摘要
目的:从临床、影像、病理特点三方面比较Xp11.2易位/TFE3基因融合相关性肾癌(Xp11.2易位性肾癌)与肾透明细胞癌的差异性。方法:收集我院2010年1月~2015年12月经手术治疗的肾癌患者411例,经病理证实Xp11.2易位性肾癌有12例,肾透明细胞癌有302例,就两组肾癌在临床、影像、病理特点进行分析。结果:Xp11.2易位性肾癌45岁以下(83.3%)常见,发病年龄略低[Xp11.2易位性肾癌患者平均年龄(33.1±18.4)岁,肾透明细胞癌患者平均年龄(63.1±11.2)岁],女性高发(66.7%),肉眼血尿首诊占58.3%,查体首诊占16.7%。肾透明细胞癌男性高发(66.6%),查体首诊占55.9%,肉眼血尿首诊占19.5%。CT:Xp11.2易位性肾癌平扫密度稍增高,易出现点状钙化和不均质改变。增强扫描肿瘤动脉期、静脉期和延迟期CT值分别为(83.4±40.1)HU、(95.8±39.1)HU和(80.4±30.1)HU。肾透明细胞癌平扫等密度或混杂密度,极少出现钙化,增强扫描肿瘤动脉期、静脉期和延迟期CT值分别为(133.4±37.1)HU、(102.8±19.1)HU和(87.4±29.1)HU。MRI扫描:Xp11.2易位性肾癌T1WI病灶等信号,T2WI低信号,肾透明细胞癌T1WI病灶等或高信号,T2WI为不均匀混杂信号,增强扫描均呈渐进式延迟强化。病理特点:Xp11.2易位性肾癌全部表达TFE3核蛋白,FISH检测可确诊,肾透明细胞癌不表达TFE3,FISH阴性。两组肾癌患者术后随访12~72个月,中位随访时间(59.7±10.6)个月。Xp11.2易位性肾癌术后发生转移者4例(33.3%),肾透明细胞癌患者23例(7.6%)。结论:Xp11.2易位性肾癌多见于伴有肉眼血尿的年轻女性,增强CT表现为少进-慢出式强化,肾透明细胞癌中老年男性高发,多为查体发现,增强CT表现为快进-快出式强化,MRI对两组肾癌的鉴别意义不大,最终诊断依据FISH检测。
Objective:To compare the difference between renal cell carcinoma associated with Xp11.2 translocation/TFE3 gene fusions(Xp11.2 RCC)and clear cell renal cell carcinoma(CCRCC)in terms of clinical characters,imaging features and pathological traits.Method:From January 2010 to December 2015,411 patients who were operated in Affiliated Hospital of Qingdao University were identified with renal carcinoma including 12 cases diagnosed as Xp11.2 RCC and 302 cases diagnosed as CCRCC.Clinical traits,imaging features and pathology characters were compared between the two groups.Result:Xp11.2 RCC often occurred in young patients[average age:Xp11.2 RCC(33.1±18.4);CCRCC(63.1±11.2)years old]whose clinical presentations were gross hematuria(58.3%)and examinations(16.7%)and below 45 years old(83.3%)whereas CCRCC often occurred in men patients(66.6%)whose clinical presentations were examination(55.9%)and gross hematuria(19.5%).CT of unenhanced scanning showed the lesions were slightly high density,and punctate calcifcations and heterogeneous changes can be easily seen in part of the Xp11.2RCC.Enhanced scanning showed the CT number of the arterial,venous and balance phases were(83.4±40.1)HU,(95.8±39.1)HU and(80.4±30.1)HU.On the aspect of CCRCC,unenhanced scanning showed equal or mixed density,but calcifcation was rare.Enhanced scanning showed the CT number of the arterial,venous and balance phases were(133.4±37.1)HU,(102.8±19.1)HU and(87.4±29.1)HU.MRI scanning showed T1 WI of the Xp11.2 RCC was mediate signal,and T2 WI low signal.T1 WI of CCRCC was mediate or high signal,and T2 WI was uneven signal.Enhanced scanning showed progressive delayed enhancement in all patients.Immunohistochemical exam illustrated that all Xp11.2 RCC were positive for TFE3,and it was confirmed by FISH.However,no TFE3 was positive in CCRCC.Four patients(33.3%)were diagnosed as distant metastasis after 12 to 72 months(59.7±10.6)of follow-up period among Xp11.2 RCC.Twenty-t
作者
黄振
荆涛
骆磊
刘勇
HUANG Zhen JING Tao LUO Lei LIU Yong(Department of Urology, Affiliated Hospital of Qingdao University, Qingdao, Shandong, 266021, China)
出处
《临床泌尿外科杂志》
2017年第3期196-199,共4页
Journal of Clinical Urology