多房性囊性肾癌的诊治体会

Diagnosis and treatment of mutilocular cystic renal cell carcinoma

目的:提高对多房性囊性肾癌(MCRCC)的诊治水平。方法:2006年1月～2011年3月我院共收治MCRCC患者12例,男8例,女4例,平均年龄50岁。该组患者均于体检时发现。术前均行B超、CT检查,其中有3例又行MRI检查,术前诊断囊实性占位10例,诊断肾囊肿2例,4例行根治性肾切除,6例行肾部分切除,1例术中病理为良性,行去顶减压术,术后病理为恶性而二次行肾切除术。1例患者术中取病理回报为恶性而行肾切除。结果:该组患者术后病理均证实为MCRCC,肿瘤最大直径为2.5～8.0cm,平均4.0cm。TNM分期均为T1N0M0期。病理分级G110例,G22例。随访3～62个月,平均36个月,均无瘤生存。结论:MCRCC恶性度低,预后好。术前诊断主要依赖于影像学检查,但影像学检查无特异性,不易与多房性肾囊肿鉴别,肾部分切除术是治疗的最佳选择。

Objective：The diagnosis and treatment of mutilocular cystic renal cell carcinoma was evaluated in order to improve the preoperative diagnosis and curative rate of the disease. Method：Twelve cases of multilocular cystic renal cell carcinoma were retrospectively analyzed in the aspects of imaging and pathologic characteris- tics. There were 8 males and 4 females with an average age of 50 years old（ranging from 44--57 years old）in this study. The tumor was incidentally found in all 12 cases and B-type ultrasonography and CT scans were available in all cases. MRI was available in 3 cases. Of the 12 cases, 6 underwent radical nephrectomy and 6 underwent partial nephrectomy. Result：Postoperative pathological findings confirmed the diagnosis of MCRCC. The mean great diam eter of the tumor was 4.0CM. The TNM stage of all 12 cases was T1N0 M0. For pathologic grade,10 cases were G1 and 2 cases were G2. All patients were followed up and remained tumor free during the average time of 36 months. Conclusion：MCRCC is an uncommon sub-type of RCC, it has a lower malignant potential and a better prognosis compared with other types of RCC. The preoperative diagnosis depends on the imaging features which have no specificity. It is difficulty of identification with Mutilocular cystic renal cyst. Nephron sparing surgery is the best treatment option for MCRCC.