肾腺瘤的临床诊断与治疗

The diagnostic and therapeutic features of renal adenoma

目的探讨肾腺瘤的临床、病理特点，提高对肾腺瘤的诊疗水平。方法回顾性分析5例肾腺瘤患者临床病理资料，结合文献对本病临床病理特点及诊断治疗方式进行讨论。男2例，女3例。年龄16～66岁。肿瘤位于左侧2例、右侧3例，肾上极1例、肾中极1例、肾下极3例。肿瘤直径0．8～6．0cm。临床表现仅1例有肉眼血尿，余4例为体检发现。5例行B超、IVU、CT，2例行MRI，1例行肾血管造影。IVU仅3例提示占位性病变，B超、CT均误诊为肾癌或错构瘤，MRI、血管造影仅提示为良性肿瘤。结果行肾癌根治性切除术2例，保留肾单位手术3例；术后病理均诊断为肾腺瘤。其中3例镜下胞质内有大片红染嗜酸性颗粒诊断为嗜酸细胞腺瘤；1例镜下可见乳头状囊腺样结构诊断为乳头状腺瘤；1例镜下有大量肾小球样结构、钙化小体、沙砾体形成，诊断为后肾腺瘤。5例术后B超、CT随访6个月～7年，未出现复发和转移，保留肾单位者患侧肾功能良好。结论肾腺瘤分为乳头状／管乳头状腺瘤、嗜酸细胞腺瘤、后肾腺瘤3种类型，常无临床症状和体征，影像学特征多不典型，术前难以定性。临床上需提高认识，综合分析B超、CT、MRI等影像学表现进行诊断。保留肾单位手术为首选治疗方法，预后较好，但应密切随访。

Objective To investigate the diagnostic and therapeutic features of renal adenoma. Methods The clinical data of 5 cases（2 men and 3 women at the average age of 35 years） of renal adenoma were retrospectively analyzed. Among the 5 cases, only 1 presented with microscopic hematuria and 4 found accidentally during physical examination with no symptoms. The tumors size were 0.8 cm to 6.0 cm in diameter. Ultrasound-B,IVU and CT scan were performed in all 5 cases,2 with MRU and 1 with renal angiography. On IVU, the diagnosis was not clear in all cases; On B-ultrasound and CT scan,all case were misdiagnosed as renal cell carcinoma or angiomyolipoma; MRU and renal angiography could only give suggestions to be benign tumors. Results Two cases underwent radical nephrectomy and g cases underwent nephron-sparing sugery. Postoperative pathology showed renal adenoma in all 5 cases,3 were renal oncocytoma, 1 was metanephric adenoma and 1 was papillary adeno ma. There is no evidence of recurrence and metastasis with a follow-up by Ultrasound-B and CT in all 5 cases. Conclusions Renal adenoma are classfied as 3 types in clinical pathology（papillary/ tubulopapillary adenoma , renal oncocytoma, metanephric adenoma ）. There are no evident symptoms and signs, imaging features indicate benign tumors. It is difficult to get the final diagnosis before operation and much attention should be focused on. Aggregate analysis should be given with imaging display of IVU,iffultrasound and CT scan et al. Nephron-sparing sugery is a primary and effective therapeutic method for this disease. The prognosis of renal adenoma is well and regular follow-up should be given.