肾嗜酸细胞腺瘤的诊疗(附35例报告)
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摘要
目的:探讨肾嗜酸细胞腺瘤(RO)的诊断和治疗。方法:回顾性分析2011年10月～2018年1月我院收治的35例RO患者的临床资料,其中男18例,女17例;年龄28～80岁,平均(53.9±26.1)岁;5例表现为腰痛,1例表现为腰痛合并全程无痛肉眼血尿,29例为体检发现。CT检查肿瘤均为单发实性占位,其中右侧19例,左侧16例;肿瘤最大径1.6～13.0cm,平均(5.4±2.3)cm;表现中央星形瘢痕14例,均未见淋巴结转移。8例行保留肾单位手术(NSS),27例行根治性肾切除术(RN)。结果:35例术后病理诊断均为RO。肉眼见瘤体呈灰褐或灰黄,其中16例可见中央纤维瘢痕;苏木精-伊红(HE)染色后镜下可见瘤细胞多呈巢状排列,胞浆丰富嗜酸性;免疫组化染色细胞角蛋白(CK)、细胞角蛋白8/18(CK8/18)、上皮膜抗原(EMA)、E-钙黏附素(E-cad)、CD117阳性表达率均为100%,Ki-67呈不同程度阳性表达(1%～5%),RCC、S-100阴性表达率均为100%,CK7、CD10、Vimentin大多阴性表达。35例均获随访,随访时间9～83个月,平均(44.5±24.7)个月,均未见肿瘤复发或转移。结论:RO临床较为少见,影像学特征缺乏特异性,病理诊断为目前唯一可靠的诊断方法,手术治疗首选NSS,预后良好,建议术后定期复查。
Objective:To analyze the diagnosis and treatment of renal oncocytoma(RO).Method:From October 2011 to January 2018,35 RO patients(18 males and 17 females)whose mean age was(53.9±26.1)(range,28-80)years old were retrospectively analyzed.Five cases were presented with lumbago;one case was combined with lumbago and painless gross hematuria;and the others were discovered by examination.CT showed single tumor(19 cases in the right,16 cases in the left),and the maximum diameter of the tumor was 1.6-13.0 cm,with an average of(5.4±2.3)cm.The central star scar was showed in 14 cases.No lymph node metastasis was found.All cases underwent surgery;of which eight underwent nephron-sparing surgery and 27 underwent radical nephrectomy.Result:The 35 cases were diagnosed as RO.The gross specimens were brown tan or yellow.Sixteen cases showed central fibrous scars.HE staining showed that the tumor cells presented solid-nested,the cytoplasm was abundant,red and eosinophilic under the microscope.Immunohistochemical staining was positive in CK,CK8/18,EMA,E-cad,CD117 and Ki-67(1%-5%);negative in RCC and S-100,most negative expression of CK7,CD10 and Vimentin.So far,neither recurrence nor metastasis has been detected for 9-83 months(mean,44.54 months)in all cases.Conclusion:RO is a kind of rare benign tumor.Histopathology remains the only reliable diagnostic modality.Nephron-sparing surgery is the first choice.Recurrence and metastasis are rare after surgery,but patients should be followed up.
Objective:To analyze the diagnosis and treatment of renal oncocytoma(RO).Method:From October 2011 to January 2018,35 RO patients(18 males and 17 females)whose mean age was(53.9±26.1)(range,28-80)years old were retrospectively analyzed.Five cases were presented with lumbago;one case was combined with lumbago and painless gross hematuria;and the others were discovered by examination.CT showed single tumor(19 cases in the right,16 cases in the left),and the maximum diameter of the tumor was 1.6-13.0 cm,with an average of(5.4±2.3)cm.The central star scar was showed in 14 cases.No lymph node metastasis was found.All cases underwent surgery;of which eight underwent nephron-sparing surgery and 27 underwent radical nephrectomy.Result:The 35 cases were diagnosed as RO.The gross specimens were brown tan or yellow.Sixteen cases showed central fibrous scars.HE staining showed that the tumor cells presented solid-nested,the cytoplasm was abundant,red and eosinophilic under the microscope.Immunohistochemical staining was positive in CK,CK8/18,EMA,E-cad,CD117 and Ki-67(1%-5%);negative in RCC and S-100,most negative expression of CK7,CD10 and Vimentin.So far,neither recurrence nor metastasis has been detected for 9-83 months(mean,44.54 months)in all cases.Conclusion:RO is a kind of rare benign tumor.Histopathology remains the only reliable diagnostic modality.Nephron-sparing surgery is the first choice.Recurrence and metastasis are rare after surgery,but patients should be followed up.
引文
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10时佳子,王杰,王志向,等.肾嗜酸细胞腺瘤27例诊疗分析[J].临床泌尿外科杂志,2016,31(9):803-805.
11黄吉炜,董柏君,孔文,等.肾嗜酸性细胞瘤12例临床分析[J].临床泌尿外科杂志,2011,26(6):427-429.
12 Eiss D,Larousserie F,Mejean A,et al.Renal oncocytoma:CT diagnostic criteria revisited[J].J Radiol,2005,86(12Pt 1):1773-1782.
13 Kim J I,Cho J Y,Moon K C.Segmental enhancement inversion at biphasic multidetector CT:characteristic finding of small renal oncocytoma[J].Radiology,2009,252(2):441-448.
14 Schieda N,Al-Subhi M,Flood T A,et al.Diagnostic accuracy of segmental enhancement inversion for the diagnosis of renal oncocytoma using biphasic computed tomography(CT)and multiphase contrast-enhanced magnetic resonance imaging(MRI)[J].Eur Radiol,2014,24(11):2787-2794.
15 Wobker S E,Przybycin C G,Sircar K,et al.Renal Oncocytoma with Vascular Invasion:A Series of 22Cases[J].Hum Pathol,2016,58:1-6.
