中华泌尿外科杂志
中華泌尿外科雜誌
중화비뇨외과잡지
CHINESE JOURNAL OF UROLOGY
2010年
6期
365-368
,共4页
彭国辉%李汉忠%彭丽君%王婷%何颂雄%李秉诚%曹满超%于素英%颜春霞%张桂俊
彭國輝%李漢忠%彭麗君%王婷%何頌雄%李秉誠%曹滿超%于素英%顏春霞%張桂俊
팽국휘%리한충%팽려군%왕정%하송웅%리병성%조만초%우소영%안춘하%장계준
肾肿瘤%肉瘤,滑膜%病理学
腎腫瘤%肉瘤,滑膜%病理學
신종류%육류,활막%병이학
Kidney neoplasms%Sarcoma,synovial%Pathology
目的 总结原发性肾滑膜肉瘤的临床表现、病理特点和诊治方法.方法 原发性肾滑膜肉瘤患者1例,男,55岁.因右腰背及上腹部疼痛5 h入院.无尿频、尿急、尿痛、血尿、发热等症状.CT检查示右肾中下极恶性占位可能,累及右肾门、肾动静脉及肝脏.行右肾肿瘤根治性切除术.结果 病理检查:肿瘤大小12.5 cm×11.0 cm×9.0 cm.镜下瘤细胞呈梭形、束状排列,细胞异型,可见核分裂相,部分区域见增生的薄壁血管,肿瘤呈浸润性生长,伴发炎症及大量坏死、出血.免疫组化染色示Vimentin、CD99、Bcl-2阳性,CK阴性.病理诊断为原发性肾滑膜肉瘤.患者术后2个月出现局部复发及肝肺转移,予异环磷酰胺、表阿霉素化疗1疗程,患者不能耐受.术后8个月死亡.结论 原发性肾滑膜肉瘤是一种罕见、高度恶性的肿瘤,预后不良,确诊需依赖病理检查、免疫组织化学及RT-PCR检测.根治性切除辅以化学治疗可行.
目的 總結原髮性腎滑膜肉瘤的臨床錶現、病理特點和診治方法.方法 原髮性腎滑膜肉瘤患者1例,男,55歲.因右腰揹及上腹部疼痛5 h入院.無尿頻、尿急、尿痛、血尿、髮熱等癥狀.CT檢查示右腎中下極噁性佔位可能,纍及右腎門、腎動靜脈及肝髒.行右腎腫瘤根治性切除術.結果 病理檢查:腫瘤大小12.5 cm×11.0 cm×9.0 cm.鏡下瘤細胞呈梭形、束狀排列,細胞異型,可見覈分裂相,部分區域見增生的薄壁血管,腫瘤呈浸潤性生長,伴髮炎癥及大量壞死、齣血.免疫組化染色示Vimentin、CD99、Bcl-2暘性,CK陰性.病理診斷為原髮性腎滑膜肉瘤.患者術後2箇月齣現跼部複髮及肝肺轉移,予異環燐酰胺、錶阿黴素化療1療程,患者不能耐受.術後8箇月死亡.結論 原髮性腎滑膜肉瘤是一種罕見、高度噁性的腫瘤,預後不良,確診需依賴病理檢查、免疫組織化學及RT-PCR檢測.根治性切除輔以化學治療可行.
목적 총결원발성신활막육류적림상표현、병리특점화진치방법.방법 원발성신활막육류환자1례,남,55세.인우요배급상복부동통5 h입원.무뇨빈、뇨급、뇨통、혈뇨、발열등증상.CT검사시우신중하겁악성점위가능,루급우신문、신동정맥급간장.행우신종류근치성절제술.결과 병리검사:종류대소12.5 cm×11.0 cm×9.0 cm.경하류세포정사형、속상배렬,세포이형,가견핵분렬상,부분구역견증생적박벽혈관,종류정침윤성생장,반발염증급대량배사、출혈.면역조화염색시Vimentin、CD99、Bcl-2양성,CK음성.병리진단위원발성신활막육류.환자술후2개월출현국부복발급간폐전이,여이배린선알、표아매소화료1료정,환자불능내수.술후8개월사망.결론 원발성신활막육류시일충한견、고도악성적종류,예후불량,학진수의뢰병리검사、면역조직화학급RT-PCR검측.근치성절제보이화학치료가행.
Objective To discuss the presentations, pathologic features, diagnosis and treatment of primary synovial sarcoma of the kidney. Methods One case of primary synovial sarcoma of the kidney was reported and the relevant literature was reviewed. A 55-year-old man was admitted with complaint of right abdomen and flank pain for 5 h. Computerized tomography revealed a 12.5 cm × 11.0 cm × 9. 0 cm mass located at the middle and lower pole of the right kidney. The patient was taken radical nephrectomy. Results The diagnosis of primary synovial sarcoma of the kidney in the patient was confirmed by postoperative pathology. Under microscope, tumor was typically mitotically active, monomorphic spindle cells growing in intersecting fascicles or in solid sheets with epithelial differentiation. In some areas a haemangiopericytoma-like pattern was found. Immunohistochemical staining showed that the tumor cells were positive for the markers Vimentin, CD99 and Bcl-2, but CK was negative. The patient died of local recurrence and multi-metastasis at 8 months after surgery. Conclusions Primary synovial sarcoma of the kidney is extremely rare with a high grade of malignancy,and its prognosis is poor. The diagnosis depends on pathological features, Immunohistochemical studies and RT-PCR detection. Radical resection combined with chemicaltherapy is considered to be the most reliable treatment so far.
