肾脏罕见肿瘤的临床特点分析

发布时间：2018-04-18 20:49

  本文选题：甲状腺滤泡癌样肾细胞癌 + 肾管状囊性癌　； 参考：《山东大学》2014年硕士论文

【摘要】：[目的] 通过对三种肾脏罕见肿瘤(甲状腺滤泡癌样肾细胞癌、肾管状囊性癌、绒毛膜癌肾转移)进行临床分析,以了解其临床特征、影像学特征、病理特点、鉴别诊断、治疗方法及预后。 [资料和方法] 报告我院从2011年至2013年收治的甲状腺滤泡癌样肾细胞癌3例、肾管状囊性癌1例、绒毛膜癌肾转移并破裂出血1例,同时自Pubmed、Medine及中文数据库搜索同类患者文献资料文献复习,然后进行汇总分析。 [结果] 1、甲状腺滤泡癌样肾细胞癌目前国内外报道一共19例,结合本院收治的3例进行汇总分析后,结果显示甲状腺滤泡癌样肾细胞癌患者的平均年龄40.5±16.19岁(22～83岁,中位年龄35岁),平均肿瘤的直径4.87±2.70厘米(1.5-11.8cm,中位直径4.2cm)。其中女性占大多数(15/22,68.18%),且男女两组患者发病年龄存在统计学差异,女性发病年龄低于男性(34.07±8.75vs.50.67±19.65, P=0.013)。其影像学特点和很多肾内、肾外的良恶性病变类似,需要仔细加以鉴别。患者甲状腺检查均未发现占位性病变,无功能异常。纵隔无异位甲状腺及肿瘤。本院3例患者术后随访超过12个月,均无复发及转移。 2、肾管状囊性癌临床罕见,汇总国内外报道83例,筛选有效病例共51例进行统计学分析,结果显示肾管状囊性癌平均发病年龄57.43±16.07岁(18～94岁,中位年龄61岁),男女发病率之比为8：1,肿瘤平均大小4.28±3.01cm(0.2～17.0cm,58.82%≤4cm)。以性别分组,男女发病年龄及肿瘤大小无明显差异(P0.5)；以有无临床症状分组,发现有临床症状者发病年龄(39.40±16.24)显著低于无临床症状者(59.39±14.95),P值0.049(0.05)。本例肾管状囊性癌患者肾切除术后随访13月无复发及转移。 3、绒毛膜癌肾转移病例目前报道较少,结合本院收治的1例患者分析后可以发现此病的共同特点为：a、好发于孕龄期妇女,多继发于正常或异位妊娠；b、突发腰腹部疼痛,压痛、反跳痛(+)；c、血压急剧下降；d、血hCG阳性；e、CT示肾周血肿,常伴肺转移。 [结论] 1、甲状腺滤泡癌样肾细胞癌是一种非常罕见的肾上皮肿瘤,目前尚未归属于任何已知的肾细胞癌亚型,好发于年轻女性,临床表现和其他肾肿瘤无明显特异性,主要依靠病理形态学及免疫组织化学检查确诊。手术切除为其主要治疗方法。有限资料显示预后良好,但仍需进一步积累病例及长期随访。提高对这一肿瘤的认识可避免误诊。 2、肾管状囊性癌是一种罕见的肾细胞癌类型,好发于男性,临床表现与其他肾肿瘤无特异性,病理形态学及免疫组织化学检查为主要确诊方法,手术切除是主要治疗手段,预后良好,具有低度恶性潜能。临床需提高对此类肿瘤的认识。 3、绒毛膜癌肾转移较罕见,单纯性绒毛膜癌经化疗后治愈率现已接近100%。但由于因该肿瘤恶性程度较高,生长迅速且有出血倾向,肾转移后可能会伴有急性和快速的出血。目前治疗以有效的控制出血后尽早化疗为优。临床需与其他肾肿瘤破裂出血仔细鉴别,避免误诊而耽误患者治疗。
[Abstract]:Purpose of the project

The clinical features , imaging features , pathological characteristics , differential diagnosis , treatment methods and prognosis of three renal rare tumors ( thyroid follicular carcinoma , renal tubular cystic carcinoma , choriocarcinoma and kidney metastasis ) were analyzed .

Data and methods

Three cases of thyroid follicular carcinoma like renal cell carcinoma , 1 case of renal tubular cystic carcinoma , 1 case of choriocarcinoma and 1 case of ruptured hemorrhage were reported from 2011 to 2013 , meanwhile , literature and literature review of similar patients were searched from Pubmed , Medine and Chinese databases , and then pooled analysis was performed .

The result is not valid .

1 . A total of 19 cases of thyroid follicular carcinoma - like renal cell carcinoma were reported at home and abroad . The results showed that the mean age of patients with thyroid follicular carcinoma was 40.5 卤 16.19 years ( 22 - 83 years , median age 35 years ) . The mean tumor diameter was 4.87 卤 2.70 cm ( 1.5 - 11.8 cm , median diameter 4.2 cm ) . The age of female was lower than that of male ( 34.07 卤 8.75 vs . 50.67 卤 19.65 , P = 0 . 013 ) . The imaging features and the benign and malignant lesions outside the kidney and kidney need to be identified carefully . None of the patients in the hospital found occupying lesions and had no abnormal function .

The results showed that the average age of renal tubular cystic carcinoma was 57.43 卤 16.07 years ( 18 - 94 years , median age 61 years ) , the ratio of male and female was 8 : 1 , the average size of tumor was 4.28 卤 3.01cm ( 0.2 ~ 17.0 cm , 58.82 % 鈮，

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