肾脏集合管癌12例诊治分析

The diagnosis and treatment of renal collecting duct carcinoma:a report of 12 cases

目的探讨肾脏集合管癌的临床、影像及病理学特征,协助诊治。方法回顾性分析我院2008年8月至2017年8月间的经病理确诊为肾集合管癌的12例患者的临床、影像及病理学资料并进行随访,并通过复习相关文献,找寻肾集合管癌的最佳诊疗方式。结果患者中,Ⅰ期3例,Ⅱ期0例,Ⅲ期7例,Ⅳ期2例;CDC于CT及MRI上多呈形态多变、边界不清的肿块影,于肾髓质处呈浸润性生长,瘤体较小时肾脏轮廓不变,但对于较大的CDC,影像学表现差异巨大;行免疫组化检查后,患者中常见标记物CK19、34βE12、vimentin、PAX-8、PAX-2、INI-1等均呈不同程度阳性表达;11名患者行手术治疗,5例于术后6～11月内死亡,失访1例,余患者截止最后随访时间2018年3月均存活;另有1例患者行介入栓塞术,该患者术后第6个月因肿瘤全身多发转移死亡。结论肾脏集合管癌恶性程度高、预后差,术前影像学检查提示肾集合管癌时应积极手术确诊,术后积极随访,肿瘤的免疫组化检查结果有助于诊断及指导靶向治疗。

Objective To investigate the clinical,pathological and imaging characteristics of collecting duct carcinoma(CDC)and the treatment.Methods The clinical,imaging and pathological data of 12 CDC cases treated between Aug.2008 and Aug.2017 were retrospectively analyzed,and the related literature was reviewed.Results According to the TNM staging system,3 cases were in stageⅠ,7 were in stageⅢ,and 2 were in stageⅣ.On the CT and MRI images,CDCs showed various shapes,unclear boundary,and invasive growth into the renal parenchyma.Small CDCs did not change the contour of kidney,while large CDCs presented various imaging characteristics.Immunohistochemical results detected positive expressions of biomarkers such as CK19,34βE12,vimentin,PAX-8,PAX-2 and INI-1,in most patients.Of all 12 patients,11 received radical surgery,5 of whom died 6~11 months after surgery,and 1 lost to follow-up;1 case underwent interventional embolization therapy and died 6 months after the treatment due to multiple metastases.Conclusions CDC is a rare type of highly aggressive renal cell carcinoma with poor prognosis.When a renal tumor is suspected as CDC on imaging examinations,radical surgery is the best way to confirm its histopathological type.Active follow-up is necessary after surgery.The immunohistochemical results can contribute to the diagnosis and target therapy of CDC.