成人后肾腺瘤临床特征及诊疗分析(附11例报告)

Analysis of clinical features,diagnosis and treatment of adult metanephric adenoma(report of 11 cases)

目的通过收集成人后肾腺瘤患者的临床资料,探讨该病的发病特点、影像学表现、病理特征、诊断、治疗及预后。方法回顾性分析2010年4月至2019年9月间于中国医科大学附属第一医院泌尿外科就诊,经术后病理确诊为后肾腺瘤的11例成人患者的临床资料,分析其临床特征、诊疗及预后。结果11例患者中,男2例,女9例,年龄29~63岁,平均(48.45±11.30)岁,其中肿瘤左侧4例,右侧7例。11例患者的肿物在CT扫描中均为圆形或类圆形肿物,肿瘤在平扫相上表现为等密度或低密度影,有4例患者伴有钙化影,2例伴有坏死样改变,增强后有3例患者呈明显不均匀强化,其余8例肿物动脉期强化不明显,实质期和静脉期呈轻中度强化,但肿物的强化程度明显低于周围正常肾组织。11位患者中,6例患者行肾部分切除术,另外5例行根治性肾切除术,术后切开肿物,最大径范围1.7~11 cm,平均(5.06±2.46)cm,肿物镜下多为良性改变,免疫组化WT1、Vimentin、CD57阳性率较高,CD10、AMACR、CK7多为阴性。所有患者术后随访结果显示预后良好,均未出现肿瘤复发和转移。结论后肾腺瘤是一种临床极少见的肾脏良性肿瘤,缺乏典型的临床表现及极具鉴别性的影像学表现,确诊仍需术后病理及免疫组化的帮助。该病经手术切除后预后良好,但其生物学表现不稳定,仍需密切的术后随访。

Objective The clinical data of adult patients with metanephric adenoma(MA)were collected to explore the pathogenic features,imaging findings,pathological features,diagnosis,treatment and prognosis of the disease.Methods From April 2010 to September 2019,11 adult patients with MA diagnosed by postoperative pathology in the Department of Urology,First Affiliated Hospital of China Medical University were collected and analyzed retrospectively,and their clinical features,diagnosis,treatment and prognosis were explored.Results Among the 11 patients,there were 2 males and 9 females,with an average age of(48.45±11.30)years,4 on the left and 7 on the right.All the tumors were round or oval on CT scanning,and the tumors showed isointense or hypointense on plain scan.Four patients had calcification,2 patients had necrotic degeneration,3 patients showed obvious inhomogeneous enhancement,the other 8 patients showed no obvious enhancement in arterial phase,mild to moderate enhancement in parenchyma phase and venous phase.However,the enhancement degree of the tumor was significantly lower than that of the surrounding normal renal tissue.Among the 11 patients,6 patients underwent partial nephrectomy and 5 patients underwent radical nephrectomy.The maximum diameter of the tumor was 1.7-11 cm,with an average of(5.06±2.46)cm.Microscopically,all the tumors were benign.the positive rate of WT,Vimentin,CD57 was high and the positive rate of CD10,AMACR,CK7 was low by immunohistochemistry.All patients were followed up.The results showed that all patients had a good prognosis and there was no tumor recurrence or metastasis.Conclusions MA is a rare clinical benign renal tumor,which lacks typical clinical symptoms and highly specific imaging features.Diagnosis still needs the help of postoperative pathology and immunohistochemistry.MA has a good prognosis after surgical resection,but its cellular biological behavior is not stable,Thus,close postoperative follow-up is still required.