肾嗜酸细胞腺瘤临床诊治分析(附10例报告)

Diagnosis and tretment of renal oncocytoma:A study of 10 patients

目的：提高肾嗜酸细胞腺瘤的临床诊治水平。方法：回顾性分析10例肾嗜酸细胞腺瘤患者临床资料。肿瘤最大直径为3～8cm，平均5，5±2．8cm，分别位于左肾上极2例，左肾下极1例，右肾上极3例，右肾下极4例。所有患者CT扫描显示肿瘤包膜完整，密度均匀一致，增强扫描成中等强化，6例瘤体中央可见星状结构。术前均诊断为肾癌而行肾癌根治术。结果：术后观察肿瘤包膜完整，切面呈棕色或棕黄色，质地均匀，未见出血及坏死灶；光镜下瘤细胞排列成腺泡管状或实性片状，胞质内含丰富的嗜酸性颗粒，细胞无明显异型性和核分裂相；免疫组织化学染色：cytokeratin 8（＋），EMA（＋），vimentin（-），Hale胶体铁染色（-）。随访8～87个月，平均38.4±21.5个月，均无瘤生存，未见肿瘤复发或转移。结论：肾嗜酸细胞腺瘤是一种较少见的良性肾脏肿瘤，常易被误诊为肾癌，诊断需依据影像学、病理组织学和免疫组织化学等特点综合判断。治疗应行肾部分切除或肿瘤剜除术。

Objective：To improve the diagnosis and treatment of renal oncocytoma. Methods：Clinical dats of 10 cases of patients with renal oncocytoma treated from 1998 to 2005 were retrospectively analyzed. The clinic features were atypical. Renal oncocytoma was characterized by homogenous attenuation on CT scan, and a central, margined stellate area on CT scan could be find in 6/10 cases. Nephrectomy was performed in all cases. Results： On light microscopy, there was strong eosinophilic cytoplasm with granules, the tumor cells being adenoid or laminar in pattern with no necrosis. The immunohistochemical stain was positive for cytokeratin 8 and EMA, whereas it was negative for vimentin and Hale＇s colloidal iron stain. With 8-87 months follow-up, no recurrence and metastasis was find. Conclusions： Renal oncocytoma is a type of benign tumor, and has no specific clinical feature. The diagnosis can be established on imaging, histopathologic and immunohistochemical studies. The treatment should be nephreetomy or enueleation of the tumor.