中华泌尿外科杂志
中華泌尿外科雜誌
중화비뇨외과잡지
CHINESE JOURNAL OF UROLOGY
2013年
2期
96-100
,共5页
王飞%王建业%万奔%钟晨阳%刘明%朱刚%张耀光%金滨%张亚群%王建龙%马宏%贾宝明%魏东
王飛%王建業%萬奔%鐘晨暘%劉明%硃剛%張耀光%金濱%張亞群%王建龍%馬宏%賈寶明%魏東
왕비%왕건업%만분%종신양%류명%주강%장요광%금빈%장아군%왕건룡%마굉%가보명%위동
癌,乳头状%癌,肾细胞%病理状态,体征和症状%治疗学%预后
癌,乳頭狀%癌,腎細胞%病理狀態,體徵和癥狀%治療學%預後
암,유두상%암,신세포%병리상태,체정화증상%치료학%예후
Carcinoma,papillary%Carcinoma,renal cell%Pathological conditions,signs and symptoms%Therapeutics%Prognosis
目的 分析不同分型乳头状肾细胞癌的特点、诊疗及预后,以期提高其诊治水平.方法 回顾性分析2005年1月至2011年1月收治14例乳头状肾细胞癌患者的临床资料.男7例,女7例.年龄20～77岁.临床表现肉眼血尿3例,腰痛3例,腹部包块1例,无症状者7例.肿瘤最大径1.6 ～7.8 cm,平均3.8 cm.左肾5例,右肾9例.术前TNM分期:T1aN0M0 8例,T1bN0M02例,T1aN0M1、T2aN0M0、T3aN0M0、T3aN1M0各1例.行根治性肾切除术6例,肾部分切除术8例. 结果 乳头状肾细胞癌Ⅰ型6例,细胞呈乳头状分布,嗜碱性,被覆单层柱状上皮细胞轴心,胞质少,嗜碱性,核级低.Ⅱ型8例,肿瘤细胞大,胞质丰富,嗜酸性,乳头表面被覆假复层柱状上皮细胞,核级高.组织学分级高分化2例,中分化12例.14例患者随访12～ 80个月.1例(Ⅰ型)术后26个月出现双肺多发转移,给予IL-2治疗,34个月出现肝转移、骨转移,给予靶向治疗,病情稳定.1例(Ⅱ型)术后23个月出现颈部淋巴结转移伴胸、腹腔积液,且均找到癌细胞,口服舒尼替尼治疗,术后42个月死亡.其余患者均无瘤生存. 结论 乳头状肾细胞癌国内少见.手术是目前首选的治疗方式.早期局限性乳头状肾细胞癌术后预后较好.靶向治疗可能成为转移性乳头状肾细胞癌治疗的新方向.
目的 分析不同分型乳頭狀腎細胞癌的特點、診療及預後,以期提高其診治水平.方法 迴顧性分析2005年1月至2011年1月收治14例乳頭狀腎細胞癌患者的臨床資料.男7例,女7例.年齡20～77歲.臨床錶現肉眼血尿3例,腰痛3例,腹部包塊1例,無癥狀者7例.腫瘤最大徑1.6 ～7.8 cm,平均3.8 cm.左腎5例,右腎9例.術前TNM分期:T1aN0M0 8例,T1bN0M02例,T1aN0M1、T2aN0M0、T3aN0M0、T3aN1M0各1例.行根治性腎切除術6例,腎部分切除術8例. 結果 乳頭狀腎細胞癌Ⅰ型6例,細胞呈乳頭狀分佈,嗜堿性,被覆單層柱狀上皮細胞軸心,胞質少,嗜堿性,覈級低.Ⅱ型8例,腫瘤細胞大,胞質豐富,嗜痠性,乳頭錶麵被覆假複層柱狀上皮細胞,覈級高.組織學分級高分化2例,中分化12例.14例患者隨訪12～ 80箇月.1例(Ⅰ型)術後26箇月齣現雙肺多髮轉移,給予IL-2治療,34箇月齣現肝轉移、骨轉移,給予靶嚮治療,病情穩定.1例(Ⅱ型)術後23箇月齣現頸部淋巴結轉移伴胸、腹腔積液,且均找到癌細胞,口服舒尼替尼治療,術後42箇月死亡.其餘患者均無瘤生存. 結論 乳頭狀腎細胞癌國內少見.手術是目前首選的治療方式.早期跼限性乳頭狀腎細胞癌術後預後較好.靶嚮治療可能成為轉移性乳頭狀腎細胞癌治療的新方嚮.
