肾集合管癌2例报告及文献复习

Collecting duct carcinoma(Report of 2 cases and literature review)

目的:探讨肾集合管癌(CDC)的临床、病理特点及诊治方法。方法:回顾性分析2例CDC患者的临床资料。2例分别为男性44岁和女性60岁,分别因间断右腰痛1个月和间断无痛肉眼血尿1周入院。彩超和CT检查发现肾门部位肿物,与周围肾组织界限不清晰,CT增强扫描肿物仅轻微强化。2例均于全麻下行肾根治性切除术。结果:大体标本见肿物位于肾门部位,无包膜,呈浸润性生长,与周围组织无明确分界。镜下见肿瘤细胞排列成不规则腺管或腺管乳头状结构,Fuhrman细胞核分级3～4级。免疫组化反应1例高分子量细胞角蛋白(CK)和花生凝集素(PNA)均呈阳性,另1例PNA阴性,但高分子量CK呈阳性。患者分别于术后8个月、13个月死亡。结论:CDC发病率低,临床罕见。CT对术前诊断可提供帮助,确定诊断依赖病理学检查。转移早、预后差是CDC的特征之一。

Objective.. To study the clinical and pathology features of collecting duct carcinoma, and its diagno- sis and treatment. Method：2 cases of CDC （male 44 and female 60 years, respectively） were reported. They were accepted in hospital because of intermittent right osphyalgia 1 month and intermittent painless visual hematuria 1 week. Renal hilum part tumor, whose boundary was not clear, was detected by color ultrasound and CT scan. Re- inforcement effect was slight when CT enhancement scanning. Renal radical resection was made to the two pa- tients. Result.. The tumors without involucre were located in the renal hilum and invasive growth can be seen in gross specimen which resulted that no clear dividing line between tumor and the surrounding renal parenchyma. Microscopically, tumor cells arranged to irregular gland tube or gland tube papillary structure. Nuclei classifica- tions were 3-4 grade by Fuhrman method. High molecular weight cytokeratin was positive in both of the 2 cases, while peanut agglutinin was positive in one of them by immunohistochemieal reaction. The two patients were died 8 and 13 months after operation. Conclusion;The incidence of CDC is very low. CT scan may be helpful to preoper- ative diagnosis, while confirm diagnosis depends on pathology examination. Early metastasis and poor prognosis are important features of CDC.