肾脏透明细胞癌伴囊性变1例报告并文献复习

Clear Cell Carcinoma of Kidney with Cystic Change: A Case Report and Literature Review

目的:探讨肾脏透明细胞癌伴囊性变的临床特征和治疗策略;方法:回顾性分析2023年3月烟台市中医医院收治的1例肾脏透明细胞癌伴囊性变患者的临床资料,年龄55岁,以无痛性肉眼血尿为临床表现,前列腺特异性抗原未见明显异常,肾脏增强CT示:左肾可见大小约2.4 × 2.7 cm的囊状低密度影,增强扫描后其内可见分隔样强化;检索2010年至今肾脏透明细胞癌伴囊性变病例报道进行文献复习;结果:该患者行腹腔镜下左肾部分切除术,术后病理:(左侧)肾脏透明细胞癌伴有囊性变(体积3 × 2.5 × 2.2 cm),WHO/ISUP分级:1级。术后1天拔除尿管后排尿通畅,无尿频、尿急等不适。结论:肾脏透明细胞癌伴囊性变的肿瘤学特征及诊疗方案还存在争议,临床容易漏诊,若能及早发现,大部分患者经过手术治疗预后良好,临床需要提高对此病的认识,避免误诊、漏诊,结合不同患者情况制定手术为主的个体化标准治疗方案,积极改善患者的预后。

Objective: To investigate the clinical features and treatment strategies of renal clear cell carcinoma with cystic degeneration. Methods: The clinical data of a 55-year-old patient with renal clear cell carcinoma with cystic degeneration admitted to Yantai Hospital of Traditional Chinese Medicine in March 2023 were retrospectively analyzed. The clinical manifestations were painless gross hema-turia and no obvious abnormality of prostate specific antigen was observed. The enhanced renal CT showed: In the left kidney, a sac-like low-density shadow with a size of 2.4 × 2.7 cm was observed. Cases of renal clear cell carcinoma with cystic lesions were retrieved from 2010 to present for liter-ature review. Results: The patient underwent laparoscopic partial nephrectomy. Postoperative pa-thology: (left) clear cell carcinoma of kidney with cystic change (volume 3 × 2.5 × 2.2 cm). WHO/ISUP grade: 1 One day after the catheter was removed, urination was smooth, and no discom-fort such as frequent urination or urgent urination was found. Conclusions: The oncologic charac-teristics and diagnosis and treatment plan of renal clear cell carcinoma with cystic degeneration are still controversial, which is easy to be missed clinically. If it can be detected early, most patients have a good prognosis after surgical treatment. Clinical awareness of this disease should be im-proved to avoid misdiagnosis and missed diagnosis, and individualized standard treatment plan based on surgery should be developed based on different patient conditions to actively improve the prognosis of patients.