肾黏液样小管状和梭形细胞癌2例病例报告并文献复习

Mucinous tubular and spindle cell carcinoma of the kidney:a report of 2 cases and literature review

目的:探讨肾癌的罕见类型肾黏液样小管和梭形细胞癌(MTSCC)的临床病理特点、治疗和预后。方法:回顾性分析2009年11月、2013年10月收治的2例MTSCC患者的临床资料,并结合文献进行讨论。结果:2例患者均为女性,发病年龄分别为47、57岁,均由体检时发现,无临床表现。均为单侧单发,直径均在4 cm左右,影像学资料提示乏血供肿瘤,均采用后腹腔镜肾根治术,病理报告显示免疫组化CK7、CK19均为阳性,CD10阳性、阴性各1例。1例随访6年,1例随访1年,术后均无复发转移。结论:MTSCC是一类罕见的肾细胞癌,恶性程度较低,预后较好。影像学资料显示乏血供的肾占位病变在MTSCC的诊断中占有重要地位,需要与乳头状肾细胞癌、肾梭形细胞癌、间叶型梭形细胞肉瘤鉴别。治疗方法可选择根治性切除术和保留肾单位手术,根据肿瘤大小、位置、肾功能进行选择,微创手术优于开放手术。尽管预后相对好,仍有伴或不伴肉瘤样改变的MTSCC发生远处转移的报道,因此应重视术后的随访。

Objective:To investiate the clinicopathologic features of mucinous tubular and spindle cell carcinoma(MTSCC) of the kidney,an extremely rare carcinoma.Methods:The clinical data about manifestations,diagnosis,surgical approaches and pathological features of 2 cases of MTSCC treated from January 2006 to February 2014 were analyzed retrospectively.The related literatures were reviewd.Results:Both of the patients in this study were female:one was 47 years old,and the other was 57.No clinical symptoms were found.The disease was not detected until B ultrasound tests were performed during health examination.The tumors were characterized with one single mass on one kidney with diameter around 4 cm.Imaging information showed that the tumors were short of blood supply.Both of the cases were treated by retroperitoneoscopic radical nephrectomy.Postoperative pathological examination showed that CK7 and CK19 were positive in both cases,CD10 positive in one case,and negative in one negative.The follow-up period was 6 years and 1 year respectively.No recurrence or metastasis was observed.Conclusions:MTSCC is a rare low-grade malignant renal epithelial carcinoma with a relatively good prognosis.MTSCC can be treated by radical nephrectomy and nephron-sparing surgery,and the latter is recommended if possible.Minimally invasive surgery is better than open surgery.Follow-up should be emphasized on because metastasis was reported in some cases with or without sarcomatoid change.