16 Zhao W,Tian B,Wu C,et al.DOG1,cyclin D1,CK7,CD117and vimentin are useful immunohistochemical markers in distinguishing chromophobe renal cell carcinoma from clear cell renal cell carcinoma and renal oncocytoma[J].Pathol Res Pract,2015,211(4):303-307.
17 Richard P O,Jewett M A,Bhatt J R,et al.Active surveillance for renal neoplasms with oncocytic features is safe[J].J Urol,2016,195(3):581-586.
18 Liu S,Lee S,Rashid P,et al.Active surveillance is suitable for intermediate term follow-up of renal oncocytoma diagnosed by percutaneous core biopsy[J].BJUInt,2016,118(S3):30-34.
19 Neuzillet Y,Lechevallier E,Andre M,et al.Follow-up of renal oncocytoma diagnosed by percutaneous tumor biopsy[J].Urology,2005,66(6):1181-1185.
20 Gudbjartsson T,Hardarson S,Petursdottir V,et al.Renal oncocytoma:a clinicopathological analysis of 45consecutive cases[J].BJU Int,2010,96(9):1275-1279.
21 Labriola M,Foo W C,George D J,et al.Pazopanib in the Treatment of Bilateral Multifocal Renal Oncocytomas:A Case Report[J].Clin Genitourin Cancer,2018,16(3):e509-e512.
2 Moch H,Humphrey P A,Ulbright T M,et al.WHOClassification of Tumours of the Urinary System and Male Genital Organs[M].Lyon:International Agency for Research on Cancer,2016:43-44.
3 Ljungberg B,Bensalah K,Canfield S,et al.EAU guidelines on renal cell carcinoma:2014update[J].Eur Urol,2015,67(5):913-924.
4 Haifler M,Copel L,Sandbank J,et al.Renal oncocytoma--are there sufficient grounds to consider surveillance following prenephrectomy histologic diagnosis[J].Urol Oncol,2012,30(4):362-368.
5 Sobrinho-Sim7es M A,Nesland J M,Holm R,et al.Hürthle cell and mitochondrion-rich papillary carcinomas of the thyroid gland:an ultrastructural and immunocytochemical study[J].Ultrastruct Pathol,1985,8(2-3):131-142.
6 Joshi S,Tolkunov D,Aviv H,et al.The Genomic Landscape of Renal Oncocytoma Identifies a Metabolic Barrier to Tumorigenesis[J].Cell Rep,2015,13(9):1895-1908.
7 Bonora E,Porcelli A M,Gasparre G,et al.Defective Oxidative Phosphorylation in Thyroid Oncocytic Carcinoma Is Associated with Pathogenic Mitochondrial DNAMutations Affecting Complexes I and III[J].Cancer Res,2006,66(12):6087-6096.
8 Correia M,Pedro P,Batista R,et al.Etiopathogenesis of oncocytomas[J].Semin Cancer Biol,2017,47:82-94.
9 Mayr J A,Meierhofer D,Zimmermann F,et al.Loss of complex I due to mitochondrial DNA mutations in renal oncocytoma[J].Clin Cancer Res,2008,14(8):2270-2275.
10时佳子,王杰,王志向,等.肾嗜酸细胞腺瘤27例诊疗分析[J].临床泌尿外科杂志,2016,31(9):803-805.
11黄吉炜,董柏君,孔文,等.肾嗜酸性细胞瘤12例临床分析[J].临床泌尿外科杂志,2011,26(6):427-429.
12 Eiss D,Larousserie F,Mejean A,et al.Renal oncocytoma:CT diagnostic criteria revisited[J].J Radiol,2005,86(12Pt 1):1773-1782.
13 Kim J I,Cho J Y,Moon K C.Segmental enhancement inversion at biphasic multidetector CT:characteristic finding of small renal oncocytoma[J].Radiology,2009,252(2):441-448.
14 Schieda N,Al-Subhi M,Flood T A,et al.Diagnostic accuracy of segmental enhancement inversion for the diagnosis of renal oncocytoma using biphasic computed tomography(CT)and multiphase contrast-enhanced magnetic resonance imaging(MRI)[J].Eur Radiol,2014,24(11):2787-2794.
15 Wobker S E,Przybycin C G,Sircar K,et al.Renal Oncocytoma with Vascular Invasion:A Series of 22Cases[J].Hum Pathol,2016,58:1-6.
16 Zhao W,Tian B,Wu C,et al.DOG1,cyclin D1,CK7,CD117and vimentin are useful immunohistochemical markers in distinguishing chromophobe renal cell carcinoma from clear cell renal cell carcinoma and renal oncocytoma[J].Pathol Res Pract,2015,211(4):303-307.
17 Richard P O,Jewett M A,Bhatt J R,et al.Active surveillance for renal neoplasms with oncocytic features is safe[J].J Urol,2016,195(3):581-586.
18 Liu S,Lee S,Rashid P,et al.Active surveillance is suitable for intermediate term follow-up of renal oncocytoma diagnosed by percutaneous core biopsy[J].BJUInt,2016,118(S3):30-34.
19 Neuzillet Y,Lechevallier E,Andre M,et al.Follow-up of renal oncocytoma diagnosed by percutaneous tumor biopsy[J].Urology,2005,66(6):1181-1185.
20 Gudbjartsson T,Hardarson S,Petursdottir V,et al.Renal oncocytoma:a clinicopathological analysis of 45consecutive cases[J].BJU Int,2010,96(9):1275-1279.
21 Labriola M,Foo W C,George D J,et al.Pazopanib in the Treatment of Bilateral Multifocal Renal Oncocytomas:A Case Report[J].Clin Genitourin Cancer,2018,16(3):e509-e512.