肾嗜酸细胞腺瘤的临床诊疗特点

Clinical diagnosis and treatment of renal oncocytoma

目的为更好地对肾嗜酸细胞腺瘤进行诊疗,总结肾嗜酸细胞腺瘤的临床特点,研究利用辅助检查手段提高肾嗜酸细胞腺瘤的诊治率。方法回顾性分析2009年6月-2021年12月在蚌埠医学院第一附属医院泌尿外科就诊的31例肾嗜酸细胞腺瘤患者的临床资料,其中包括临床症状、辅助检查、影像学资料、治疗方法、病理检查及随访情况等。结果本组31例患者占同期肾肿瘤患者2.35%(31/1321),因体检发现肾占位入院的患者20例,其余表现为腰部不适7例,间歇性肉眼血尿2例,发热2例。肾恶性肿瘤和肾嗜酸细胞腺瘤平扫期、皮质期、肾盂期、相对皮质期和相对肾盂期的CT值差异均有统计学意义(均P<0.05)。7例辅助检查报告考虑为肾嗜酸细胞腺瘤。肾嗜酸细胞腺瘤行保留肾单位手术12例,肾癌根治术19例。术后经病理检查均确诊为肾嗜酸细胞腺瘤。免疫组化分析显示EMA、E-cadherin、CD117等高表达。共随访31例患者,21例预后良好,患者均存活,生存时间最长达12年,4例因为非肿瘤原因或其他肿瘤性死亡,有6例患者失访。结论利用CT值变化结合实验室检查以及穿刺活检和免疫组化结果对于明确术前嗜酸细胞腺瘤诊断有积极意义,治疗上建议根据肿瘤性质及大小决定保留肾单位手术。该病预后良好,但仍需积极复检。

Objective To improve the diagnose and treatment of renal eosinophilic adenoma,to summarize the clinical characteristics of renal eosinophilic adenoma and study the use of auxiliary examination methods to improve the diagnosis and treatment rate of renal eosinophilic adenoma.Methods Retrospective analysis of the clinical data of 31 patients with renal eosinophilic adenoma who were treated in the Department of Urology,the First Affiliated Hospital of Bengbu Medical College from June 2009 to December 2021,including clinical symptoms,auxiliary examinations,imaging data,treatment methods,pathological examinations and follow-up results.Results Thrity-one patients accounted for 2.35%(31/1321)of kidney tumor patients during the same period.Twenty patients were admitted to the hospital due to renal space occupancy on physical examination,while the remaining 7 patients showed lumbar discomfort,2 patients showed intermittent gross hematuria,and 2 patients developed fever.The CT values of renal malignancy and renal oncocytoma in plain scan,cortical phase,renal pelvis phase,relative cortical phase and relative renal pelvis phase were statistically different(all P<0.05).Seven auxiliary examination reports were considered as renal eosinophilic adenoma.Twelve patients underwent nephron-sparing surgery and 19 patients underwent radical nephrectomy for renal cell carcinoma.After surgery,all patients were diagnosed with renal eosinophilic adenoma by pathological examination,and immunohistochemical analysis showed high expression of EMA,E-cadherin,CD117.A total of 31 cases were followed up,and 21 cases had a good prognosis.All patients survived,with a maximum survival time of more than 12 years.Four patients died from non-tumor or other tumor-related causes,and 6 patients were lost to follow-up.Conclusion It is important to confirm the preoperative diagnosis of eosinophilic adenoma using changes in CT values,laboratory examination,puncture biopsies and immunohistochemical results.In treatment,it is recommended to reserve nephron according to the type and size of the tumor.The prognosis of this disease is good,but it still needs active follow-up.