肾集合管癌临床病理分析

Collecting duct carcinoma of kidney: a clinicopathologic study

目的 研究肾集合管癌的临床病理特征。方法 回顾性研究 8例肾集合管癌的临床、病理资料并进行随访。结果 肾集合管癌好发于老年男性 ,主要症状是血尿、腰痛、体检发现肿块 ;肿瘤主要位于肾中极髓质处 ,呈灰白或灰黄色 ,侵袭性生长 ;以腺管或腺管乳头状结构为主 ,可见“鞋钉样”结构 ,周围肾组织集合管可出现异型增生或原位癌 ;Fuhrman细胞核分级 :G2 ,1例 ;G3 ,4例 ;G4,3例。pTNM分期 :Ⅰ期 1例 ,Ⅱ期 1例 ,Ⅲ期 4例 ,Ⅳ期 2例。 3例术后 9～ 17个月死亡 ,平均生存时间13个月 ;2例术后 13、6 0个月仍存活 ;3例失访。结论 肾集合管癌pTNM分期及Fuhrman细胞核分级高 ,进展快 ,预后差 。

Purpose To study the clinicopathologic characteristics of renal collecting duct carcinoma(CDC). Methods A retrospective study was done in 8 cases of CDC. Results CDC showed an old male predominance. The major manifestations of the patients were hematuria,flank pain and abdominal mass. The primary tumor was centrally located in the renal medulla and appeared gray or white. Histologic examination showed prominent tubular or tubulopapillary structures. Frequently,cells with a hobnail pattern were present.Collecting ducts near the tumor usually showed dysplastic changes. According to Fuhrman's nuclear grade,1 was in G 2,4 in G 3 and 3 in G 4. pTNM stage:1 in stage Ⅰ, 1 in stage Ⅱ,4 in stage Ⅲ and 2 in stage Ⅳ. Three patients died within 9～17 months(mean 13 months) after operation,2 survived for 13 and 60 months,respectively, and 3 were lost from follow up. Conclusion CDC is a poor prognosis tumor with progressive clinical course and high pTNM stage and Fuhrman's nuclear grade.