肾嗜酸细胞腺瘤3例并文献回顾性分析

Renal oncocytoma:

目的提高肾嗜酸细胞腺瘤的诊治水平。方法对青岛大学医学院附属医院收治的3例及1986年1月至2010年12月中国期刊全文数据库报道的105例肾嗜酸细胞瘤的临床特点、影像学检查、病理特征、诊治方法及预后进行分析。结果临床表现中无症状型(偶发)占57.14%,腰痛为主型占30.48%,血尿为主型占4.76%,肿块为主型占7.62%;B超表现为均质、边界清楚的实性回声,肿瘤内有星状回声者占15.24%,肿瘤内见钙化者占5.71%;CT表现为边界清楚的等密度或稍低密度块状影,增强后肿瘤均匀强化,瘤中心见星状低密度灶者占19.05%;术前误诊为肾癌者42例、肾盂癌者1例、肾上腺肿瘤者3例,术前确诊者9例;行肾癌根治术治疗者89例,肾部分切除术治疗者16例;光镜下瘤细胞呈腺泡状及梁束状排列,胞质含嗜酸性颗粒,核圆形、大小一致、位于中央;行免疫组化cytokeration8染色者96例均呈阳性,vimentine染色者96例均为阴性,EMA染色者82例均呈阳性;随访1～87个月,均无肿瘤复发及转移。结论肾嗜酸细胞瘤是一种易被误诊为肾癌的良性肿瘤,其临床表现和影像学检查有一定的特点,诊断需靠病理检查,治疗时可行肾部分切除术。

Objective To improve the diagnosis and treatment of renal oncocytoma.Methods The clinical,radiological and pathological features and treatment and prognosis characteristics were analyzed in 3 cases of renal oncocytoma in our hospital and 105 cases in a search of domestic document from 1986 to 2010.Results 60 patients（57.14%） were asymptomatic,and the others presented to be lumbago in 32（30.48%）,hematuria in 5（4.76%）,flank or abdominal mass in 8（7.62%）.The B-ultrasonic findings showed a homogeneous echo with an intact capsule as the stellate-echo（15.24%） and the calcification-echo （5.71%）.CT showed a well defined isodensity or slightly lower density mass and a moderately intensified shadow in intensified tomography,with centrally margined stellate area in 20 （19.05%） cases.Preoperatively,42 （40.00%） cases were misdiagnosed as renal cell carcinoma including one case of pelvis carcinoma and 3 cases as adrenal tumor,while 9 （8.57%） cases were correctly diagnosed.89 （84.76%） patients received radical nephrectomy,and others received nephron sparing surgery.By the light microscopy,the tumor cells were demonstrated to be arranged in adenoid or laminar pattern,have the strong eosinophilic cytoplasm with coarse granules with the round and uniform nuclear locating centrally.The immunohistochemical staining was positive for cytokeratin 8 in all 96 cases and EMA in 82 cases,whereas negative for vimentin in all 96 cases.With 1 to 87 months follow-up,no recurrence and metastasis occured.Conclusions renal oncocytoma is a type of benign tumor with specific clinical and imaging features,which was often misdiagnosed as renal cell carcinoma.The pathological examination are needed in the diagnosis and the nephron sparing surgery may be adequate for tumor removal.