRCC.The pathologic TNM stage of GRCC was as follows: pT1aN0M0 in 2 cases,pT1bN0M0 in 4 cases,pT2N0M0 in 5,pT3aN0M0 in 1 case,pT3aN1M0 in 2 cases,pT3bN0M0 in 2,pT3cN1M0 in 1 cases and pT4 in 3.The pathologic grade of GRCC was G1 in 7 cases and G2 in 10.G3-4 in 3,fifteen cases were followed up.During the follow up of 6 to 40 months(mean,24 months),1 died of cerebral hemorrhage,4 died of recurrence or metastases and 10 were surviving tumor free.Conclusion Granular renal cell carcinoma and Renal clear cell carcinoma(RCCC) have similar to Clinical manifestations;The difference between GRCC and RCCC benefit from CT and MRI special performance,immunohistochemical staining Vimentin positive,CK8 and CK18 positive at the same time,light microscopy showed cancer cells with a large number of eosinophilic cytoplasm fine particle which were found by electron microscopy for the rich mitochondria;Radical nephrectomy + retroperitoneal lymph node dissection of systemic is the first choice method.
出处 《临床军医杂志》 CAS 2011年第2期289-291,共3页 Clinical Journal of Medical Officers
关键词 肾细胞癌 颗粒细胞癌 病理学 手术治疗 renal cell carcinoma renal granular cell carcinoma pathology operation
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参考文献12

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