肾脏双原发恶性肿瘤1例并文献复习

Double primary malignant tumors of kidney:a case report and literature review

目的探讨肾脏原发的乳头状肾透明细胞癌和梭形细胞肉瘤的诊断和治疗。方法结合文献回顾分析1例原发性肾脏乳头状肾透明细胞癌和梭形细胞肉瘤患者的临床表现、组织学形态、免疫组化及治疗随访情况。结果患者在笔者所在医院行右肾癌根治术、病理诊断为肾双原发恶性肿瘤(乳头状肾透明细胞癌和梭形细胞肉瘤)。行免疫治疗及生物反馈免疫化疗,门诊随访11个月无复发。结论原发性乳头状透明细胞癌和梭形细胞肉瘤少见,起病隐匿,无明显临床症状,一般以腰部疼痛为主,可伴肉眼血尿,但不易诊断,需借助免疫组织化学染色确诊。根治性肾切除是目前有效的治疗措施,化疗对患者的生存期有一定的影响,具体机制尚不明确。

Objective To explore the clinical features and protocols for diagnosis and treatment of double primary malignant tumors of kidney. Methods The clinical,pathological,immunohistochemical and follow-up data of 1 case of double primary malignant tumors of kidney were reviewed and analyzed combined with literature.Results The patient was subjected to radical nephrectomy. The pathology examination showed double primary malignant tumors of kidney（clear cell carcinoma of kidney and fasciculated sarcoma of kindey）. He accepted immunotherapy,and still alived in 11 months＇ follow-up. Conclusions Double primary malignant tumors of kidney is rare. Patients with double primary malignant tumors of kidney always complain lumbago and gross hematuria. So it is not easy to diagnose before operation and the final confirmed diagnosis depends on the immunohistochemistry staining. Radical nephrectomy is a very effective therapy;certain effect has been achieved through immunotherapy;chemotherapy has certain impact on patient＇s surviral but the mechanism is not very clear yet.