乳头状肾细胞癌60例临床病理特征分析

Analysis of clinicopathologic features of papillary renal cell carcinoma:report of 60 cases and literature review

目的分析乳头状肾癌(PRCC)临床病理特征,为临床诊治提供依据。方法我院2003年1月至2016年7月共收治1 268例肾癌患者,其中病理诊断为PRCC患者60例,占同期肾癌4.7%。回顾性收集60例PRCC临床资料,分析影像学及病理学特征与预后情况。结果 PRCC在超声上以低回声为主,CT平扫病灶区密度平均为(40.8±11.1)Hu;增强后呈轻度强化,平均为(65.8±28.6)Hu。MRI中T1WI序列呈低信号5例、等信号3例、高信号3例、混杂信号2例;T2WI序列低信号5例、等信号2例、高信号2例、混杂信号4例。本组PRCC绝大多数为T1期(93.2%)。Ⅰ型PRCC 30例,Ⅱ型PRCC 29例,Ⅱ型PRCC肿瘤直径较Ⅰ型大[(4.1±2.0)cmvs.(2.9±1.6)cm,P<0.05],Fuhrman核分级Ⅲ~Ⅳ级比例高(79.3%vs.3.3%,P<0.05),肉瘤样变比例高(10.3%vs.0%,P<0.05)。免疫组化阳性率高的标记物有CD7、vimentin、CD10及P504S。55例患者随访4~72月,2例分别于术后4月与12月死于肿瘤转移,1例于术后36月出现肿瘤多发性骨转移,1例术后72月复查发现肿瘤局部复发,以上4例均为Ⅱ型PRCC。结论 PRCC是一种预后较好的特殊类型肾癌,影像学与病理学均具有一定的特征性。Ⅱ型PRCC较Ⅰ型直径较大,细胞核分化较差,预后可能较差,但仍需进一步论证。

Objective To summarize the clinicopathologic features of papillary renal cell carcinoma （PRCC） in order to improve the diagnosis and treatment. Methods A total of 1 268 cases of renal cell carcinoma were treated during Jan. 2003 and Jul. 2016 in our hospital,including 60 cases of PRCC （4.7%）. The clinical data of these PRCC cases were retrospectively reviewed,and the characteristics of imaging,pathology and prognosis were analyzed. Results PRCC was predominantly hypo- echoic in ultrasound. The average density of lesion in CT was （40.8i 11.1） Hu. The enhancement was mild, averaged （65.8± 28.6） Hu. In MRI, T1WI showed 5 hypointensity, 3 isointensity, 3 hyperintensity and 2 heterogeneous intensity ; T2WI showed 5 hypointensity, 2 isointensity, 2 hyperintensity and 4 heterogeneous intensity. The majority of PRCC cases were T1 （93.2 % ） ,in- cluding 30 cases of type I, and 29 cases of type Ⅱ. Compared with type I, Type Ⅱ PRCC was larger in diameter[（4.1 ± 2.0）cm vs. （2.9±1.6）cm,P〈0.05],had higher Fuhrman nuclear grade Ⅲ-Ⅳ （79.3% vs. 3.3%,P〈0.05）,and had higher rate of sarcoma differentiation （10.3 % vs. 0 % , P 〈 0.05）. CD7, vimentin, CD10, P504S were highly expressed in PRCC. Of the 55 patients who were followed up for 4-72 months, 2 died of cancer metastases after 4 and 12 months respectively, 1 developed multiple bone metastases after 36 months,and 1 suffered local relapse after 72 months. All of the 4 cases above were type Ⅱ PRCC. Conclusions PRCC is a special type of renal carcinoma with relatively better prognosis. Both imaging and pathology have special characteristics. Type Ⅱ PRCC is large in diameter,has poor nuclear differentiation and poor prognosis. The results still need further investigation.