摘要
目的探讨成人原发性肾肉瘤的临床表现、影像学特点、病理学特点、治疗方法及预后。方法回顾性分析2009年1月至2018年12月收治的48例成人原发性肾肉瘤患者的临床资料,男30例,女18例。年龄27~76岁,平均50岁。临床表现为腰、腹部疼痛24例,腹部包块2例,肉眼血尿4例,发热2例,体检发现21例。肿瘤位于左肾31例,右肾17例。肿瘤直径3~16 cm,平均8 cm。48例术前行泌尿系彩色多普勒超声、CT、MRI检查。泌尿系彩色多普勒超声检查示肿物内部不均匀回声,边界不清,部分肿瘤内部可合并液化坏死病灶。CT、MRI检查主要表现为肾占位性病变,部分肿瘤内有液化、坏死,可呈囊性改变,增强后肿物不规则强化,边缘不清。其中脂肪肉瘤平均直径10.2 cm,CT检查示肿瘤密度较低,与肾血管平滑肌脂肪瘤难以鉴别;平滑肌肉瘤平均直径6.5 cm,增强扫描肿瘤密度低于肾实质。46例行根治性肾切除术,2例行肾肿瘤穿刺活检术。结果本组48例术后病理诊断为脂肪肉瘤19例,平滑肌肉瘤9例,滑膜肉瘤4例,尤文肉瘤4例,其他肉瘤12例。36例获得随访,存活4~64个月,平均28个月。脂肪肉瘤患者术后平均生存期最长,为32个月(11~64)个月,滑膜肉瘤患者平均生存期为25个月(5~58)个月,尤文肉瘤患者平均生存期为22个月(12~46)个月,平滑肌肉瘤患者平均生存期最短,为20个月(4~36)个月。结论肾肉瘤是成人罕见的肿瘤类型,恶性程度高,早期症状不典型,需结合临床表现、影像学检查结果及病理检查结果共同诊断。
Objective To investigate the clinical manifestations, imaging and pathological features and treatment prognosis of primary renal sarcoma in adults. Methods A retrospective analysis was performed on the clinical data of 48 patients with primary renal sarcoma from January 2009 to December 2018 in the first affiliated hospital and cancer center of Sun Yat-Sen university. There were 30 males and 18 females. Their aged ranged from 27 to 76 yrs with an average age of 50 yrs. A total of 24 patients presented with lumbar and abdominal pain. Abdominal mass was found in 2 cases. Gross hematuria was noticed in 4 cases. Febrile was recorded in 2 cases and 21 cases were diagnosed by physical examination. 31 tumors located in the left kidney and 17 tumors located in the right kidney. The tumor diameter ranged from 3 to 16 cm with an average diameter of 8 cm.All patients underwent ultrasound or CT/MRI examination of the urinary system before surgery. The ultrasound showed the undistributed echo inside the tumor with the undistinguished border. The image of necrosis and liquefaction could be seen in some cases. The CT/MRI examination showed the lesion site with the necrosis, liquefaction or cystic changing. The mass exhibited the unregular enhancement with undistinguished border line. The mean diameter of liposcarcoma was 10.2 cm. CT scan demonstrated the relative low density of tumor, which was hard to be identified with AML. The average diameter of leiomyosarcoma was 6.5 cm. The enhanced CT scan showed the low density of tumor, compared with renal parenchyma. 46 patients underwent radical nephrectomy, 2 patients underwent renal tumor biopsy. And postoperative follow-up was performed. Results Pathological diagnosis revealed that 19 cases with liposarcoma, 9 cases with leiomyosarcoma and 4 cases with synovial sarcoma, especially 4 cases with Ewing’s sarcoma and 12 cases with other sarcoma. 36 cases were followed up and survived for 4 to 64 months. The average survival time was 28 months. The longest mean survival time was seen
作者
唐一鸣
曹云
郭燕
陈炜
陈文芳
廖冰
陈旭
韦锦焕
张志凌
罗俊航
Tang Yiming;Cao Yun;Guo Yan;Chen Wei;Chen Wenfang;Liao Bing;Chen Xu;Wei Jinhuan;Zhang Zhiling;Luo Junhang(Department of Urology, First Affiliated Hospital, Sun Yat-Sen University, Guangzhou 510080, China;Department of Pathology, Cancer Center, Sun Yat-Sen University, Guangzhou 510060, China;Department of Radiology, First Affiliated Hospital, Sun Yat-Sen University, Guangzhou 510080, China;Department of Pathology, First Affiliated Hospital, Sun Yat-Sen University, Guangzhou 510080, China;Department of Urology, Cancer Center, Sun Yat-Sen University, Guangzhou 510060, China)
出处
《中华泌尿外科杂志》
CAS
CSCD
北大核心
2019年第5期370-373,共4页
Chinese Journal of Urology
关键词
肾肿瘤
肉瘤
诊断
临床
Kidney neoplasm
Sarcoma
Diagnosis
Clinical
