肾集合管癌的临床特征分析

Clinical features of renal collecting duct carcinoma

目的探讨肾集合管癌的临床病理特征及预后。方法回顾性研究2007年3月至2012年6月间收治的5例肾集合管癌患者的临床及病理资料并进行随访。结果 5例肾集合管癌占同期肾癌的0.74%,男3例,女2例,平均年龄61岁。左肾4例,右肾1例。主要症状为血尿、腰腹痛。其中4例B超示肾占位性病变,1例示肾盂占位性病变。CT增强后强化不均匀。其中1例入院时双肺多发结节,其余4例入院时均未发现转移。2例行开放性根治性肾切除术,3例行肾切除术,术后病理报告为肾集合管癌伴乳头状结构。1例免疫组化示CK7阳性、vimentin部分阳性、CK20阴性,其余4例均无免疫组化结果。3例分别于术后9、12和15个月死于肾癌转移,2例无瘤生存。3例平均生存时间12.3个月。结论肾集合管癌临床症状明显,侵袭力强,预后差。目前术前诊断主要依赖CT和B超检查;主要治疗方法为根治性肾切除术,术后靶向治疗可能改善患者预后,但仍需要临床试验进一步验证。

Objective To explore the clinical features and prognosis of renal collecting duct carcinoma （CDC）. Methods Clinical date of 5 cases of CDC from March 2007 to June 2012 in our institute were retrospectively reviewed. Results 5 cases accounted for 0.74% of 676 cases of renal cell carcinomas. 3 cases were male and the others were female. The average age was 61 years （45- 74）. The main symptoms were hematurian and abdominal pain. Four cases presented with renal space occupying lesion and one presented with renal pelvis space occupying lesion with B-ultrasonic wave. Computed tomography showed slow and heterogeneous enhancement of the leision. One case was suspected with lung metastasis. Open radical nephroectomy was performed on two cases. Ne- phorectomy were performed on three cases. Pathological examination demonstrated that the primary tumor was collecting duct carcinoma with papillary pattern. Targeted therapy was given to one case accordingly. Immunohistochemistry of one case showed positive for CK7 expression, reduction ex- pression of vimentin and negative for CK20 expression. 3 cases died of collecting duct carcinoma me- tastasis 9, 12 and 15 months after surgery, respectively. Other 2 cases were still alive. The median survival of three died cases was 12.3 months. Conclusions CDC is a distinctive renal cell carcino- ma with prominent invasiveness and migration capability with poor prognosis. Radical nephroectomy is the best treatment. Postoperative target therapy may be undergone to improve the prognosis of pa- tients, but further clinical trials were needed to identify it.