肾混合性上皮间质瘤临床诊治分析
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摘要
目的对肾混合性上皮间质瘤(MESTK)病例进行回顾性分析,探讨肾混合性上皮间质肿瘤(MESTK)的临床特点及诊治体会。方法回顾性分析2003年1月-2015年7月收治的13例MESTK患者的临床资料。其中,男性2例,女性11例;年龄15~57岁,平均38岁。所有患者均行影像学检查,计算机体层摄影(CT)主要表现为多呈无壁结节的多房囊性改变,均行手术治疗。结果 13例MESTK患者,其中4例行开放根治性肾切除术,包括1例因巨大肿瘤术前先行肾动脉栓塞术,3例行后腹腔镜下根治性肾切除术,4例行后腹腔镜下肾部分切除术,2例行腹腔镜下肾部分切除术。13例患者均成功随访,随访时间5~159个月,其中1例患者术后24个月复发,再次手术,目前继续随访中,其余患者未见复发及转移。结论 MESTK临床少见,临床表现缺乏特异性,误诊率高。CT上多呈无壁结节的多房囊性改变及延迟强化,术中冰冻病理有助于鉴别肿瘤良恶性,治疗以完整切除肿瘤为原则,保留肾单位手术安全有效,鉴于少数MESTK有一定复发及恶变倾向,术后需密切随访。
Objective To analyze 13 cases with mixed epithelial and stromal tumor of the kidney(MESTK) and to approach the treatment. Methods The clinical data of 13 MESTK patients(2 males and 11 females, aged 15-57years) treated in our department from January 2003 to July 2015 were retrospectively analyzed. Medical imaging manifested ulti-cystic lesions without mural nodules. All the patients underwent surgical resection. Results Among the 13 MESTK patients, 4 accepted radical nephrectomy including 1 receiving embolization of renal artery before operation, 3 accepted retroperitoneal laparoscopic radical nephrectomy, 4 accepted retroperitoneal laparoscopic partial nephrectomy, 2 accepted laparoscopic partial nephrectomy. All the patients were successfully followed up for5 to 159 months. One of them had recurrence 24 months after operation and received operation again, and is still followed up. The remaining cases had no recurrence or metastasis. Conclusions MESTK is an unusual tumor with high misdiagnosis because it has no specific clinical manifestations. MESTK should be taken into consideration when ulti-cystic lesions have no mural nodules but delayed enhancement. Intraoperative frozen section is helpful to distinguish benign from malignant tumors, Complete resection of the tumor is the treatment principle, nephron-sparing surgery is safe and effective. In addition, regular follow-up is necessary for the cases with recurrence and malignant potential.
Objective To analyze 13 cases with mixed epithelial and stromal tumor of the kidney(MESTK) and to approach the treatment. Methods The clinical data of 13 MESTK patients(2 males and 11 females, aged 15-57years) treated in our department from January 2003 to July 2015 were retrospectively analyzed. Medical imaging manifested ulti-cystic lesions without mural nodules. All the patients underwent surgical resection. Results Among the 13 MESTK patients, 4 accepted radical nephrectomy including 1 receiving embolization of renal artery before operation, 3 accepted retroperitoneal laparoscopic radical nephrectomy, 4 accepted retroperitoneal laparoscopic partial nephrectomy, 2 accepted laparoscopic partial nephrectomy. All the patients were successfully followed up for5 to 159 months. One of them had recurrence 24 months after operation and received operation again, and is still followed up. The remaining cases had no recurrence or metastasis. Conclusions MESTK is an unusual tumor with high misdiagnosis because it has no specific clinical manifestations. MESTK should be taken into consideration when ulti-cystic lesions have no mural nodules but delayed enhancement. Intraoperative frozen section is helpful to distinguish benign from malignant tumors, Complete resection of the tumor is the treatment principle, nephron-sparing surgery is safe and effective. In addition, regular follow-up is necessary for the cases with recurrence and malignant potential.
引文
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[13]OZLUK Y,SARI S O,GUZEL N T,et al.Mixed epithelial and stromal tumor of the kidney with sarcomatous transformation metastatic to the lung.a case report[J].Anal Quant Cytopathol Histpathol,2015,37(3):199-205.
[2]ADSAY N V,EBLE J N,SRIGLEY J R,et al.Mixed epithelial and stromal tumor of the kidney[J].Am J Surg Pathol,2000,24(7):958-970.
[3]YING W,JUNQING Y,JIHONG W,et al.Mixed epithelial and stromal tumor of the kidney:report of a rare case and review of literature[J].Int J Clin Exp Pathol,2015,8(9):11772-11775.
[4]ZOU L,ZHANG X,XIANG H,et al.Malignant mixed epithelial and stromal tumor of the kidney:the second male case and review of literature[J].Int J Clin Exp Pathol,2014,7(5):2568-2663.
[5]WANG C J,LIN Y W,XIANG H,et al.Mixed epithelial and stromal tumor of the kidney:report of eight cases and literature review[J].World J Surg Oncol,2013,20,11(1):207.
[6]KUM J B,GRIGNON D J,WANG M,et al.Mixed epithelial and stromal tumors of the kidney:evidence for a single cell of origin with capacity for epithelial and stromal differentiation[J].Am JSurg Pathol,2011,35(8):1114-1122.
[7]CHENG Y,JIANZHONG W,HEXI D,et al.Mixed epithelial and stromal tumor of the kidney:a rare case report and review of the literatures[J].Int J Clin Exp Med,2015,8(8):14180-14183.
[8]田雨,王国良,马潞林,等.囊性肾瘤和混合性上皮间质瘤13例诊治体会[J].中华泌尿外科杂,2013,34(11):814-818.
[9]LIU C H,YU C C,CHANG C R,et al.Mixed epithelial and stromal tumor of the kidney with elevated serum level of cancer antigen 125[J].J Formos Med Assoc,2011,110(2):125-128.
[10]KAMEL M H,DAVIS R,COX R M,et al.Enucleation/partial nephrectomy for large mixed epithelial stromal tumor and herniating into the pelvicalyceal system[J].Urol Ann,2014,6(4):377-380.
[11]SUN B L,ABERN M,GARZON S,et al.Cystic nephroma/mixed epithelial stromal tumor a benign neoplasm with potential for recurrence[J].Int J Surg Pathol,2015,23(3):238-242.
[12]SMICHI I,ZEHANI A,CHELLY I,et al.About a rare tumor of the Malignant mixed kidney:epithelial and stromal tumor[J].Prog Urol,2015,25(6):293-297.
[13]OZLUK Y,SARI S O,GUZEL N T,et al.Mixed epithelial and stromal tumor of the kidney with sarcomatous transformation metastatic to the lung.a case report[J].Anal Quant Cytopathol Histpathol,2015,37(3):199-205.