CAJ | 학술논문

目的探讨肾源性腺瘤临床病理学特点.方法经病理确诊的肾源性腺瘤患者11例.男5例,女6例.平均年龄56(37～78)岁.对肿瘤进行临床病理学观察并复习文献.结果 11例肿瘤发生于输尿管2例,膀胱9例.9例膀胱肾源性腺瘤中行膀胱部分切除术1例,行经尿道膀胱肿瘤电切术8例.发生于输尿管2例分别行右输尿管镜检术及左输尿管切开取石术.患者术后病理确诊为肾源性腺瘤8例,非典型性肾源性腺瘤2例,肾源性腺瘤恶变1例.镜下肾源性腺瘤表现为典型的肾小管样形态;非典型性肾源性腺瘤细胞核大、深染、核仁明显及核分裂象;肾源性腺瘤恶变者局部瘤细胞保持典型肾源性腺瘤的基本组织结构,周围同种形态的细胞失去细胞间黏附力,呈弥漫实性生长并侵犯浅肌层.非典型性及恶变者3例分别定期行羟喜树碱、吡柔比星及表柔比星膀胱内灌注治疗.11例患者平均随访46(24～104)个月.复发1例,死于其他疾病1例,未复发9例.结论肾源性腺瘤临床少见,临床症状及膀胱镜检查均无特异性;病理形态学与肌浸润行为证据上提示肾源性腺瘤可以恶变;治疗以局部切除为主,非典型性和恶变者进一步行膀胱内定期灌注治疗;肾源性腺瘤术后需长期密切随访.
목적 탐토신원성선류림상병이학특점.방법경병리학진적신원성선류환자11례.남5례,녀6례.평균년령56(37～78)세.대종류진행림상병이학관찰병복습문헌.결과 11례종류발생우수뇨관2례,방광9례.9례방광신원성선류중행방광부분절제술1례,행경뇨도방광종류전절술8례.발생우수뇨관2례분별행우수뇨관경검술급좌수뇨관절개취석술.환자술후병리학진위신원성선류8례,비전형성신원성선류2례,신원성선류악변1례.경하신원성선류표현위전형적신소관양형태;비전형성신원성선류세포핵대、심염、핵인명현급핵분렬상;신원성선류악변자국부류세포보지전형신원성선류적기본조직결구,주위동충형태적세포실거세포간점부력,정미만실성생장병침범천기층.비전형성급악변자3례분별정기행간희수감、필유비성급표유비성방광내관주치료.11례환자평균수방46(24～104)개월.복발1례,사우기타질병1례,미복발9례.결론신원성선류림상소견,림상증상급방광경검사균무특이성;병리형태학여기침윤행위증거상제시신원성선류가이악변;치료이국부절제위주,비전형성화악변자진일보행방광내정기관주치료;신원성선류술후수장기밀절수방.
Objective To investigate the clinical and pathological characteristics of nephrogenic adenoma. Methods Eleven patients were diagnosed as nephrogenic adenoma including 5 men and 6 women, aged 37-78 years (56 on average). The pathological findings in all cases of nephrogenic adenoma were presented with a review of the literature. Results Eleven cases of nephrogenic adenomas were evaluated, 2 cases were in ureter and 9 cases were in the bladder. Eight of the 9 bladder cases underwent TUR-BT surgery in continuous epidural anesthesia, 1 case underwent partial cystectomy with general anesthesia. A right ureteroscopy and left ureterolithotomy were performed respectively in continuous epidural anesthesia for the 2 cases in ureter. The final diagnosis was based on histopathological findings. For all of cases, 8 cases were diagnosed as nephrogenic adenomas, 2 cases as atypical nephrogenic adenoma and 1 case as nephrogenic adenoma with malignant transformation. The microscopic appearance of nephrogenic adenoma demonstrated that morphology closely resembled aberrant tubules of the kidney. In addition, atypical nephrogenic adenomas appeared as the presence of cytologic atypia, including nuclear enlargement, nuclear hyperchromasia and prominent nucleoli. The morphologic changes of nephrogenic adenomas with malignant transformation were that tumor cells retained the basic structural characteristics of typical nephrogenic adenomas, and the similar morphological cells lost adhesion ability among cells and presented diffuse solid growth in the surrounding area.Intravesical perfusion was further performed for treating the patients with atypical nephrogenic adenomas or nephrogenic adenomas with malignant transformation. The mean patient follow up was 46 months (range, 24- 104 months), and there was only 1 case of recurrence. Conclusions Nephrogenic adenoma is an uncommon benign lesion of the urinary tract. The symptoms and cystoscopic manifestations are not unique. We reported one patient of nephrogenic adenomas with malignant transformation and provided some evidence for malignant alteration in morphology and invasive behavior. All patients underwent local excision of the lesions. Intravesical perfusion was further performed for treating the patients of atypical nephrogenic adenomas or nephrogenic adenomas with malignant transformation. Whether it is nephrogenic adenoma or atypical nephrogenic adenoma, long-term follow-up after treatment is necessary.