목적 분석불동분형유두상신세포암적특점、진료급예후,이기제고기진치수평.방법 회고성분석2005년1월지2011년1월수치14례유두상신세포암환자적림상자료.남7례,녀7례.년령20～77세.림상표현육안혈뇨3례,요통3례,복부포괴1례,무증상자7례.종류최대경1.6 ～7.8 cm,평균3.8 cm.좌신5례,우신9례.술전TNM분기:T1aN0M0 8례,T1bN0M02례,T1aN0M1、T2aN0M0、T3aN0M0、T3aN1M0각1례.행근치성신절제술6례,신부분절제술8례. 결과 유두상신세포암Ⅰ형6례,세포정유두상분포,기감성,피복단층주상상피세포축심,포질소,기감성,핵급저.Ⅱ형8례,종류세포대,포질봉부,기산성,유두표면피복가복층주상상피세포,핵급고.조직학분급고분화2례,중분화12례.14례환자수방12～ 80개월.1례(Ⅰ형)술후26개월출현쌍폐다발전이,급여IL-2치료,34개월출현간전이、골전이,급여파향치료,병정은정.1례(Ⅱ형)술후23개월출현경부림파결전이반흉、복강적액,차균조도암세포,구복서니체니치료,술후42개월사망.기여환자균무류생존. 결론 유두상신세포암국내소견.수술시목전수선적치료방식.조기국한성유두상신세포암술후예후교호.파향치료가능성위전이성유두상신세포암치료적신방향.
Objective To study the characteristics of different papillary renal cell carcinoma (PRCC)subtypes and their prognosis after nephrectomy.Methods Clinical data of 14 PRCC patients(7 males,7 females)with ages ranging from 20-77 in our institute from 2005 to 2011 were retrospectively reviewed.There were 5 tumors in the left kidney and 9 tumors in the right kidney.The average maximum tumor diameter was 3.8(1.6-7.8)cm.Patients presented with gross hematuria(n =3),flank pain(n =3),palpable abdominal mass(n =1)or asymptomatic(n =7).The TNM stages were 8 T1aN0M0,2 T1bN0M0,1 T1aN0M1,1 T2aN0M0,1 T3aN0M0 and 1 T3aN1 M0.Six patients were treated with radical nephrectomy,8 cases were treated with partial nephrectomy.Results There were 6 type Ⅰ and 8 type Ⅱ PRCCs cases.In pathology,type Ⅰ PRCC showed papillae covered by small cells with scanty basophilic cytoplasm,and arranged in a single layer on the papillary basement membrane with low nuclear grade.Type Ⅱ PRCC was composed of cells with higher nuclear grade,abundant eosinophilic cytoplasm,and pseudostratified nuclei on papillary cores.There were 12 well-differentiated cases,2 moderate-differentiated cases and no poorly differentiated case.Follow-up was carried out from 12to 80 months.During the follow-up,1 patient with type Ⅰ PRCC developed multiple lung metastases 26 month after surgery and deteriorated into hepatic and bone metastases at 34 month after surgery.We offered the patient with targeted therapy and the patient was still alive.There was 1 type Ⅱ PRCC patient died with multiple metastases at 42 month after surgery.Others were still alive without local recurrence and metastasis.Conclusions PRCC is not a common subtype of renal cell carcinoma in China.Early stage PRCC patient would achieve good prognosis after treated with nephrectomy.Targeted therapy is a good treatment option for metastatic papillary renal cell carcinoma patients.
