肾嗜酸性细胞腺瘤1例报道及国内20年21例文献分析

Renal Oncocytoma:A Case Rreport and Domestic Documental Analysis on21ca ses from1981to2000.

目的:提高肾嗜酸性细胞腺瘤的诊疗水平。方法:报道1例,计算机检索国内20年文献21例。分析22例肾嗜酸性细胞腺瘤的临床特征、影像及病理表现、治疗及预后。结果:22例中,男性9例,女性13例;左侧8例,右侧14例;体检偶然发现者9例,有症状者13例,其中,腰部胀痛不适6例,腰痛伴高血压1例,包块5例,包块伴黄疸1例;肿瘤均为单发,直径3.0～20.0cm,平均7.6cm;CT表现为边界清楚的等密度或稍低密度,增强扫描呈中等强化,部分可见中央星型斑痕;无出血、坏死征象;B超表现为均质、边界清楚的实性回声;术前误诊为肾癌18例,确诊4例;免疫组化染色Cytokeratin8阳性;光镜下肿瘤细胞胞浆呈嗜酸性,胞核呈光滑有规律的圆形,位于细胞中央,染色质分布均匀,无明显核仁,肿瘤无坏死,核分裂相罕见,电镜下可见细胞内富含线粒体,而其它细胞器和脂质则相对减少。行根治性肾切除15例,肾切除3例;随访1～112个月无肿瘤复发或转移。结论:肾嗜酸性细胞腺瘤是一种具有明显临床及病理特征的良性肿瘤。

Objective:To improve the diagnosis and treatment o f renal oncocytoma.Methods:Twenty-one cases of renal oncocytoma were found i n a search of domestic document from1981to2000,and one case in our ho spital was reported.The clinical,radiological and pathological features and tr eatment and prognosis characteristics of all these22cases were ana-lyzed.Re sults:Of the total22patients,9(41%)were male.13(59%)were fema le;All the renal masses were solitary,with a diameter ranged3～20cm(mean d iameter7.6cm).The mass was on the left in8(36%),right in14(64 %).In9(41%)cases,the renal mass was discovered incidentally,the other s presented with lumbago in7(32%),flank or abdominal mass in5(23%) ,jaundice and hyperten sion in1(5%).Eighteen(82%)cases were misdiagn osed as renal cell carcinoma and4(18%).were correctly diagnosed.CT show ed a well defined isodensity or slightly lower density mass and it showed a mode rately intensified shadow in intensified tomography,in some part a patch of ce n tral stellate.coiuld be seen.The B-ultrasonic findings showed a homogeneous echo with an intact capsule.Light microscopy showed strongly eosinophilic cyt oplasm with coarse gran-ules,the nuclear was soomthly and regularly round,loc ated in the center of the cell.Chromatin was homogenously distributed and the n ucleolus was not obvious,and mitosis was seldomly seen..Electronic mi croscop y showed large mitochondria.Cytokeratin8was positive in immunohistochem-istry staining.Most of the patients(82%)received radical or simple nephrectomy ,no documented partial nephrectomy was found.The patients were followed up fo r1～112months,no recurrence or metastasis was observed.Conclusion:Renal oncocytoma is a benign tumor wit h its own clinical and pathological characteristic manifesta tions.