CAJ | 학술논문

目的分析肾集合管癌(collecting duct carcinoma,CDC)的临床及病理特点. 方法 1999年1月至2010年12月收治CDC患者11例,男6例,女5例.年龄22～67岁,平均55岁.主要症状为血尿、腰腹痛.实验室检查无阳性发现.CT检查示肿瘤直径2.1～8.5 cm,平均5.6 cm.肿瘤位于肾髓质或同时伴有肾皮质、肾盂浸润,边界不清,病变肾脏外形增大,但肾脏轮廓基本存在,增强后呈不均匀轻～中度强化. 结果 8例行根治性肾切除术,3例行姑息性肾切除术.肿瘤切面呈灰白色,浸润性生长；以腺管乳头状结构为主,部分肿瘤细胞呈靴钉状突向腺腔内,肿瘤间质纤维组织增生明显,有较多淋巴细胞及浆细胞浸润；免疫组化染色检查UEA-1、EMA、PNA、HMW-CK表达阳性,而CD10表达阴性.10例获得随访,随访时间0.3 ～8.0年,平均2.8年.随访期间死亡7例,平均生存期为12.5个月,2例无瘤生存分别9个月和8年,1例仍在化疗中,1例失访. 结论 CDC是一种非常少见的肾癌类型,确诊主要依据病理学检查,肿瘤恶性程度高,进展迅速,预后差.
목적 분석신집합관암(collecting duct carcinoma,CDC)적림상급병리특점. 방법 1999년1월지2010년12월수치CDC환자11례,남6례,녀5례.년령22～67세,평균55세.주요증상위혈뇨、요복통.실험실검사무양성발현.CT검사시종류직경2.1～8.5 cm,평균5.6 cm.종류위우신수질혹동시반유신피질、신우침윤,변계불청,병변신장외형증대,단신장륜곽기본존재,증강후정불균균경～중도강화. 결과 8례행근치성신절제술,3례행고식성신절제술.종류절면정회백색,침윤성생장；이선관유두상결구위주,부분종류세포정화정상돌향선강내,종류간질섬유조직증생명현,유교다림파세포급장세포침윤；면역조화염색검사UEA-1、EMA、PNA、HMW-CK표체양성,이CD10표체음성.10례획득수방,수방시간0.3 ～8.0년,평균2.8년.수방기간사망7례,평균생존기위12.5개월,2례무류생존분별9개월화8년,1례잉재화료중,1례실방. 결론 CDC시일충비상소견적신암류형,학진주요의거병이학검사,종류악성정도고,진전신속,예후차.
Objective To analyze the clinical and pathological features of collecting duct carcinoma (CDC) of the kidney. Methods 11 patients with CDC were analyzed,among which 6 were males and 5 were females.Their age ranged from 22 to 67 years old with a mean age of 55.4 cases were found by routine health examination,4 cases were presented with gross hematuria and 3 cases had flank or abdomen pain.The CT scan showed an unclear boundary mass in kidney,with tumor sizes from 2.1 to 8.5 cm ( mean 5.6 cm).Only medullary involvement was present on CT in 3 cases,Medullary and cortical involvement in 5 cases,Medullary and pelvic involvement in 2 cases,and all involvement in 1 case.Infiltrative lesion has expanded kidney but maintains reniform contour.Contrast-enhanced CT scan showed lesion mild to moderate enhancement compared with surrounding parenchyma. Results Radical nephrectomy was performed in 8 cases and palliative nephrectomy in 3 cases.All patients were finally diagnosed by pathology.Grossly,the tumor is often appears gray or white.In HE staining,tumor showed prominent tubular or tubulaopapillary structures with desmoplasia and inflammatory reaction.Occasionally,some tumor cells take on a hobnail appearance.Immunohistochemical examination showed UEA-1 positive in all cases,EMA positive in 9 cases,PNA positive in 8 cases,and HMW-CK positive in 7 cases.Only 2 patients showed positive CD10.7 patients died within 6 to 47 months (mean 12.5 months),2 survived with tumor free for 9 months and 8 years respectively,one lost of follow-up,and one patient with distant metastasis is receiving postoperative chemotherapy. Conclusions Collecting duct carcinoma of the kidney is a rare histological type of renal cell carcinoma,whose final diagnosis depends on histopathological examination.Rapid progression,highly malignant,poor prognosis are the characteristics of this disease.