多房囊性肾细胞癌的临床特点及预后

Clinical presentation and prognosis of multilocular cystic renal cell carcinoma

目的评价多房囊性肾细胞癌的诊疗特点及预后。方法回顾性分析6例多房囊性肾细胞癌的临床特点、影像学表现、外科手术方法、病理特点,随访其预后。结果男3例,女3例,肿瘤最大直径3.0～7.5cm。CT示多囊性肿物,实性部位平扫CT值30～36Hu,皮质期88～130Hu,排泄期75～96Hu,为隔膜型增强型。腹腔镜肾部分切除术1例,根治性肾切除5例。病理TNM分期,pT1aN0M02例,pT1bN0M03例,pT2N0M01例,癌细胞核分级均为G1。中位随访24个月,随访期内未发现远处转移及肿瘤复发,无瘤存活100%。结论多房囊性肾细胞癌为一种特殊的病理类型,病理分期、分级低,预后良好,术前怀疑或术中证实为多房囊性肾细胞癌应考虑行腔镜保留肾单位的肾部分切除术。

Objective To assess the diagnosis treatment options, and prognosis of multilocular cystic renal cell carcinoma （MCRCC）. Methods The clinical features, radiologic features, surgical procedure, pathologic features, and follow-up outcomes of 6 patients with MCRCC were retrospectively analyzed. Results There were 3 male and 3 female with tumor diameter varying from 3.0 to 7.5 cm. Computed tomography （CT） scan presented a multiloculated cyst of tumor with the pattern of septal enhancement and CT of solid lesions were 30-36Hu in unenhanced phase, 88-130Hu in the corticomedullary phase and 75-96 Hu in the excretory phase. 1 case underwent laparoscopic nephron-sparing surgery while the other 5 cases received nephrectomy. The pathological staging showed pT1, N0 M0 in 2 cases, pT1b No M0 in 3 and pT2 N0 M0 in 1, and all of the pathological classification was Fuhrman Grade I renal clear cell carcinoma. None of the 6 patients showed any evidence of recurrence during the median follow-up period of 24 months and specific survival rate of carcinoma were 100%. Conclusion The MCRCC is a peculiar entity with a low pathology stage and grade, and with excellent Prognosis. Laparoseopic nephron-sparing surgery should be considered when the diagnosis of MCRCC is suspected preoperatively and confirmed intraoperatively.