肾嗜酸细胞瘤的诊治(附2例报告及文献复习)

The diagnosis and treatment of renal oncocytoma:A report of 2 cases and review of literature

目的探讨肾嗜酸细胞瘤的诊断和治疗。方法回顾分析2例肾嗜酸细胞瘤患者的临床资料。临床无特异表现,肿瘤大小分别为5.3cm×4.5cm,6.3cm×5.2cm。MRI扫描以中央星状瘢痕为特征。术前均诊断为肾癌而行肾癌根治术。结果肉眼见肿瘤切面灰褐色或黄褐色,质软;镜检瘤细胞均呈圆形或类圆形,胞质富含浓染嗜酸颗粒,核泡状,瘤细胞呈巢状、管状、微囊状或卵圆形片状排列,瘤组织中心部可见玻璃样变无细胞区;免疫组织化学:Cytokeratin(+),EMA(+),Vimentin(-)。结论肾嗜酸细胞瘤系肾脏的良性倾向肿瘤,术前诊断较困难,应依据免疫学、影像学、病理组织学综合诊断。治疗以保肾手术首选,但应密切随访。

Objective To study the diagnosis and treatment of renal oncocytoma. Methods The clinical data of 2 cases of renal oncocytoma were retrospectively analyzed. The clinical features were atypical. The size of the tumors in 2 patients was 5.3 cm× 4. 5 cm, 6. 3 cm× 5.2 cm respectively. Renal oncocytoma was characterized by a central star-shaped scar on MRI scan. two cases were misdiagnosed to renal cell carcinoma before operation, and radical nephrectomy was performed. Results Histopathologically study, the gross color of the tumor section was grey-brown or yellow-brown with a soft texture. Under microscopic examination, the tumor was characterized by diffuse sheets of homogeneous round or similar round cells containing aboundant axyphil pellets and bubble-shaped nucleus along with bizarre big nucleus occasionally, and the cells arranged as nest, tubular,microsaccate or ovoid shape structure and a centre hyaline change could be seen simultaneously. Immunohistochemical assay showed positive reaction for cytokeratin and EMA or negative for Vimentin. Conclusion The renal oncocytoma is a benign tendency disease which is difficultly diagnosed before operation. The diagnosis can be established on image feature, histopathologic and immunohistochemical studies. Kidney-preserving surgical operation is the first choice treatment.