肾脏黏液性管状和梭形细胞癌的临床病理特征及预后

Clinicopathological characteristics and prognosis of 11 patients with renal mucinous tubular and spindle cell carcinoma

目的 探讨肾脏黏液性管状和梭形细胞癌（MTSCC）的临床病理特点、治疗方法和预后.方法 回顾性分析11例经病理证实的肾脏MTSCC患者的临床病理资料,女7例,男4例;平均年龄51.6岁.肉眼血尿2例,腰痛1例,其余为体检发现.结果 CT增强检查呈少血供特征.7例行肾癌根治术,4例行肾脏部分切除术.肿瘤平均直径4.4 cm,pT1aN0M0期6例,pT1bN0M0期3例,pT2N0M0期2例.肿瘤镜下表现为管状和梭形细胞结构穿插于黏液样间质中.术后中位随访时间为41个月,未见肿瘤复发和转移.结论 MTSCC是一种罕见的低度恶性的肾脏上皮肿瘤,预后良好.CT检查对于术前诊断有提示作用,对治疗选择有一定的指导意义.保留肾单位的手术是其推荐的治疗术式,尤其是对于肿瘤体积较小的患者.

Objective To explore the clinicopathological features, treatment and prognosis of renal mucinous tubular and spindle cell carcinoma （MTSCC）. Methods The clinicopathological data of eleven patients of pathologically confirmed renal MTSCC were reviewed retrospectively. Among the 11 patients, there were 4 males and 7 females with a mean age of 51.6 years （range, 24 to 81 years）. Two patients presented with hematuria, one presented with lumbago and others were asymptomatic. Results The renal MTSCC was of hypovascular tumor in enhanced CT scan. Seven cases were treated with radical nephrectomy, and the other four with partial nephrectomy. The mean diameter of tumors was 4.4 cm. The TNM stages were as follows： pTlaNOM0 in 6, pTIbNOMO in 3, pT2NOM0 in 2 cases. Histological examination of the tumors showed that they consisted of spindle cells arranged in tubular and trabecular patterns embedded in a myxoid stroma. No recurrence or metastasis was observed during the follow-up （median 41 months ）. Conclusions MTSCC is a rare low-grade renal epithelial carcinoma with a relatively good prognosis. Preoperative CT scan is partly helpful for diagnosis and guiding decision making. Nephron-sparing surgery is recommended in most cases, especially in patients with small tumors.