肾嗜酸细胞瘤的临床病理特征和疗效分析

The clinicopathological characteristics and therapeutic analysis of renal oncocytoma

目的总结肾嗜酸细胞瘤的临床病理特征和治疗方法。方法回顾性分析中国医科大学附属第一医院2013年1月至2020年8月收治的35例肾嗜酸细胞瘤患者的病例资料。男15例,女20例。平均年龄(59.0±11.3)(35~79)岁。主要症状为腰痛5例,肉眼血尿3例,余27例为体检或因其他疾病检查时偶然发现。所有患者均为单侧肿瘤,左侧22例,右侧13例。肿瘤位于肾上极7例、中极14例、下极14例。33例行超声检查,表现为低回声18例,高回声10例,等回声3例,混合回声2例。30例行CT检查,平扫表现为肿瘤与正常肾实质比较呈等密度或稍低密度影,增强后肿瘤表现为边界清晰的低强化影,其中12例有典型的中央星芒状瘢痕征。所有患者均接受手术治疗,其中肾部分切除术12例,根治性肾切除术23例;后腹腔镜手术23例,开放手术12例。结果术后病理检查,肿瘤平均直径(4.0±2.3)(1.3~14.0)cm,切面为黄褐色14例,红褐色19例,黑色和咖啡色2例。镜下观察,肿瘤典型特征为瘤细胞呈巢状、腺泡状或管状排列,细胞呈圆形或多角形,大小基本一致,胞质含有丰富的嗜酸颗粒,核圆深染,核仁较小。免疫组化染色检查指标阳性率分别为EMA 100.0%(23/23)、E-cadherin 100.0%(20/20)、CK 96.2%(25/26)、CD11795.5%(21/22)、p504S(AMACR)35.0%(7/20)、CD1033.3%(9/27)、CK731.0%(9/29)、Vimentin 17.2%(5/29),Ki-67均为阴性(0/28)。本组35例中4例失访,余31例平均随访时间(46.9±25.0)(7~90)个月,所有患者预后良好,未见复发和转移。3例术后短期内曾出现轻度肾功能不全,均恢复正常。术前肉眼血尿3例,术后血尿症状消失;腰痛5例中,2例症状明显改善,3例仍有腰部间断性钝痛。结论肾嗜酸细胞瘤是较少见的肾良性肿瘤,术前与肾恶性肿瘤难以鉴别,病理检查是确诊和鉴别诊断的主要依据。本病的主要治疗方式为手术,预后良好。因肿瘤有复发和转移的可能性,术后需定期随访。

Objective To discuss the clinical and pathological features of the patients with renal oncocytoma.Methods Making a retrospective analysis of the clinical data of 35 patients with renal oncocytoma who were admitted to the department of urology in the First affiliated Hospital of China Medical University from January 2013 to August 2020,discussing their clinical features,pathological characteristics,treatment and prognosis.The age range of the 35 patients was 35-79 years,with an average age of(59.0±11.3)years,there were 15 males and 20 females.The tumors of the 35 patients were unilateral,concluded 22 cases on the left side and 13 cases on the right side.Among the 35 patients,the tumors of 7 cases located in the upper pole,14 in the middle pole,and 14 in the lower pole.At the time of admission,5 patients complained with flank pain,3 patients had gross hematuria,and the other patients were found during physical examination or examination due to other diseases.In the imaging examination,there were 33 cases of ultrasound data,including 18 cases of hypoechoic,10 cases of hyperechoic,3 cases of isoechoic and 2 cases of mixed echo.The data of CT were collected in 30 cases.The tumors showed isointense or slightly hypointense on plain scan,after enhancement,it showed low enhancement with clear boundary to the renal parenchyma and 12 patients had typical central stellate scar sign.All patients accepted surgical treatment,including 23 cases of retroperitoneal laparoscopic surgery and 12 cases of open surgery,but only 12 cases had partial nephrectomy.Results The tumors were incised after the operation,the range of the tumors’diameter was 1.3-14.0 cm,with an average of(4.0±2.3)cm.The color of the cross-section was tawny in 14 cases,mahogany in 19 cases and 2 cases of other colors.The typical features of tumor cell under microscope were arranged in nests,alveolar or tubular shapes,the cells were round or polygonal.The cell size was uniform,the cytoplasm was rich in eosinophilic granules,the nuclei was deeply stained and the nucleoli was small.There are 9 indicators reach to 20 cases in immunohistochemical stain,and the positive rates of each indicator are respectively EMA 100.0%(23/23),E-cadherin 100.0%(20/20),CK 96.2%(25/26),CD11795.5%(21/22),p504S(AMACR)35.0%(7/20),CD1033.3%(9/27),CK731.0%(9/29),Vimentin 17.2%(5/29),Ki-67(0/28).Thirty-five patients were followed up after surgery,4 patients were lost to follow-up,and the follow-up time of the other 31 patients ranged from 7 to 90 months,with an average of(46.9±25.0)months.All patients had a good prognosis without recurrence or metastasis.Among them,3 patients had mild renal insufficiency in a short time after operation,and they have all recovered.Three patients with gross hematuria before the operation disappeared after the operation.In 5 patients with low back pain,only two patients felt significant improvement,and the other three still felt intermittent episodes of dull lumbar pain.Conclusions Renal oncocytoma is a relatively rare benign tumor of the kidney.Because of the lack of effective diagnostic methods,it is difficult to differentiate from renal malignant tumors preoperatively.Pathological results are the golden standard for the diagnosis and differential diagnosis of renal oncocytoma.The main treatment of renal oncocytoma is surgery,and after surgery,the patient's prognosis is good,but renal oncocytoma has the possibility of recurrence and metastasis,regular follow-up and surveillance are still required.