多房性囊性肾细胞癌2例报告及文献复习

目的 研究分析多房性囊性肾细胞癌（MCRCC）临床、螺旋CT和病理表现，以提高对MCRCC的认识。方法报告2例MCRCC患者的临床资料和结合文献复习，阐述该病的临床、病理及其螺旋CT表现。结果该病临床症状轻微；螺旋CT表现为多房性囊性肿物，边界清楚，囊壁可有局部增厚，间隔粗细不均，附壁及间隔结节直径〈5mm，增强后囊壁、分隔及结节中度以上强化；其病理特征为肿瘤均有包膜，由大小不等的囊腔构成，囊腔内衬单层或多层透明细胞，囊腔间隔内可见灶状透明细胞，Fuhrmam分级为Ⅰ～Ⅱ级，免疫组化显示广谱CK＋，EMA＋，CD68＋。2例均行根治性肾切除术，分别随访45个月和32个月，均无复发和转移。结论MCRCC是一种肾细胞癌的罕见亚型，属于低级别恶性肿瘤，螺旋CT和病理表现具有明显特征，早期正确诊断对治疗和预后有重要的意义。

Objective To investigate the clinical manifestations and spiral CT signs and pathological features of multilocular cystic renal cell carcinoma （MCRCC） for Enhancing understanding. Methods The clinical datas and pathological features and spiral CT signs of 2 patients were analyzed and corresponding literature were reviewed. Results MCRCC had mild clinical symptoms. All the tumors on CT appeared as multilocular cystic mass with distinct boundary. Cystic wall was local thickened; Thickness of septum was uneven; The diameter of septum with nodule was less than 5 mm. Enhancement of moderate degree or above was appeared in cystic wall and septum and nodule. The pathological characteristics of MCRCC were as following： Capsule was found in the tumor which is composed of some cystic cavities with different size. Most of cystic cavities were covered by monostratified or stratified cubic clear cells. Besides, septum also had clear cells which form small collections. The Fuhrman grading was Ⅰ -Ⅱ. Immunohistochemically, the clear tumor cells were positive for CK and EMA, and all were negative for CD68. The two patients were performed surgery and were followed up for 45 months and 32 months respectively, and no recurrence nor metastasis were found. Conclusion MCRCC is an uncommon subtype of renal cell carcinoma, and its grade and stage and malignant degree is low, at the same time, it have typical spiral CT and pathologic features, so early diagnosis is very important to treatment and prognosis.